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Service Code NDC 00781196260
Hospital Charge Code 9617
Hospital Revenue Code 637
Min. Negotiated Rate $111.49
Max. Negotiated Rate $250.86
Rate for Payer: Aetna Commercial $236.92
Rate for Payer: Aetna Medicare $139.36
Rate for Payer: Aetna New Business (MI Preferred) $181.17
Rate for Payer: BCBS Complete $111.49
Rate for Payer: Cash Price $222.98
Rate for Payer: Cofinity Commercial $195.11
Rate for Payer: Cofinity Commercial $239.71
Rate for Payer: Cofinity Medicare Advantage $195.11
Rate for Payer: Encore Health Key Benefits Commercial $222.98
Rate for Payer: Healthscope Commercial $250.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial $236.92
Rate for Payer: PHP Commercial $236.92
Rate for Payer: Priority Health Cigna Priority Health $181.17
Rate for Payer: Priority Health SBD $175.60
Service Code NDC 00904687204
Hospital Charge Code 9617
Hospital Revenue Code 637
Min. Negotiated Rate $113.94
Max. Negotiated Rate $256.36
Rate for Payer: Aetna Commercial $242.11
Rate for Payer: Aetna Medicare $142.42
Rate for Payer: Aetna New Business (MI Preferred) $185.15
Rate for Payer: BCBS Complete $113.94
Rate for Payer: Cash Price $227.87
Rate for Payer: Cofinity Commercial $199.39
Rate for Payer: Cofinity Commercial $244.96
Rate for Payer: Cofinity Medicare Advantage $199.39
Rate for Payer: Encore Health Key Benefits Commercial $227.87
Rate for Payer: Healthscope Commercial $256.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial $242.11
Rate for Payer: PHP Commercial $242.11
Rate for Payer: Priority Health Cigna Priority Health $185.15
Rate for Payer: Priority Health SBD $179.45
Service Code CPT 23120
Hospital Revenue Code 360
Min. Negotiated Rate $628.57
Max. Negotiated Rate $9,991.56
Rate for Payer: Aetna Medicare $3,306.16
Rate for Payer: Allen County Amish Medical Aid Commercial $3,973.75
Rate for Payer: Amish Plain Church Group Commercial $3,973.75
Rate for Payer: BCBS Complete $1,789.14
Rate for Payer: BCBS MAPPO $3,179.00
Rate for Payer: BCBS Trust/PPO $1,271.09
Rate for Payer: BCN Commercial $1,271.09
Rate for Payer: BCN Medicare Advantage $3,179.00
Rate for Payer: Health Alliance Plan Medicare Advantage $3,179.00
Rate for Payer: Mclaren Medicaid $1,703.94
Rate for Payer: Mclaren Medicare $3,179.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage $3,337.95
Rate for Payer: Meridian Medicaid $1,789.14
Rate for Payer: MI Amish Medical Board Commercial $3,655.85
Rate for Payer: Nomi Health Commercial $6,675.90
Rate for Payer: PACE Medicare $3,020.05
Rate for Payer: PACE SWMI $3,179.00
Rate for Payer: PHP Medicare Advantage $3,179.00
Rate for Payer: Priority Health Choice Medicaid $1,703.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network $9,991.56
Rate for Payer: Priority Health Medicare $3,179.00
Rate for Payer: Priority Health Narrow Network $7,993.25
Rate for Payer: Railroad Medicare Medicare $3,179.00
Rate for Payer: UHC All Payor (Choice/PPO) $628.57
Rate for Payer: UHC Core $5,427.00
Rate for Payer: UHC Dual Complete DSNP $3,179.00
Rate for Payer: UHC Exchange $5,811.00
Rate for Payer: UHC Medicare Advantage $3,179.00
Rate for Payer: UHCCP Medicaid $1,789.78
Rate for Payer: VA VA $3,179.00
Service Code HCPCS J0736
Hospital Charge Code 1743
Hospital Revenue Code 636
Min. Negotiated Rate $14.74
Max. Negotiated Rate $21.06
Rate for Payer: Aetna Commercial $19.89
Rate for Payer: Aetna New Business (MI Preferred) $15.21
Rate for Payer: Cash Price $18.72
Rate for Payer: Cofinity Commercial $16.38
Rate for Payer: Cofinity Commercial $20.12
Rate for Payer: Cofinity Medicare Advantage $16.38
Rate for Payer: Encore Health Key Benefits Commercial $18.72
Rate for Payer: Healthscope Commercial $21.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial $19.89
Rate for Payer: PHP Commercial $19.89
Rate for Payer: Priority Health Cigna Priority Health $15.21
Rate for Payer: Priority Health SBD $14.74
Service Code HCPCS J0736
Hospital Charge Code 1743
Hospital Revenue Code 636
Min. Negotiated Rate $6.96
Max. Negotiated Rate $21.06
Rate for Payer: Aetna Commercial $19.89
Rate for Payer: Aetna Medicare $11.70
Rate for Payer: Aetna New Business (MI Preferred) $15.21
Rate for Payer: BCBS Complete $9.36
Rate for Payer: BCBS Trust/PPO $6.96
Rate for Payer: BCN Commercial $6.96
Rate for Payer: Cash Price $18.72
Rate for Payer: Cash Price $18.72
Rate for Payer: Cofinity Commercial $16.38
Rate for Payer: Cofinity Commercial $20.12
Rate for Payer: Cofinity Medicare Advantage $16.38
Rate for Payer: Encore Health Key Benefits Commercial $18.72
Rate for Payer: Healthscope Commercial $21.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial $19.89
Rate for Payer: PHP Commercial $19.89
Rate for Payer: Priority Health Cigna Priority Health $15.21
Rate for Payer: Priority Health SBD $14.74
Service Code NDC 00168027740
Hospital Charge Code 9624
Hospital Revenue Code 637
Min. Negotiated Rate $103.88
Max. Negotiated Rate $233.73
Rate for Payer: Aetna Commercial $220.74
Rate for Payer: Aetna Medicare $129.85
Rate for Payer: Aetna New Business (MI Preferred) $168.80
Rate for Payer: BCBS Complete $103.88
Rate for Payer: Cash Price $207.76
Rate for Payer: Cofinity Commercial $181.79
Rate for Payer: Cofinity Commercial $223.34
Rate for Payer: Cofinity Medicare Advantage $181.79
Rate for Payer: Encore Health Key Benefits Commercial $207.76
Rate for Payer: Healthscope Commercial $233.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial $220.74
Rate for Payer: PHP Commercial $220.74
Rate for Payer: Priority Health Cigna Priority Health $168.80
Rate for Payer: Priority Health SBD $163.61
Service Code NDC 00168027740
Hospital Charge Code 9624
Hospital Revenue Code 637
Min. Negotiated Rate $163.61
Max. Negotiated Rate $233.73
Rate for Payer: Aetna Commercial $220.74
Rate for Payer: Aetna New Business (MI Preferred) $168.80
Rate for Payer: Cash Price $207.76
Rate for Payer: Cofinity Commercial $181.79
Rate for Payer: Cofinity Commercial $223.34
Rate for Payer: Cofinity Medicare Advantage $181.79
Rate for Payer: Encore Health Key Benefits Commercial $207.76
Rate for Payer: Healthscope Commercial $233.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial $220.74
Rate for Payer: PHP Commercial $220.74
Rate for Payer: Priority Health Cigna Priority Health $168.80
Rate for Payer: Priority Health SBD $163.61
Service Code HCPCS J0736
Hospital Charge Code 183289
Hospital Revenue Code 636
Min. Negotiated Rate $6.96
Max. Negotiated Rate $19.22
Rate for Payer: Aetna Commercial $18.16
Rate for Payer: Aetna Commercial $27.23
Rate for Payer: Aetna Medicare $16.02
Rate for Payer: Aetna Medicare $10.68
Rate for Payer: Aetna New Business (MI Preferred) $13.88
Rate for Payer: Aetna New Business (MI Preferred) $20.83
Rate for Payer: BCBS Complete $12.82
Rate for Payer: BCBS Complete $8.54
Rate for Payer: BCBS Trust/PPO $6.96
Rate for Payer: BCBS Trust/PPO $6.96
Rate for Payer: BCN Commercial $6.96
Rate for Payer: BCN Commercial $6.96
Rate for Payer: Cash Price $25.63
Rate for Payer: Cash Price $25.63
Rate for Payer: Cash Price $17.09
Rate for Payer: Cash Price $17.09
Rate for Payer: Cofinity Commercial $14.95
Rate for Payer: Cofinity Commercial $27.55
Rate for Payer: Cofinity Commercial $22.43
Rate for Payer: Cofinity Commercial $18.37
Rate for Payer: Cofinity Medicare Advantage $22.43
Rate for Payer: Cofinity Medicare Advantage $14.95
Rate for Payer: Encore Health Key Benefits Commercial $17.09
Rate for Payer: Encore Health Key Benefits Commercial $25.63
Rate for Payer: Healthscope Commercial $19.22
Rate for Payer: Healthscope Commercial $28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $27.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial $18.16
Rate for Payer: PHP Commercial $27.23
Rate for Payer: PHP Commercial $18.16
Rate for Payer: Priority Health Cigna Priority Health $13.88
Rate for Payer: Priority Health Cigna Priority Health $20.83
Rate for Payer: Priority Health SBD $20.19
Rate for Payer: Priority Health SBD $13.46
Service Code HCPCS J0736
Hospital Charge Code 183289
Hospital Revenue Code 636
Min. Negotiated Rate $13.46
Max. Negotiated Rate $19.22
Rate for Payer: Aetna Commercial $18.16
Rate for Payer: Aetna Commercial $27.23
Rate for Payer: Aetna New Business (MI Preferred) $13.88
Rate for Payer: Aetna New Business (MI Preferred) $20.83
Rate for Payer: Cash Price $17.09
Rate for Payer: Cash Price $25.63
Rate for Payer: Cofinity Commercial $14.95
Rate for Payer: Cofinity Commercial $22.43
Rate for Payer: Cofinity Commercial $27.55
Rate for Payer: Cofinity Commercial $18.37
Rate for Payer: Cofinity Medicare Advantage $22.43
Rate for Payer: Cofinity Medicare Advantage $14.95
Rate for Payer: Encore Health Key Benefits Commercial $17.09
Rate for Payer: Encore Health Key Benefits Commercial $25.63
Rate for Payer: Healthscope Commercial $19.22
Rate for Payer: Healthscope Commercial $28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $18.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial $27.23
Rate for Payer: PHP Commercial $18.16
Rate for Payer: PHP Commercial $27.23
Rate for Payer: Priority Health Cigna Priority Health $20.83
Rate for Payer: Priority Health Cigna Priority Health $13.88
Rate for Payer: Priority Health SBD $20.19
Rate for Payer: Priority Health SBD $13.46
Service Code HCPCS J0737
Hospital Charge Code 183289
Hospital Revenue Code 636
Min. Negotiated Rate $7.93
Max. Negotiated Rate $19.22
Rate for Payer: Aetna Commercial $18.16
Rate for Payer: Aetna Medicare $10.68
Rate for Payer: Aetna New Business (MI Preferred) $13.88
Rate for Payer: BCBS Complete $8.54
Rate for Payer: BCBS Trust/PPO $7.93
Rate for Payer: BCN Commercial $7.93
Rate for Payer: Cash Price $17.09
Rate for Payer: Cash Price $17.09
Rate for Payer: Cofinity Commercial $14.95
Rate for Payer: Cofinity Commercial $18.37
Rate for Payer: Cofinity Medicare Advantage $14.95
Rate for Payer: Encore Health Key Benefits Commercial $17.09
Rate for Payer: Healthscope Commercial $19.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial $18.16
Rate for Payer: PHP Commercial $18.16
Rate for Payer: Priority Health Cigna Priority Health $13.88
Rate for Payer: Priority Health SBD $13.46
Service Code HCPCS J0737
Hospital Charge Code 183289
Hospital Revenue Code 636
Min. Negotiated Rate $13.46
Max. Negotiated Rate $19.22
Rate for Payer: Aetna Commercial $18.16
Rate for Payer: Aetna New Business (MI Preferred) $13.88
Rate for Payer: Cash Price $17.09
Rate for Payer: Cofinity Commercial $14.95
Rate for Payer: Cofinity Commercial $18.37
Rate for Payer: Cofinity Medicare Advantage $14.95
Rate for Payer: Encore Health Key Benefits Commercial $17.09
Rate for Payer: Healthscope Commercial $19.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial $18.16
Rate for Payer: PHP Commercial $18.16
Rate for Payer: Priority Health Cigna Priority Health $13.88
Rate for Payer: Priority Health SBD $13.46
Service Code HCPCS J0736
Hospital Charge Code 9626
Hospital Revenue Code 636
Min. Negotiated Rate $6.96
Max. Negotiated Rate $19.22
Rate for Payer: Aetna Commercial $18.16
Rate for Payer: Aetna Medicare $10.68
Rate for Payer: Aetna New Business (MI Preferred) $13.88
Rate for Payer: BCBS Complete $8.54
Rate for Payer: BCBS Trust/PPO $6.96
Rate for Payer: BCN Commercial $6.96
Rate for Payer: Cash Price $17.09
Rate for Payer: Cash Price $17.09
Rate for Payer: Cofinity Commercial $14.95
Rate for Payer: Cofinity Commercial $18.37
Rate for Payer: Cofinity Medicare Advantage $14.95
Rate for Payer: Encore Health Key Benefits Commercial $17.09
Rate for Payer: Healthscope Commercial $19.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial $18.16
Rate for Payer: PHP Commercial $18.16
Rate for Payer: Priority Health Cigna Priority Health $13.88
Rate for Payer: Priority Health SBD $13.46
Service Code HCPCS J7036
Hospital Charge Code 9626
Hospital Revenue Code 636
Min. Negotiated Rate $20.19
Max. Negotiated Rate $28.84
Rate for Payer: Aetna Commercial $27.23
Rate for Payer: Aetna New Business (MI Preferred) $20.83
Rate for Payer: Cash Price $25.63
Rate for Payer: Cofinity Commercial $22.43
Rate for Payer: Cofinity Commercial $27.55
Rate for Payer: Cofinity Medicare Advantage $22.43
Rate for Payer: Encore Health Key Benefits Commercial $25.63
Rate for Payer: Healthscope Commercial $28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $27.23
Rate for Payer: PHP Commercial $27.23
Rate for Payer: Priority Health Cigna Priority Health $20.83
Rate for Payer: Priority Health SBD $20.19
Service Code HCPCS J7036
Hospital Charge Code 9626
Hospital Revenue Code 636
Min. Negotiated Rate $12.82
Max. Negotiated Rate $28.84
Rate for Payer: Aetna Commercial $27.23
Rate for Payer: Aetna Medicare $16.02
Rate for Payer: Aetna New Business (MI Preferred) $20.83
Rate for Payer: BCBS Complete $12.82
Rate for Payer: Cash Price $25.63
Rate for Payer: Cofinity Commercial $22.43
Rate for Payer: Cofinity Commercial $27.55
Rate for Payer: Cofinity Medicare Advantage $22.43
Rate for Payer: Encore Health Key Benefits Commercial $25.63
Rate for Payer: Healthscope Commercial $28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $27.23
Rate for Payer: PHP Commercial $27.23
Rate for Payer: Priority Health Cigna Priority Health $20.83
Rate for Payer: Priority Health SBD $20.19
Service Code HCPCS J0736
Hospital Charge Code 9626
Hospital Revenue Code 636
Min. Negotiated Rate $13.46
Max. Negotiated Rate $19.22
Rate for Payer: Aetna Commercial $18.16
Rate for Payer: Aetna New Business (MI Preferred) $13.88
Rate for Payer: Cash Price $17.09
Rate for Payer: Cofinity Commercial $14.95
Rate for Payer: Cofinity Commercial $18.37
Rate for Payer: Cofinity Medicare Advantage $14.95
Rate for Payer: Encore Health Key Benefits Commercial $17.09
Rate for Payer: Healthscope Commercial $19.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial $18.16
Rate for Payer: PHP Commercial $18.16
Rate for Payer: Priority Health Cigna Priority Health $13.88
Rate for Payer: Priority Health SBD $13.46
Service Code NDC 00781328909
Hospital Charge Code 300021
Hospital Revenue Code 250
Min. Negotiated Rate $20.19
Max. Negotiated Rate $28.84
Rate for Payer: Aetna Commercial $27.23
Rate for Payer: Aetna New Business (MI Preferred) $20.83
Rate for Payer: Cash Price $25.63
Rate for Payer: Cofinity Commercial $27.55
Rate for Payer: Cofinity Commercial $22.43
Rate for Payer: Cofinity Medicare Advantage $22.43
Rate for Payer: Encore Health Key Benefits Commercial $25.63
Rate for Payer: Healthscope Commercial $28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $27.23
Rate for Payer: PHP Commercial $27.23
Rate for Payer: Priority Health Cigna Priority Health $20.83
Rate for Payer: Priority Health SBD $20.19
Service Code NDC 00781328991
Hospital Charge Code 300021
Hospital Revenue Code 250
Min. Negotiated Rate $12.82
Max. Negotiated Rate $28.84
Rate for Payer: Aetna Commercial $27.23
Rate for Payer: Aetna Medicare $16.02
Rate for Payer: Aetna New Business (MI Preferred) $20.83
Rate for Payer: BCBS Complete $12.82
Rate for Payer: Cash Price $25.63
Rate for Payer: Cofinity Commercial $22.43
Rate for Payer: Cofinity Commercial $27.55
Rate for Payer: Cofinity Medicare Advantage $22.43
Rate for Payer: Encore Health Key Benefits Commercial $25.63
Rate for Payer: Healthscope Commercial $28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $27.23
Rate for Payer: PHP Commercial $27.23
Rate for Payer: Priority Health Cigna Priority Health $20.83
Rate for Payer: Priority Health SBD $20.19
Service Code HCPCS J0736
Hospital Charge Code 300021
Hospital Revenue Code 250
Min. Negotiated Rate $6.96
Max. Negotiated Rate $19.22
Rate for Payer: Aetna Commercial $18.16
Rate for Payer: Aetna Medicare $10.68
Rate for Payer: Aetna New Business (MI Preferred) $13.88
Rate for Payer: BCBS Complete $8.54
Rate for Payer: BCBS Trust/PPO $6.96
Rate for Payer: BCN Commercial $6.96
Rate for Payer: Cash Price $17.09
Rate for Payer: Cash Price $17.09
Rate for Payer: Cofinity Commercial $14.95
Rate for Payer: Cofinity Commercial $18.37
Rate for Payer: Cofinity Medicare Advantage $14.95
Rate for Payer: Encore Health Key Benefits Commercial $17.09
Rate for Payer: Healthscope Commercial $19.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial $18.16
Rate for Payer: PHP Commercial $18.16
Rate for Payer: Priority Health Cigna Priority Health $13.88
Rate for Payer: Priority Health SBD $13.46
Service Code NDC 09900000157
Hospital Charge Code 300021
Hospital Revenue Code 250
Min. Negotiated Rate $8.41
Max. Negotiated Rate $18.93
Rate for Payer: Aetna Commercial $17.88
Rate for Payer: Aetna Medicare $10.52
Rate for Payer: Aetna New Business (MI Preferred) $13.67
Rate for Payer: BCBS Complete $8.41
Rate for Payer: Cash Price $16.82
Rate for Payer: Cofinity Commercial $14.72
Rate for Payer: Cofinity Commercial $18.09
Rate for Payer: Cofinity Medicare Advantage $14.72
Rate for Payer: Encore Health Key Benefits Commercial $16.82
Rate for Payer: Healthscope Commercial $18.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial $17.88
Rate for Payer: PHP Commercial $17.88
Rate for Payer: Priority Health Cigna Priority Health $13.67
Rate for Payer: Priority Health SBD $13.25
Service Code NDC 00781328991
Hospital Charge Code 300021
Hospital Revenue Code 250
Min. Negotiated Rate $20.19
Max. Negotiated Rate $28.84
Rate for Payer: Aetna Commercial $27.23
Rate for Payer: Aetna New Business (MI Preferred) $20.83
Rate for Payer: Cash Price $25.63
Rate for Payer: Cofinity Commercial $22.43
Rate for Payer: Cofinity Commercial $27.55
Rate for Payer: Cofinity Medicare Advantage $22.43
Rate for Payer: Encore Health Key Benefits Commercial $25.63
Rate for Payer: Healthscope Commercial $28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $27.23
Rate for Payer: PHP Commercial $27.23
Rate for Payer: Priority Health Cigna Priority Health $20.83
Rate for Payer: Priority Health SBD $20.19
Service Code HCPCS J0736
Hospital Charge Code 300021
Hospital Revenue Code 250
Min. Negotiated Rate $13.46
Max. Negotiated Rate $19.22
Rate for Payer: Aetna Commercial $18.16
Rate for Payer: Aetna New Business (MI Preferred) $13.88
Rate for Payer: Cash Price $17.09
Rate for Payer: Cofinity Commercial $14.95
Rate for Payer: Cofinity Commercial $18.37
Rate for Payer: Cofinity Medicare Advantage $14.95
Rate for Payer: Encore Health Key Benefits Commercial $17.09
Rate for Payer: Healthscope Commercial $19.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial $18.16
Rate for Payer: PHP Commercial $18.16
Rate for Payer: Priority Health Cigna Priority Health $13.88
Rate for Payer: Priority Health SBD $13.46
Service Code NDC 00781328909
Hospital Charge Code 300021
Hospital Revenue Code 250
Min. Negotiated Rate $12.82
Max. Negotiated Rate $28.84
Rate for Payer: Aetna Commercial $27.23
Rate for Payer: Aetna Medicare $16.02
Rate for Payer: Aetna New Business (MI Preferred) $20.83
Rate for Payer: BCBS Complete $12.82
Rate for Payer: Cash Price $25.63
Rate for Payer: Cofinity Commercial $22.43
Rate for Payer: Cofinity Commercial $27.55
Rate for Payer: Cofinity Medicare Advantage $22.43
Rate for Payer: Encore Health Key Benefits Commercial $25.63
Rate for Payer: Healthscope Commercial $28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $27.23
Rate for Payer: PHP Commercial $27.23
Rate for Payer: Priority Health Cigna Priority Health $20.83
Rate for Payer: Priority Health SBD $20.19
Service Code NDC 09900000157
Hospital Charge Code 300021
Hospital Revenue Code 250
Min. Negotiated Rate $13.25
Max. Negotiated Rate $18.93
Rate for Payer: Aetna Commercial $17.88
Rate for Payer: Aetna New Business (MI Preferred) $13.67
Rate for Payer: Cash Price $16.82
Rate for Payer: Cofinity Commercial $14.72
Rate for Payer: Cofinity Commercial $18.09
Rate for Payer: Cofinity Medicare Advantage $14.72
Rate for Payer: Encore Health Key Benefits Commercial $16.82
Rate for Payer: Healthscope Commercial $18.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial $17.88
Rate for Payer: PHP Commercial $17.88
Rate for Payer: Priority Health Cigna Priority Health $13.67
Rate for Payer: Priority Health SBD $13.25
Service Code NDC 23155060351
Hospital Charge Code 37642
Hospital Revenue Code 637
Min. Negotiated Rate $242.80
Max. Negotiated Rate $346.86
Rate for Payer: Aetna Commercial $327.59
Rate for Payer: Aetna New Business (MI Preferred) $250.51
Rate for Payer: Cash Price $308.32
Rate for Payer: Cofinity Commercial $269.78
Rate for Payer: Cofinity Commercial $331.44
Rate for Payer: Cofinity Medicare Advantage $269.78
Rate for Payer: Encore Health Key Benefits Commercial $308.32
Rate for Payer: Healthscope Commercial $346.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial $327.59
Rate for Payer: PHP Commercial $327.59
Rate for Payer: Priority Health Cigna Priority Health $250.51
Rate for Payer: Priority Health SBD $242.80
Service Code NDC 23155060351
Hospital Charge Code 37642
Hospital Revenue Code 637
Min. Negotiated Rate $154.16
Max. Negotiated Rate $346.86
Rate for Payer: Aetna Commercial $327.59
Rate for Payer: Aetna Medicare $192.70
Rate for Payer: Aetna New Business (MI Preferred) $250.51
Rate for Payer: BCBS Complete $154.16
Rate for Payer: Cash Price $308.32
Rate for Payer: Cofinity Commercial $269.78
Rate for Payer: Cofinity Commercial $331.44
Rate for Payer: Cofinity Medicare Advantage $269.78
Rate for Payer: Encore Health Key Benefits Commercial $308.32
Rate for Payer: Healthscope Commercial $346.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial $327.59
Rate for Payer: PHP Commercial $327.59
Rate for Payer: Priority Health Cigna Priority Health $250.51
Rate for Payer: Priority Health SBD $242.80