|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$319.12
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.05 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$271.25
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cofinity Commercial |
$223.38
|
| Rate for Payer: Cofinity Commercial |
$274.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$287.21
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.25
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$271.25
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.43
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$201.05
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
IP
|
$951.99
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.75 |
| Max. Negotiated Rate |
$856.79 |
| Rate for Payer: Aetna Commercial |
$809.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.79
|
| Rate for Payer: Cash Price |
$761.59
|
| Rate for Payer: Cofinity Commercial |
$666.39
|
| Rate for Payer: Cofinity Commercial |
$818.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$666.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.59
|
| Rate for Payer: Healthscope Commercial |
$856.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.19
|
| Rate for Payer: PHP Commercial |
$809.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: Priority Health SBD |
$599.75
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
OP
|
$951.99
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$809.19
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$761.59
|
| Rate for Payer: Cash Price |
$761.59
|
| Rate for Payer: Cofinity Commercial |
$818.71
|
| Rate for Payer: Cofinity Commercial |
$666.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$666.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$856.79
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.19
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$809.19
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$599.75
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
IP
|
$275.29
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.43 |
| Max. Negotiated Rate |
$247.76 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.94
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$192.70
|
| Rate for Payer: Cofinity Commercial |
$236.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.23
|
| Rate for Payer: Healthscope Commercial |
$247.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.00
|
| Rate for Payer: PHP Commercial |
$234.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.94
|
| Rate for Payer: Priority Health SBD |
$173.43
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
OP
|
$275.29
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.43 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$236.75
|
| Rate for Payer: Cofinity Commercial |
$192.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$247.76
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.00
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$234.00
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.94
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$173.43
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$489.96 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health SBD |
$489.96
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health SBD |
$489.96
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$162.08
|
| Rate for Payer: VA VA |
$287.89
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health SBD |
$489.96
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$162.08
|
| Rate for Payer: VA VA |
$287.89
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$489.96 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health SBD |
$489.96
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$737.39
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$464.56 |
| Max. Negotiated Rate |
$663.65 |
| Rate for Payer: Aetna Commercial |
$626.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.30
|
| Rate for Payer: Cash Price |
$589.91
|
| Rate for Payer: Cofinity Commercial |
$516.17
|
| Rate for Payer: Cofinity Commercial |
$634.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$516.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.91
|
| Rate for Payer: Healthscope Commercial |
$663.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.78
|
| Rate for Payer: PHP Commercial |
$626.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.30
|
| Rate for Payer: Priority Health SBD |
$464.56
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$737.39
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.96 |
| Max. Negotiated Rate |
$663.65 |
| Rate for Payer: Aetna Commercial |
$626.78
|
| Rate for Payer: Aetna Medicare |
$368.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.30
|
| Rate for Payer: BCBS Complete |
$294.96
|
| Rate for Payer: Cash Price |
$589.91
|
| Rate for Payer: Cofinity Commercial |
$516.17
|
| Rate for Payer: Cofinity Commercial |
$634.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$516.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.91
|
| Rate for Payer: Healthscope Commercial |
$663.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.78
|
| Rate for Payer: PHP Commercial |
$626.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.30
|
| Rate for Payer: Priority Health SBD |
$464.56
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
IP
|
$512.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.60 |
| Max. Negotiated Rate |
$460.86 |
| Rate for Payer: Aetna Commercial |
$435.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.85
|
| Rate for Payer: Cash Price |
$409.66
|
| Rate for Payer: Cofinity Commercial |
$358.45
|
| Rate for Payer: Cofinity Commercial |
$440.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$358.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.66
|
| Rate for Payer: Healthscope Commercial |
$460.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.26
|
| Rate for Payer: PHP Commercial |
$435.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.85
|
| Rate for Payer: Priority Health SBD |
$322.60
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
OP
|
$512.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.83 |
| Max. Negotiated Rate |
$460.86 |
| Rate for Payer: Aetna Commercial |
$435.26
|
| Rate for Payer: Aetna Medicare |
$256.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.85
|
| Rate for Payer: BCBS Complete |
$204.83
|
| Rate for Payer: Cash Price |
$409.66
|
| Rate for Payer: Cofinity Commercial |
$358.45
|
| Rate for Payer: Cofinity Commercial |
$440.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$358.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.66
|
| Rate for Payer: Healthscope Commercial |
$460.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.26
|
| Rate for Payer: PHP Commercial |
$435.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.85
|
| Rate for Payer: Priority Health SBD |
$322.60
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
OP
|
$324.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$291.88 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Aetna Medicare |
$162.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.80
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: Cash Price |
$259.45
|
| Rate for Payer: Cofinity Commercial |
$227.02
|
| Rate for Payer: Cofinity Commercial |
$278.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.45
|
| Rate for Payer: Healthscope Commercial |
$291.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.66
|
| Rate for Payer: PHP Commercial |
$275.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: Priority Health SBD |
$204.32
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
IP
|
$324.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.32 |
| Max. Negotiated Rate |
$291.88 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.80
|
| Rate for Payer: Cash Price |
$259.45
|
| Rate for Payer: Cofinity Commercial |
$227.02
|
| Rate for Payer: Cofinity Commercial |
$278.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.45
|
| Rate for Payer: Healthscope Commercial |
$291.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.66
|
| Rate for Payer: PHP Commercial |
$275.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: Priority Health SBD |
$204.32
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
IP
|
$270.94
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.69 |
| Max. Negotiated Rate |
$243.85 |
| Rate for Payer: Aetna Commercial |
$230.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.11
|
| Rate for Payer: Cash Price |
$216.75
|
| Rate for Payer: Cofinity Commercial |
$189.66
|
| Rate for Payer: Cofinity Commercial |
$233.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.75
|
| Rate for Payer: Healthscope Commercial |
$243.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.30
|
| Rate for Payer: PHP Commercial |
$230.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.11
|
| Rate for Payer: Priority Health SBD |
$170.69
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
OP
|
$270.94
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$243.85 |
| Rate for Payer: Aetna Commercial |
$230.30
|
| Rate for Payer: Aetna Medicare |
$135.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.11
|
| Rate for Payer: BCBS Complete |
$108.38
|
| Rate for Payer: Cash Price |
$216.75
|
| Rate for Payer: Cofinity Commercial |
$189.66
|
| Rate for Payer: Cofinity Commercial |
$233.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.75
|
| Rate for Payer: Healthscope Commercial |
$243.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.30
|
| Rate for Payer: PHP Commercial |
$230.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.11
|
| Rate for Payer: Priority Health SBD |
$170.69
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health SBD |
$180.25
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health SBD |
$180.25
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.89 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$112.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health SBD |
$141.58
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.58 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health SBD |
$141.58
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.58 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health SBD |
$141.58
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.89 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$112.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health SBD |
$141.58
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
OP
|
$155.62
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$140.06 |
| Rate for Payer: Aetna Commercial |
$132.28
|
| Rate for Payer: Aetna Medicare |
$77.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.15
|
| Rate for Payer: BCBS Complete |
$62.25
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cofinity Commercial |
$108.93
|
| Rate for Payer: Cofinity Commercial |
$133.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.50
|
| Rate for Payer: Healthscope Commercial |
$140.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.28
|
| Rate for Payer: PHP Commercial |
$132.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.15
|
| Rate for Payer: Priority Health SBD |
$98.04
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
IP
|
$155.62
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.04 |
| Max. Negotiated Rate |
$140.06 |
| Rate for Payer: Aetna Commercial |
$132.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.15
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cofinity Commercial |
$108.93
|
| Rate for Payer: Cofinity Commercial |
$133.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.50
|
| Rate for Payer: Healthscope Commercial |
$140.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.28
|
| Rate for Payer: PHP Commercial |
$132.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.15
|
| Rate for Payer: Priority Health SBD |
$98.04
|
|
