|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
IP
|
$695.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$486.95 |
| Max. Negotiated Rate |
$695.64 |
| Rate for Payer: Aetna Commercial |
$626.08
|
| Rate for Payer: ASR ASR |
$674.77
|
| Rate for Payer: BCBS Trust/PPO |
$539.33
|
| Rate for Payer: BCN Commercial |
$539.33
|
| Rate for Payer: Cash Price |
$556.51
|
| Rate for Payer: Cofinity Commercial |
$653.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.51
|
| Rate for Payer: Healthscope Commercial |
$695.64
|
| Rate for Payer: Healthscope Whirlpool |
$674.77
|
| Rate for Payer: Mclaren Commercial |
$626.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$591.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.16
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
OP
|
$678.30
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$271.32 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna Commercial |
$610.47
|
| Rate for Payer: ASR ASR |
$657.95
|
| Rate for Payer: BCBS Complete |
$271.32
|
| Rate for Payer: BCBS Trust/PPO |
$525.89
|
| Rate for Payer: BCN Commercial |
$525.89
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$637.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Healthscope Commercial |
$678.30
|
| Rate for Payer: Healthscope Whirlpool |
$657.95
|
| Rate for Payer: Mclaren Commercial |
$610.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.25
|
| Rate for Payer: Priority Health Narrow Network |
$481.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$596.90
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
IP
|
$678.30
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$474.81 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna Commercial |
$610.47
|
| Rate for Payer: ASR ASR |
$657.95
|
| Rate for Payer: BCBS Trust/PPO |
$525.89
|
| Rate for Payer: BCN Commercial |
$525.89
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$637.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Healthscope Commercial |
$678.30
|
| Rate for Payer: Healthscope Whirlpool |
$657.95
|
| Rate for Payer: Mclaren Commercial |
$610.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$596.90
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$486.20
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$340.34 |
| Max. Negotiated Rate |
$486.20 |
| Rate for Payer: Aetna Commercial |
$437.58
|
| Rate for Payer: ASR ASR |
$471.61
|
| Rate for Payer: BCBS Trust/PPO |
$376.95
|
| Rate for Payer: BCN Commercial |
$376.95
|
| Rate for Payer: Cash Price |
$388.96
|
| Rate for Payer: Cofinity Commercial |
$457.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.96
|
| Rate for Payer: Healthscope Commercial |
$486.20
|
| Rate for Payer: Healthscope Whirlpool |
$471.61
|
| Rate for Payer: Mclaren Commercial |
$437.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$413.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.86
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$486.20
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.48 |
| Max. Negotiated Rate |
$486.20 |
| Rate for Payer: Aetna Commercial |
$437.58
|
| Rate for Payer: ASR ASR |
$471.61
|
| Rate for Payer: BCBS Complete |
$194.48
|
| Rate for Payer: BCBS Trust/PPO |
$376.95
|
| Rate for Payer: BCN Commercial |
$376.95
|
| Rate for Payer: Cash Price |
$388.96
|
| Rate for Payer: Cofinity Commercial |
$457.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.96
|
| Rate for Payer: Healthscope Commercial |
$486.20
|
| Rate for Payer: Healthscope Whirlpool |
$471.61
|
| Rate for Payer: Mclaren Commercial |
$437.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$413.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$442.44
|
| Rate for Payer: Priority Health Narrow Network |
$345.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.86
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
IP
|
$430.32
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$301.22 |
| Max. Negotiated Rate |
$430.32 |
| Rate for Payer: Aetna Commercial |
$387.29
|
| Rate for Payer: ASR ASR |
$417.41
|
| Rate for Payer: BCBS Trust/PPO |
$333.63
|
| Rate for Payer: BCN Commercial |
$333.63
|
| Rate for Payer: Cash Price |
$344.26
|
| Rate for Payer: Cofinity Commercial |
$404.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.26
|
| Rate for Payer: Healthscope Commercial |
$430.32
|
| Rate for Payer: Healthscope Whirlpool |
$417.41
|
| Rate for Payer: Mclaren Commercial |
$387.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.68
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
OP
|
$430.32
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$430.32 |
| Rate for Payer: Aetna Commercial |
$387.29
|
| Rate for Payer: ASR ASR |
$417.41
|
| Rate for Payer: BCBS Complete |
$172.13
|
| Rate for Payer: BCBS Trust/PPO |
$333.63
|
| Rate for Payer: BCN Commercial |
$333.63
|
| Rate for Payer: Cash Price |
$344.26
|
| Rate for Payer: Cofinity Commercial |
$404.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.26
|
| Rate for Payer: Healthscope Commercial |
$430.32
|
| Rate for Payer: Healthscope Whirlpool |
$417.41
|
| Rate for Payer: Mclaren Commercial |
$387.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.59
|
| Rate for Payer: Priority Health Narrow Network |
$305.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.68
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
OP
|
$404.43
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$404.43 |
| Rate for Payer: Aetna Commercial |
$363.99
|
| Rate for Payer: ASR ASR |
$392.30
|
| Rate for Payer: BCBS Complete |
$161.77
|
| Rate for Payer: BCBS Trust/PPO |
$313.55
|
| Rate for Payer: BCN Commercial |
$313.55
|
| Rate for Payer: Cash Price |
$323.54
|
| Rate for Payer: Cofinity Commercial |
$380.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.54
|
| Rate for Payer: Healthscope Commercial |
$404.43
|
| Rate for Payer: Healthscope Whirlpool |
$392.30
|
| Rate for Payer: Mclaren Commercial |
$363.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.03
|
| Rate for Payer: Priority Health Narrow Network |
$287.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.90
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
IP
|
$404.43
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$283.10 |
| Max. Negotiated Rate |
$404.43 |
| Rate for Payer: Aetna Commercial |
$363.99
|
| Rate for Payer: ASR ASR |
$392.30
|
| Rate for Payer: BCBS Trust/PPO |
$313.55
|
| Rate for Payer: BCN Commercial |
$313.55
|
| Rate for Payer: Cash Price |
$323.54
|
| Rate for Payer: Cofinity Commercial |
$380.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.54
|
| Rate for Payer: Healthscope Commercial |
$404.43
|
| Rate for Payer: Healthscope Whirlpool |
$392.30
|
| Rate for Payer: Mclaren Commercial |
$363.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.90
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
OP
|
$207.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$207.64 |
| Rate for Payer: Aetna Commercial |
$186.88
|
| Rate for Payer: ASR ASR |
$201.41
|
| Rate for Payer: BCBS Complete |
$83.06
|
| Rate for Payer: BCBS Trust/PPO |
$160.98
|
| Rate for Payer: BCN Commercial |
$160.98
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Commercial |
$195.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Healthscope Commercial |
$207.64
|
| Rate for Payer: Healthscope Whirlpool |
$201.41
|
| Rate for Payer: Mclaren Commercial |
$186.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.95
|
| Rate for Payer: Priority Health Narrow Network |
$147.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.72
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
IP
|
$207.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$207.64 |
| Rate for Payer: Aetna Commercial |
$186.88
|
| Rate for Payer: ASR ASR |
$201.41
|
| Rate for Payer: BCBS Trust/PPO |
$160.98
|
| Rate for Payer: BCN Commercial |
$160.98
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Commercial |
$195.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Healthscope Commercial |
$207.64
|
| Rate for Payer: Healthscope Whirlpool |
$201.41
|
| Rate for Payer: Mclaren Commercial |
$186.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.72
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
IP
|
$389.01
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.31 |
| Max. Negotiated Rate |
$389.01 |
| Rate for Payer: Aetna Commercial |
$350.11
|
| Rate for Payer: ASR ASR |
$377.34
|
| Rate for Payer: BCBS Trust/PPO |
$301.60
|
| Rate for Payer: BCN Commercial |
$301.60
|
| Rate for Payer: Cash Price |
$311.21
|
| Rate for Payer: Cofinity Commercial |
$365.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.21
|
| Rate for Payer: Healthscope Commercial |
$389.01
|
| Rate for Payer: Healthscope Whirlpool |
$377.34
|
| Rate for Payer: Mclaren Commercial |
$350.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.33
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
OP
|
$389.01
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$389.01 |
| Rate for Payer: Aetna Commercial |
$350.11
|
| Rate for Payer: ASR ASR |
$377.34
|
| Rate for Payer: BCBS Complete |
$155.60
|
| Rate for Payer: BCBS Trust/PPO |
$301.60
|
| Rate for Payer: BCN Commercial |
$301.60
|
| Rate for Payer: Cash Price |
$311.21
|
| Rate for Payer: Cofinity Commercial |
$365.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.21
|
| Rate for Payer: Healthscope Commercial |
$389.01
|
| Rate for Payer: Healthscope Whirlpool |
$377.34
|
| Rate for Payer: Mclaren Commercial |
$350.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.00
|
| Rate for Payer: Priority Health Narrow Network |
$276.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.33
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
OP
|
$291.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.71 |
| Max. Negotiated Rate |
$291.77 |
| Rate for Payer: Aetna Commercial |
$262.59
|
| Rate for Payer: ASR ASR |
$283.02
|
| Rate for Payer: BCBS Complete |
$116.71
|
| Rate for Payer: BCBS Trust/PPO |
$226.21
|
| Rate for Payer: BCN Commercial |
$226.21
|
| Rate for Payer: Cash Price |
$233.42
|
| Rate for Payer: Cofinity Commercial |
$274.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.42
|
| Rate for Payer: Healthscope Commercial |
$291.77
|
| Rate for Payer: Healthscope Whirlpool |
$283.02
|
| Rate for Payer: Mclaren Commercial |
$262.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.51
|
| Rate for Payer: Priority Health Narrow Network |
$207.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.76
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
IP
|
$291.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.24 |
| Max. Negotiated Rate |
$291.77 |
| Rate for Payer: Aetna Commercial |
$262.59
|
| Rate for Payer: ASR ASR |
$283.02
|
| Rate for Payer: BCBS Trust/PPO |
$226.21
|
| Rate for Payer: BCN Commercial |
$226.21
|
| Rate for Payer: Cash Price |
$233.42
|
| Rate for Payer: Cofinity Commercial |
$274.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.42
|
| Rate for Payer: Healthscope Commercial |
$291.77
|
| Rate for Payer: Healthscope Whirlpool |
$283.02
|
| Rate for Payer: Mclaren Commercial |
$262.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.76
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: ASR ASR |
$395.76
|
| Rate for Payer: BCBS Trust/PPO |
$316.32
|
| Rate for Payer: BCN Commercial |
$316.32
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$408.00
|
| Rate for Payer: Healthscope Whirlpool |
$395.76
|
| Rate for Payer: Mclaren Commercial |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.04
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: ASR ASR |
$395.76
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS Trust/PPO |
$316.32
|
| Rate for Payer: BCN Commercial |
$316.32
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$408.00
|
| Rate for Payer: Healthscope Whirlpool |
$395.76
|
| Rate for Payer: Mclaren Commercial |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.28
|
| Rate for Payer: Priority Health Narrow Network |
$289.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.04
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$916.76
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$641.73 |
| Max. Negotiated Rate |
$916.76 |
| Rate for Payer: Aetna Commercial |
$825.08
|
| Rate for Payer: ASR ASR |
$889.26
|
| Rate for Payer: BCBS Trust/PPO |
$710.76
|
| Rate for Payer: BCN Commercial |
$710.76
|
| Rate for Payer: Cash Price |
$733.41
|
| Rate for Payer: Cofinity Commercial |
$861.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.41
|
| Rate for Payer: Healthscope Commercial |
$916.76
|
| Rate for Payer: Healthscope Whirlpool |
$889.26
|
| Rate for Payer: Mclaren Commercial |
$825.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$779.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$806.75
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$916.76
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$916.76 |
| Rate for Payer: Aetna Commercial |
$825.08
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$889.26
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$710.76
|
| Rate for Payer: BCN Commercial |
$710.76
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$733.41
|
| Rate for Payer: Cash Price |
$733.41
|
| Rate for Payer: Cofinity Commercial |
$861.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$916.76
|
| Rate for Payer: Healthscope Whirlpool |
$889.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$825.08
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$779.25
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$834.25
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$650.90
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$806.75
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EP+PVI ABL
|
Facility
|
OP
|
$8,727.45
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,109.22 |
| Max. Negotiated Rate |
$26,389.02 |
| Rate for Payer: Aetna Commercial |
$7,854.70
|
| Rate for Payer: Aetna Medicare |
$21,111.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,389.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,389.02
|
| Rate for Payer: ASR ASR |
$8,465.63
|
| Rate for Payer: BCBS Complete |
$12,126.28
|
| Rate for Payer: BCBS MAPPO |
$21,111.22
|
| Rate for Payer: BCBS Trust/PPO |
$6,766.39
|
| Rate for Payer: BCN Commercial |
$6,766.39
|
| Rate for Payer: BCN Medicare Advantage |
$21,111.22
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$8,203.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,111.22
|
| Rate for Payer: Healthscope Commercial |
$8,727.45
|
| Rate for Payer: Healthscope Whirlpool |
$8,465.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,111.22
|
| Rate for Payer: Mclaren Commercial |
$7,854.70
|
| Rate for Payer: Mclaren Medicaid |
$11,547.84
|
| Rate for Payer: Mclaren Medicare |
$21,111.22
|
| Rate for Payer: Meridian Medicaid |
$12,126.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,166.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,277.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: PACE Medicare |
$20,055.66
|
| Rate for Payer: PACE SWMI |
$21,111.22
|
| Rate for Payer: PHP Commercial |
$23,222.34
|
| Rate for Payer: PHP Medicaid |
$11,547.84
|
| Rate for Payer: PHP Medicare Advantage |
$21,111.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,547.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,925.92
|
| Rate for Payer: Priority Health Medicare |
$21,111.22
|
| Rate for Payer: Priority Health Narrow Network |
$9,540.74
|
| Rate for Payer: Railroad Medicare Medicare |
$21,111.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,680.16
|
| Rate for Payer: UHC Medicare Advantage |
$21,744.56
|
| Rate for Payer: VA VA |
$21,111.22
|
|
|
HC EP+PVI ABL
|
Facility
|
IP
|
$8,727.45
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,109.22 |
| Max. Negotiated Rate |
$8,727.45 |
| Rate for Payer: Aetna Commercial |
$7,854.70
|
| Rate for Payer: ASR ASR |
$8,465.63
|
| Rate for Payer: BCBS Trust/PPO |
$6,766.39
|
| Rate for Payer: BCN Commercial |
$6,766.39
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$8,203.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.96
|
| Rate for Payer: Healthscope Commercial |
$8,727.45
|
| Rate for Payer: Healthscope Whirlpool |
$8,465.63
|
| Rate for Payer: Mclaren Commercial |
$7,854.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,680.16
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$112.87 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: ASR ASR |
$35.62
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$28.47
|
| Rate for Payer: BCN Commercial |
$28.47
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Healthscope Whirlpool |
$35.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$9.92
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$19.95
|
| Rate for Payer: PHP Medicaid |
$9.92
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.87
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$90.30
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.31
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: ASR ASR |
$35.62
|
| Rate for Payer: BCBS Trust/PPO |
$28.47
|
| Rate for Payer: BCN Commercial |
$28.47
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Healthscope Whirlpool |
$35.62
|
| Rate for Payer: Mclaren Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.31
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: ASR ASR |
$35.62
|
| Rate for Payer: BCBS Trust/PPO |
$28.47
|
| Rate for Payer: BCN Commercial |
$28.47
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Healthscope Whirlpool |
$35.62
|
| Rate for Payer: Mclaren Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.31
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$112.87 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: ASR ASR |
$35.62
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$28.47
|
| Rate for Payer: BCN Commercial |
$28.47
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Healthscope Whirlpool |
$35.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$9.92
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$19.95
|
| Rate for Payer: PHP Medicaid |
$9.92
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.87
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$90.30
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.31
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: VA VA |
$18.14
|
|
