|
HC COLPOSCOPY VULVA W/BIOPSY
|
Facility
|
IP
|
$854.17
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.21 |
| Max. Negotiated Rate |
$854.17 |
| Rate for Payer: Aetna Commercial |
$768.75
|
| Rate for Payer: ASR ASR |
$828.54
|
| Rate for Payer: ASR Commercial |
$828.54
|
| Rate for Payer: BCBS Trust/PPO |
$696.06
|
| Rate for Payer: BCN Commercial |
$662.24
|
| Rate for Payer: Cash Price |
$683.34
|
| Rate for Payer: Cofinity Commercial |
$802.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.34
|
| Rate for Payer: Healthscope Commercial |
$854.17
|
| Rate for Payer: Healthscope Whirlpool |
$828.54
|
| Rate for Payer: Mclaren Commercial |
$768.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.04
|
| Rate for Payer: Nomi Health Commercial |
$700.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$751.67
|
|
|
HC COMBI CATH SUPPLY
|
Facility
|
IP
|
$123.46
|
|
| Hospital Charge Code |
27200116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.25 |
| Max. Negotiated Rate |
$123.46 |
| Rate for Payer: Aetna Commercial |
$111.11
|
| Rate for Payer: ASR ASR |
$119.76
|
| Rate for Payer: ASR Commercial |
$119.76
|
| Rate for Payer: BCBS Trust/PPO |
$100.61
|
| Rate for Payer: BCN Commercial |
$95.72
|
| Rate for Payer: Cash Price |
$98.77
|
| Rate for Payer: Cofinity Commercial |
$116.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.77
|
| Rate for Payer: Healthscope Commercial |
$123.46
|
| Rate for Payer: Healthscope Whirlpool |
$119.76
|
| Rate for Payer: Mclaren Commercial |
$111.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.94
|
| Rate for Payer: Nomi Health Commercial |
$101.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.64
|
|
|
HC COMBI CATH SUPPLY
|
Facility
|
OP
|
$123.46
|
|
| Hospital Charge Code |
27200116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$123.46 |
| Rate for Payer: Aetna Commercial |
$111.11
|
| Rate for Payer: Aetna Medicare |
$61.73
|
| Rate for Payer: ASR ASR |
$119.76
|
| Rate for Payer: ASR Commercial |
$119.76
|
| Rate for Payer: BCBS Complete |
$49.38
|
| Rate for Payer: BCBS Trust/PPO |
$101.10
|
| Rate for Payer: BCN Commercial |
$95.72
|
| Rate for Payer: Cash Price |
$98.77
|
| Rate for Payer: Cofinity Commercial |
$116.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.77
|
| Rate for Payer: Healthscope Commercial |
$123.46
|
| Rate for Payer: Healthscope Whirlpool |
$119.76
|
| Rate for Payer: Mclaren Commercial |
$111.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.94
|
| Rate for Payer: Nomi Health Commercial |
$101.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.18
|
| Rate for Payer: Priority Health Narrow Network |
$86.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.64
|
|
|
HC COMBINED VACCINE, MMR+VARICELLA, SUBQ
|
Facility
|
IP
|
$213.28
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
63600206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.63 |
| Max. Negotiated Rate |
$213.28 |
| Rate for Payer: Aetna Commercial |
$191.95
|
| Rate for Payer: ASR ASR |
$206.88
|
| Rate for Payer: ASR Commercial |
$206.88
|
| Rate for Payer: BCBS Trust/PPO |
$173.80
|
| Rate for Payer: BCN Commercial |
$165.36
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$200.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Whirlpool |
$206.88
|
| Rate for Payer: Mclaren Commercial |
$191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: Nomi Health Commercial |
$174.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.69
|
|
|
HC COMBINED VACCINE, MMR+VARICELLA, SUBQ
|
Facility
|
OP
|
$213.28
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
63600206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.31 |
| Max. Negotiated Rate |
$213.28 |
| Rate for Payer: Aetna Commercial |
$191.95
|
| Rate for Payer: Aetna Medicare |
$106.64
|
| Rate for Payer: ASR ASR |
$206.88
|
| Rate for Payer: ASR Commercial |
$206.88
|
| Rate for Payer: BCBS Complete |
$85.31
|
| Rate for Payer: BCBS Trust/PPO |
$174.65
|
| Rate for Payer: BCN Commercial |
$165.36
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$200.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Whirlpool |
$206.88
|
| Rate for Payer: Mclaren Commercial |
$191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: Nomi Health Commercial |
$174.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.88
|
| Rate for Payer: Priority Health Narrow Network |
$149.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.69
|
|
|
HC COMMON REED IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC COMMON REED IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna Medicare |
$48.45
|
| Rate for Payer: ASR ASR |
$93.99
|
| Rate for Payer: ASR Commercial |
$93.99
|
| Rate for Payer: BCBS Complete |
$38.76
|
| Rate for Payer: BCBS Trust/PPO |
$79.35
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$91.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$96.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.99
|
| Rate for Payer: Mclaren Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.90
|
| Rate for Payer: Priority Health Narrow Network |
$67.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.27
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: ASR ASR |
$93.99
|
| Rate for Payer: ASR Commercial |
$93.99
|
| Rate for Payer: BCBS Trust/PPO |
$78.96
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$91.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$96.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.99
|
| Rate for Payer: Mclaren Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.27
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
IP
|
$658.62
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$428.10 |
| Max. Negotiated Rate |
$658.62 |
| Rate for Payer: Aetna Commercial |
$592.76
|
| Rate for Payer: ASR ASR |
$638.86
|
| Rate for Payer: ASR Commercial |
$638.86
|
| Rate for Payer: BCBS Trust/PPO |
$536.71
|
| Rate for Payer: BCN Commercial |
$510.63
|
| Rate for Payer: Cash Price |
$526.90
|
| Rate for Payer: Cofinity Commercial |
$619.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.90
|
| Rate for Payer: Healthscope Commercial |
$658.62
|
| Rate for Payer: Healthscope Whirlpool |
$638.86
|
| Rate for Payer: Mclaren Commercial |
$592.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.83
|
| Rate for Payer: Nomi Health Commercial |
$540.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.59
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
OP
|
$658.62
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$263.45 |
| Max. Negotiated Rate |
$658.62 |
| Rate for Payer: Aetna Commercial |
$592.76
|
| Rate for Payer: Aetna Medicare |
$329.31
|
| Rate for Payer: ASR ASR |
$638.86
|
| Rate for Payer: ASR Commercial |
$638.86
|
| Rate for Payer: BCBS Complete |
$263.45
|
| Rate for Payer: BCBS Trust/PPO |
$539.34
|
| Rate for Payer: BCN Commercial |
$510.63
|
| Rate for Payer: Cash Price |
$526.90
|
| Rate for Payer: Cofinity Commercial |
$619.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.90
|
| Rate for Payer: Healthscope Commercial |
$658.62
|
| Rate for Payer: Healthscope Whirlpool |
$638.86
|
| Rate for Payer: Mclaren Commercial |
$592.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.83
|
| Rate for Payer: Nomi Health Commercial |
$540.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$577.08
|
| Rate for Payer: Priority Health Narrow Network |
$461.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.59
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
IP
|
$238.68
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$155.14 |
| Max. Negotiated Rate |
$238.68 |
| Rate for Payer: Aetna Commercial |
$214.81
|
| Rate for Payer: ASR ASR |
$231.52
|
| Rate for Payer: ASR Commercial |
$231.52
|
| Rate for Payer: BCBS Trust/PPO |
$194.50
|
| Rate for Payer: BCN Commercial |
$185.05
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Commercial |
$224.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Healthscope Commercial |
$238.68
|
| Rate for Payer: Healthscope Whirlpool |
$231.52
|
| Rate for Payer: Mclaren Commercial |
$214.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: Nomi Health Commercial |
$195.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.04
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
OP
|
$238.68
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$238.68 |
| Rate for Payer: Aetna Commercial |
$214.81
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: ASR ASR |
$231.52
|
| Rate for Payer: ASR Commercial |
$231.52
|
| Rate for Payer: BCBS Complete |
$95.47
|
| Rate for Payer: BCBS Trust/PPO |
$195.46
|
| Rate for Payer: BCN Commercial |
$185.05
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Commercial |
$224.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Healthscope Commercial |
$238.68
|
| Rate for Payer: Healthscope Whirlpool |
$231.52
|
| Rate for Payer: Mclaren Commercial |
$214.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: Nomi Health Commercial |
$195.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.13
|
| Rate for Payer: Priority Health Narrow Network |
$167.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.04
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna Commercial |
$11.02
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: ASR ASR |
$11.87
|
| Rate for Payer: ASR Commercial |
$11.87
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.02
|
| Rate for Payer: BCN Commercial |
$9.49
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$12.24
|
| Rate for Payer: Healthscope Whirlpool |
$11.87
|
| Rate for Payer: Mclaren Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.72
|
| Rate for Payer: Priority Health Narrow Network |
$8.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.77
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna Commercial |
$11.02
|
| Rate for Payer: ASR ASR |
$11.87
|
| Rate for Payer: ASR Commercial |
$11.87
|
| Rate for Payer: BCBS Trust/PPO |
$9.97
|
| Rate for Payer: BCN Commercial |
$9.49
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$12.24
|
| Rate for Payer: Healthscope Whirlpool |
$11.87
|
| Rate for Payer: Mclaren Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.77
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: ASR Commercial |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$13.30
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$15.83
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: ASR Commercial |
$15.83
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.36
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$15.83
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.30
|
| Rate for Payer: Priority Health Narrow Network |
$11.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$51.53
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$51.79
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
IP
|
$338.64
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.12 |
| Max. Negotiated Rate |
$338.64 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: ASR ASR |
$328.48
|
| Rate for Payer: ASR Commercial |
$328.48
|
| Rate for Payer: BCBS Trust/PPO |
$275.96
|
| Rate for Payer: BCN Commercial |
$262.55
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$318.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$338.64
|
| Rate for Payer: Healthscope Whirlpool |
$328.48
|
| Rate for Payer: Mclaren Commercial |
$304.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.84
|
| Rate for Payer: Nomi Health Commercial |
$277.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.00
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
OP
|
$338.64
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$135.46 |
| Max. Negotiated Rate |
$338.64 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: Aetna Medicare |
$169.32
|
| Rate for Payer: ASR ASR |
$328.48
|
| Rate for Payer: ASR Commercial |
$328.48
|
| Rate for Payer: BCBS Complete |
$135.46
|
| Rate for Payer: BCBS Trust/PPO |
$277.31
|
| Rate for Payer: BCN Commercial |
$262.55
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$318.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$338.64
|
| Rate for Payer: Healthscope Whirlpool |
$328.48
|
| Rate for Payer: Mclaren Commercial |
$304.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.84
|
| Rate for Payer: Nomi Health Commercial |
$277.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.72
|
| Rate for Payer: Priority Health Narrow Network |
$237.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.00
|
|
|
HC COMP BURN GARM BELLY BAND
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.25
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC COMP BURN GARM BELLY BAND
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$33.41
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.75
|
| Rate for Payer: Priority Health Narrow Network |
$28.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
OP
|
$240.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$240.72 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna Medicare |
$120.36
|
| Rate for Payer: ASR ASR |
$233.50
|
| Rate for Payer: ASR Commercial |
$233.50
|
| Rate for Payer: BCBS Complete |
$96.29
|
| Rate for Payer: BCBS Trust/PPO |
$197.13
|
| Rate for Payer: BCN Commercial |
$186.63
|
| Rate for Payer: Cash Price |
$192.58
|
| Rate for Payer: Cofinity Commercial |
$226.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.58
|
| Rate for Payer: Healthscope Commercial |
$240.72
|
| Rate for Payer: Healthscope Whirlpool |
$233.50
|
| Rate for Payer: Mclaren Commercial |
$216.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.61
|
| Rate for Payer: Nomi Health Commercial |
$197.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.92
|
| Rate for Payer: Priority Health Narrow Network |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.83
|
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
IP
|
$240.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.47 |
| Max. Negotiated Rate |
$240.72 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: ASR ASR |
$233.50
|
| Rate for Payer: ASR Commercial |
$233.50
|
| Rate for Payer: BCBS Trust/PPO |
$196.16
|
| Rate for Payer: BCN Commercial |
$186.63
|
| Rate for Payer: Cash Price |
$192.58
|
| Rate for Payer: Cofinity Commercial |
$226.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.58
|
| Rate for Payer: Healthscope Commercial |
$240.72
|
| Rate for Payer: Healthscope Whirlpool |
$233.50
|
| Rate for Payer: Mclaren Commercial |
$216.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.61
|
| Rate for Payer: Nomi Health Commercial |
$197.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.83
|
|
