|
HC EPIDURAL PREP (OB)
|
Facility
|
OP
|
$646.09
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$258.44 |
| Max. Negotiated Rate |
$646.09 |
| Rate for Payer: Aetna Commercial |
$581.48
|
| Rate for Payer: Aetna Medicare |
$323.04
|
| Rate for Payer: ASR ASR |
$626.71
|
| Rate for Payer: ASR Commercial |
$626.71
|
| Rate for Payer: BCBS Complete |
$258.44
|
| Rate for Payer: BCBS Trust/PPO |
$529.08
|
| Rate for Payer: BCN Commercial |
$500.91
|
| Rate for Payer: Cash Price |
$516.87
|
| Rate for Payer: Cofinity Commercial |
$607.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.87
|
| Rate for Payer: Healthscope Commercial |
$646.09
|
| Rate for Payer: Healthscope Whirlpool |
$626.71
|
| Rate for Payer: Mclaren Commercial |
$581.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.18
|
| Rate for Payer: Nomi Health Commercial |
$529.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$566.10
|
| Rate for Payer: Priority Health Narrow Network |
$452.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$568.56
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
IP
|
$646.09
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$419.96 |
| Max. Negotiated Rate |
$646.09 |
| Rate for Payer: Aetna Commercial |
$581.48
|
| Rate for Payer: ASR ASR |
$626.71
|
| Rate for Payer: ASR Commercial |
$626.71
|
| Rate for Payer: BCBS Trust/PPO |
$526.50
|
| Rate for Payer: BCN Commercial |
$500.91
|
| Rate for Payer: Cash Price |
$516.87
|
| Rate for Payer: Cofinity Commercial |
$607.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.87
|
| Rate for Payer: Healthscope Commercial |
$646.09
|
| Rate for Payer: Healthscope Whirlpool |
$626.71
|
| Rate for Payer: Mclaren Commercial |
$581.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.18
|
| Rate for Payer: Nomi Health Commercial |
$529.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$568.56
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
IP
|
$488.47
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.51 |
| Max. Negotiated Rate |
$488.47 |
| Rate for Payer: Aetna Commercial |
$439.62
|
| Rate for Payer: ASR ASR |
$473.82
|
| Rate for Payer: ASR Commercial |
$473.82
|
| Rate for Payer: BCBS Trust/PPO |
$398.05
|
| Rate for Payer: BCN Commercial |
$378.71
|
| Rate for Payer: Cash Price |
$390.78
|
| Rate for Payer: Cofinity Commercial |
$459.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.78
|
| Rate for Payer: Healthscope Commercial |
$488.47
|
| Rate for Payer: Healthscope Whirlpool |
$473.82
|
| Rate for Payer: Mclaren Commercial |
$439.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.20
|
| Rate for Payer: Nomi Health Commercial |
$400.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.85
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
OP
|
$488.47
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$488.47 |
| Rate for Payer: Aetna Commercial |
$439.62
|
| Rate for Payer: Aetna Medicare |
$244.24
|
| Rate for Payer: ASR ASR |
$473.82
|
| Rate for Payer: ASR Commercial |
$473.82
|
| Rate for Payer: BCBS Complete |
$195.39
|
| Rate for Payer: BCBS Trust/PPO |
$400.01
|
| Rate for Payer: BCN Commercial |
$378.71
|
| Rate for Payer: Cash Price |
$390.78
|
| Rate for Payer: Cash Price |
$390.78
|
| Rate for Payer: Cofinity Commercial |
$459.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.78
|
| Rate for Payer: Healthscope Commercial |
$488.47
|
| Rate for Payer: Healthscope Whirlpool |
$473.82
|
| Rate for Payer: Mclaren Commercial |
$439.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.20
|
| Rate for Payer: Nomi Health Commercial |
$400.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.31
|
| Rate for Payer: Priority Health Narrow Network |
$131.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.85
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
IP
|
$709.55
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$461.21 |
| Max. Negotiated Rate |
$709.55 |
| Rate for Payer: Aetna Commercial |
$638.60
|
| Rate for Payer: ASR ASR |
$688.26
|
| Rate for Payer: ASR Commercial |
$688.26
|
| Rate for Payer: BCBS Trust/PPO |
$578.21
|
| Rate for Payer: BCN Commercial |
$550.11
|
| Rate for Payer: Cash Price |
$567.64
|
| Rate for Payer: Cofinity Commercial |
$666.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.64
|
| Rate for Payer: Healthscope Commercial |
$709.55
|
| Rate for Payer: Healthscope Whirlpool |
$688.26
|
| Rate for Payer: Mclaren Commercial |
$638.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.12
|
| Rate for Payer: Nomi Health Commercial |
$581.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$624.40
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
OP
|
$709.55
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$709.55 |
| Rate for Payer: Aetna Commercial |
$638.60
|
| Rate for Payer: Aetna Medicare |
$354.78
|
| Rate for Payer: ASR ASR |
$688.26
|
| Rate for Payer: ASR Commercial |
$688.26
|
| Rate for Payer: BCBS Complete |
$283.82
|
| Rate for Payer: BCBS Trust/PPO |
$581.05
|
| Rate for Payer: BCN Commercial |
$550.11
|
| Rate for Payer: Cash Price |
$567.64
|
| Rate for Payer: Cash Price |
$567.64
|
| Rate for Payer: Cofinity Commercial |
$666.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.64
|
| Rate for Payer: Healthscope Commercial |
$709.55
|
| Rate for Payer: Healthscope Whirlpool |
$688.26
|
| Rate for Payer: Mclaren Commercial |
$638.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.12
|
| Rate for Payer: Nomi Health Commercial |
$581.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.31
|
| Rate for Payer: Priority Health Narrow Network |
$131.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$624.40
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
OP
|
$691.87
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$691.87 |
| Rate for Payer: Aetna Commercial |
$622.68
|
| Rate for Payer: Aetna Medicare |
$345.94
|
| Rate for Payer: ASR ASR |
$671.11
|
| Rate for Payer: ASR Commercial |
$671.11
|
| Rate for Payer: BCBS Complete |
$276.75
|
| Rate for Payer: BCBS Trust/PPO |
$566.57
|
| Rate for Payer: BCN Commercial |
$536.41
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cofinity Commercial |
$650.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.50
|
| Rate for Payer: Healthscope Commercial |
$691.87
|
| Rate for Payer: Healthscope Whirlpool |
$671.11
|
| Rate for Payer: Mclaren Commercial |
$622.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.09
|
| Rate for Payer: Nomi Health Commercial |
$567.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.31
|
| Rate for Payer: Priority Health Narrow Network |
$131.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.85
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
IP
|
$691.87
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$449.72 |
| Max. Negotiated Rate |
$691.87 |
| Rate for Payer: Aetna Commercial |
$622.68
|
| Rate for Payer: ASR ASR |
$671.11
|
| Rate for Payer: ASR Commercial |
$671.11
|
| Rate for Payer: BCBS Trust/PPO |
$563.80
|
| Rate for Payer: BCN Commercial |
$536.41
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cofinity Commercial |
$650.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.50
|
| Rate for Payer: Healthscope Commercial |
$691.87
|
| Rate for Payer: Healthscope Whirlpool |
$671.11
|
| Rate for Payer: Mclaren Commercial |
$622.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.09
|
| Rate for Payer: Nomi Health Commercial |
$567.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.85
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.35 |
| Max. Negotiated Rate |
$495.92 |
| Rate for Payer: Aetna Commercial |
$446.33
|
| Rate for Payer: ASR ASR |
$481.04
|
| Rate for Payer: ASR Commercial |
$481.04
|
| Rate for Payer: BCBS Trust/PPO |
$404.13
|
| Rate for Payer: BCN Commercial |
$384.49
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$466.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Healthscope Commercial |
$495.92
|
| Rate for Payer: Healthscope Whirlpool |
$481.04
|
| Rate for Payer: Mclaren Commercial |
$446.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: Nomi Health Commercial |
$406.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.41
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$495.92 |
| Rate for Payer: Aetna Commercial |
$446.33
|
| Rate for Payer: Aetna Medicare |
$247.96
|
| Rate for Payer: ASR ASR |
$481.04
|
| Rate for Payer: ASR Commercial |
$481.04
|
| Rate for Payer: BCBS Complete |
$198.37
|
| Rate for Payer: BCBS Trust/PPO |
$406.11
|
| Rate for Payer: BCN Commercial |
$384.49
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$466.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Healthscope Commercial |
$495.92
|
| Rate for Payer: Healthscope Whirlpool |
$481.04
|
| Rate for Payer: Mclaren Commercial |
$446.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: Nomi Health Commercial |
$406.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.31
|
| Rate for Payer: Priority Health Narrow Network |
$131.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.41
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
OP
|
$438.93
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$438.93 |
| Rate for Payer: Aetna Commercial |
$395.04
|
| Rate for Payer: Aetna Medicare |
$219.46
|
| Rate for Payer: ASR ASR |
$425.76
|
| Rate for Payer: ASR Commercial |
$425.76
|
| Rate for Payer: BCBS Complete |
$175.57
|
| Rate for Payer: BCBS Trust/PPO |
$359.44
|
| Rate for Payer: BCN Commercial |
$340.30
|
| Rate for Payer: Cash Price |
$351.14
|
| Rate for Payer: Cash Price |
$351.14
|
| Rate for Payer: Cofinity Commercial |
$412.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.14
|
| Rate for Payer: Healthscope Commercial |
$438.93
|
| Rate for Payer: Healthscope Whirlpool |
$425.76
|
| Rate for Payer: Mclaren Commercial |
$395.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.09
|
| Rate for Payer: Nomi Health Commercial |
$359.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.31
|
| Rate for Payer: Priority Health Narrow Network |
$131.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.26
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
IP
|
$438.93
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.30 |
| Max. Negotiated Rate |
$438.93 |
| Rate for Payer: Aetna Commercial |
$395.04
|
| Rate for Payer: ASR ASR |
$425.76
|
| Rate for Payer: ASR Commercial |
$425.76
|
| Rate for Payer: BCBS Trust/PPO |
$357.68
|
| Rate for Payer: BCN Commercial |
$340.30
|
| Rate for Payer: Cash Price |
$351.14
|
| Rate for Payer: Cofinity Commercial |
$412.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.14
|
| Rate for Payer: Healthscope Commercial |
$438.93
|
| Rate for Payer: Healthscope Whirlpool |
$425.76
|
| Rate for Payer: Mclaren Commercial |
$395.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.09
|
| Rate for Payer: Nomi Health Commercial |
$359.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.26
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
OP
|
$412.52
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$412.52 |
| Rate for Payer: Aetna Commercial |
$371.27
|
| Rate for Payer: Aetna Medicare |
$206.26
|
| Rate for Payer: ASR ASR |
$400.14
|
| Rate for Payer: ASR Commercial |
$400.14
|
| Rate for Payer: BCBS Complete |
$165.01
|
| Rate for Payer: BCBS Trust/PPO |
$337.81
|
| Rate for Payer: BCN Commercial |
$319.83
|
| Rate for Payer: Cash Price |
$330.02
|
| Rate for Payer: Cash Price |
$330.02
|
| Rate for Payer: Cofinity Commercial |
$387.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.02
|
| Rate for Payer: Healthscope Commercial |
$412.52
|
| Rate for Payer: Healthscope Whirlpool |
$400.14
|
| Rate for Payer: Mclaren Commercial |
$371.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.64
|
| Rate for Payer: Nomi Health Commercial |
$338.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.31
|
| Rate for Payer: Priority Health Narrow Network |
$131.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.02
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
IP
|
$412.52
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.14 |
| Max. Negotiated Rate |
$412.52 |
| Rate for Payer: Aetna Commercial |
$371.27
|
| Rate for Payer: ASR ASR |
$400.14
|
| Rate for Payer: ASR Commercial |
$400.14
|
| Rate for Payer: BCBS Trust/PPO |
$336.16
|
| Rate for Payer: BCN Commercial |
$319.83
|
| Rate for Payer: Cash Price |
$330.02
|
| Rate for Payer: Cofinity Commercial |
$387.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.02
|
| Rate for Payer: Healthscope Commercial |
$412.52
|
| Rate for Payer: Healthscope Whirlpool |
$400.14
|
| Rate for Payer: Mclaren Commercial |
$371.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.64
|
| Rate for Payer: Nomi Health Commercial |
$338.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.02
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
IP
|
$211.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$211.79 |
| Rate for Payer: Aetna Commercial |
$190.61
|
| Rate for Payer: ASR ASR |
$205.44
|
| Rate for Payer: ASR Commercial |
$205.44
|
| Rate for Payer: BCBS Trust/PPO |
$172.59
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Cofinity Commercial |
$199.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.43
|
| Rate for Payer: Healthscope Commercial |
$211.79
|
| Rate for Payer: Healthscope Whirlpool |
$205.44
|
| Rate for Payer: Mclaren Commercial |
$190.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.02
|
| Rate for Payer: Nomi Health Commercial |
$173.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.38
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
OP
|
$211.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.72 |
| Max. Negotiated Rate |
$211.79 |
| Rate for Payer: Aetna Commercial |
$190.61
|
| Rate for Payer: Aetna Medicare |
$105.90
|
| Rate for Payer: ASR ASR |
$205.44
|
| Rate for Payer: ASR Commercial |
$205.44
|
| Rate for Payer: BCBS Complete |
$84.72
|
| Rate for Payer: BCBS Trust/PPO |
$173.43
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Cofinity Commercial |
$199.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.43
|
| Rate for Payer: Healthscope Commercial |
$211.79
|
| Rate for Payer: Healthscope Whirlpool |
$205.44
|
| Rate for Payer: Mclaren Commercial |
$190.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.02
|
| Rate for Payer: Nomi Health Commercial |
$173.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.31
|
| Rate for Payer: Priority Health Narrow Network |
$131.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.38
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
OP
|
$396.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$396.79 |
| Rate for Payer: Aetna Commercial |
$357.11
|
| Rate for Payer: Aetna Medicare |
$198.40
|
| Rate for Payer: ASR ASR |
$384.89
|
| Rate for Payer: ASR Commercial |
$384.89
|
| Rate for Payer: BCBS Complete |
$158.72
|
| Rate for Payer: BCBS Trust/PPO |
$324.93
|
| Rate for Payer: BCN Commercial |
$307.63
|
| Rate for Payer: Cash Price |
$317.43
|
| Rate for Payer: Cash Price |
$317.43
|
| Rate for Payer: Cofinity Commercial |
$372.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.43
|
| Rate for Payer: Healthscope Commercial |
$396.79
|
| Rate for Payer: Healthscope Whirlpool |
$384.89
|
| Rate for Payer: Mclaren Commercial |
$357.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.27
|
| Rate for Payer: Nomi Health Commercial |
$325.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.31
|
| Rate for Payer: Priority Health Narrow Network |
$131.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.18
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
IP
|
$396.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.91 |
| Max. Negotiated Rate |
$396.79 |
| Rate for Payer: Aetna Commercial |
$357.11
|
| Rate for Payer: ASR ASR |
$384.89
|
| Rate for Payer: ASR Commercial |
$384.89
|
| Rate for Payer: BCBS Trust/PPO |
$323.34
|
| Rate for Payer: BCN Commercial |
$307.63
|
| Rate for Payer: Cash Price |
$317.43
|
| Rate for Payer: Cofinity Commercial |
$372.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.43
|
| Rate for Payer: Healthscope Commercial |
$396.79
|
| Rate for Payer: Healthscope Whirlpool |
$384.89
|
| Rate for Payer: Mclaren Commercial |
$357.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.27
|
| Rate for Payer: Nomi Health Commercial |
$325.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.18
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
OP
|
$297.61
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.04 |
| Max. Negotiated Rate |
$297.61 |
| Rate for Payer: Aetna Commercial |
$267.85
|
| Rate for Payer: Aetna Medicare |
$148.80
|
| Rate for Payer: ASR ASR |
$288.68
|
| Rate for Payer: ASR Commercial |
$288.68
|
| Rate for Payer: BCBS Complete |
$119.04
|
| Rate for Payer: BCBS Trust/PPO |
$243.71
|
| Rate for Payer: BCN Commercial |
$230.74
|
| Rate for Payer: Cash Price |
$238.09
|
| Rate for Payer: Cash Price |
$238.09
|
| Rate for Payer: Cofinity Commercial |
$279.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.09
|
| Rate for Payer: Healthscope Commercial |
$297.61
|
| Rate for Payer: Healthscope Whirlpool |
$288.68
|
| Rate for Payer: Mclaren Commercial |
$267.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.97
|
| Rate for Payer: Nomi Health Commercial |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.31
|
| Rate for Payer: Priority Health Narrow Network |
$131.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.90
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
IP
|
$297.61
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.45 |
| Max. Negotiated Rate |
$297.61 |
| Rate for Payer: Aetna Commercial |
$267.85
|
| Rate for Payer: ASR ASR |
$288.68
|
| Rate for Payer: ASR Commercial |
$288.68
|
| Rate for Payer: BCBS Trust/PPO |
$242.52
|
| Rate for Payer: BCN Commercial |
$230.74
|
| Rate for Payer: Cash Price |
$238.09
|
| Rate for Payer: Cofinity Commercial |
$279.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.09
|
| Rate for Payer: Healthscope Commercial |
$297.61
|
| Rate for Payer: Healthscope Whirlpool |
$288.68
|
| Rate for Payer: Mclaren Commercial |
$267.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.97
|
| Rate for Payer: Nomi Health Commercial |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.90
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
IP
|
$416.16
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$270.50 |
| Max. Negotiated Rate |
$416.16 |
| Rate for Payer: Aetna Commercial |
$374.54
|
| Rate for Payer: ASR ASR |
$403.68
|
| Rate for Payer: ASR Commercial |
$403.68
|
| Rate for Payer: BCBS Trust/PPO |
$339.13
|
| Rate for Payer: BCN Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Commercial |
$391.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$416.16
|
| Rate for Payer: Healthscope Whirlpool |
$403.68
|
| Rate for Payer: Mclaren Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Nomi Health Commercial |
$341.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.22
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
OP
|
$416.16
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.46 |
| Max. Negotiated Rate |
$416.16 |
| Rate for Payer: Aetna Commercial |
$374.54
|
| Rate for Payer: Aetna Medicare |
$208.08
|
| Rate for Payer: ASR ASR |
$403.68
|
| Rate for Payer: ASR Commercial |
$403.68
|
| Rate for Payer: BCBS Complete |
$166.46
|
| Rate for Payer: BCBS Trust/PPO |
$340.79
|
| Rate for Payer: BCN Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Commercial |
$391.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$416.16
|
| Rate for Payer: Healthscope Whirlpool |
$403.68
|
| Rate for Payer: Mclaren Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Nomi Health Commercial |
$341.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.64
|
| Rate for Payer: Priority Health Narrow Network |
$291.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.22
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$935.10
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$607.82 |
| Max. Negotiated Rate |
$935.10 |
| Rate for Payer: Aetna Commercial |
$841.59
|
| Rate for Payer: ASR ASR |
$907.05
|
| Rate for Payer: ASR Commercial |
$907.05
|
| Rate for Payer: BCBS Trust/PPO |
$762.01
|
| Rate for Payer: BCN Commercial |
$724.98
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cofinity Commercial |
$878.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.08
|
| Rate for Payer: Healthscope Commercial |
$935.10
|
| Rate for Payer: Healthscope Whirlpool |
$907.05
|
| Rate for Payer: Mclaren Commercial |
$841.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.84
|
| Rate for Payer: Nomi Health Commercial |
$766.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$822.89
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$935.10
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$935.10 |
| Rate for Payer: Aetna Commercial |
$841.59
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$907.05
|
| Rate for Payer: ASR Commercial |
$907.05
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$765.75
|
| Rate for Payer: BCN Commercial |
$724.98
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cofinity Commercial |
$878.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$935.10
|
| Rate for Payer: Healthscope Whirlpool |
$907.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$841.59
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.84
|
| Rate for Payer: Nomi Health Commercial |
$766.78
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$819.33
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$655.51
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$822.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EP+PVI ABL
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,786.30 |
| Max. Negotiated Rate |
$37,256.20 |
| Rate for Payer: Aetna Commercial |
$8,011.80
|
| Rate for Payer: Aetna Medicare |
$24,036.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,045.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,045.32
|
| Rate for Payer: ASR ASR |
$8,634.94
|
| Rate for Payer: ASR Commercial |
$8,634.94
|
| Rate for Payer: BCBS Complete |
$13,527.61
|
| Rate for Payer: BCBS MAPPO |
$24,036.26
|
| Rate for Payer: BCBS Trust/PPO |
$7,289.85
|
| Rate for Payer: BCN Commercial |
$6,901.72
|
| Rate for Payer: BCN Medicare Advantage |
$24,036.26
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$8,367.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,036.26
|
| Rate for Payer: Healthscope Commercial |
$8,902.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,634.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,036.26
|
| Rate for Payer: Mclaren Commercial |
$8,011.80
|
| Rate for Payer: Mclaren Medicaid |
$12,883.44
|
| Rate for Payer: Mclaren Medicare |
$24,036.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,238.07
|
| Rate for Payer: Meridian Medicaid |
$13,527.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,641.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PACE Medicare |
$22,834.45
|
| Rate for Payer: PACE SWMI |
$24,036.26
|
| Rate for Payer: PHP Commercial |
$26,439.89
|
| Rate for Payer: PHP Medicaid |
$12,883.44
|
| Rate for Payer: PHP Medicare Advantage |
$24,036.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,883.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,760.73
|
| Rate for Payer: Priority Health Medicare |
$24,036.26
|
| Rate for Payer: Priority Health Narrow Network |
$10,208.58
|
| Rate for Payer: Railroad Medicare Medicare |
$24,036.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,833.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,036.26
|
| Rate for Payer: UHC Exchange |
$37,256.20
|
| Rate for Payer: UHC Medicare Advantage |
$24,036.26
|
| Rate for Payer: UHCCP DNSP |
$24,036.26
|
| Rate for Payer: UHCCP Medicaid |
$12,883.44
|
| Rate for Payer: VA VA |
$24,036.26
|
|
