|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
OP
|
$772.50
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$772.50 |
| Rate for Payer: Aetna Commercial |
$695.25
|
| Rate for Payer: Aetna Medicare |
$386.25
|
| Rate for Payer: ASR ASR |
$749.32
|
| Rate for Payer: ASR Commercial |
$749.32
|
| Rate for Payer: BCBS Complete |
$309.00
|
| Rate for Payer: BCBS Trust/PPO |
$632.60
|
| Rate for Payer: BCN Commercial |
$598.92
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cofinity Commercial |
$726.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.00
|
| Rate for Payer: Healthscope Commercial |
$772.50
|
| Rate for Payer: Healthscope Whirlpool |
$749.32
|
| Rate for Payer: Mclaren Commercial |
$695.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.62
|
| Rate for Payer: Nomi Health Commercial |
$633.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.25
|
| Rate for Payer: Priority Health Narrow Network |
$100.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$679.80
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
IP
|
$772.50
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$772.50 |
| Rate for Payer: Aetna Commercial |
$695.25
|
| Rate for Payer: ASR ASR |
$749.32
|
| Rate for Payer: ASR Commercial |
$749.32
|
| Rate for Payer: BCBS Trust/PPO |
$629.51
|
| Rate for Payer: BCN Commercial |
$598.92
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cofinity Commercial |
$726.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.00
|
| Rate for Payer: Healthscope Commercial |
$772.50
|
| Rate for Payer: Healthscope Whirlpool |
$749.32
|
| Rate for Payer: Mclaren Commercial |
$695.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.62
|
| Rate for Payer: Nomi Health Commercial |
$633.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$679.80
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
IP
|
$476.86
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$309.96 |
| Max. Negotiated Rate |
$476.86 |
| Rate for Payer: Aetna Commercial |
$429.17
|
| Rate for Payer: ASR ASR |
$462.55
|
| Rate for Payer: ASR Commercial |
$462.55
|
| Rate for Payer: BCBS Trust/PPO |
$388.59
|
| Rate for Payer: BCN Commercial |
$369.71
|
| Rate for Payer: Cash Price |
$381.49
|
| Rate for Payer: Cofinity Commercial |
$448.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.49
|
| Rate for Payer: Healthscope Commercial |
$476.86
|
| Rate for Payer: Healthscope Whirlpool |
$462.55
|
| Rate for Payer: Mclaren Commercial |
$429.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.33
|
| Rate for Payer: Nomi Health Commercial |
$391.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.64
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
OP
|
$476.86
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$476.86 |
| Rate for Payer: Aetna Commercial |
$429.17
|
| Rate for Payer: Aetna Medicare |
$238.43
|
| Rate for Payer: ASR ASR |
$462.55
|
| Rate for Payer: ASR Commercial |
$462.55
|
| Rate for Payer: BCBS Complete |
$190.74
|
| Rate for Payer: BCBS Trust/PPO |
$390.50
|
| Rate for Payer: BCN Commercial |
$369.71
|
| Rate for Payer: Cash Price |
$381.49
|
| Rate for Payer: Cash Price |
$381.49
|
| Rate for Payer: Cofinity Commercial |
$448.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.49
|
| Rate for Payer: Healthscope Commercial |
$476.86
|
| Rate for Payer: Healthscope Whirlpool |
$462.55
|
| Rate for Payer: Mclaren Commercial |
$429.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.33
|
| Rate for Payer: Nomi Health Commercial |
$391.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.25
|
| Rate for Payer: Priority Health Narrow Network |
$100.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.64
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
IP
|
$336.46
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.70 |
| Max. Negotiated Rate |
$336.46 |
| Rate for Payer: Aetna Commercial |
$302.81
|
| Rate for Payer: ASR ASR |
$326.37
|
| Rate for Payer: ASR Commercial |
$326.37
|
| Rate for Payer: BCBS Trust/PPO |
$274.18
|
| Rate for Payer: BCN Commercial |
$260.86
|
| Rate for Payer: Cash Price |
$269.17
|
| Rate for Payer: Cofinity Commercial |
$316.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.17
|
| Rate for Payer: Healthscope Commercial |
$336.46
|
| Rate for Payer: Healthscope Whirlpool |
$326.37
|
| Rate for Payer: Mclaren Commercial |
$302.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.99
|
| Rate for Payer: Nomi Health Commercial |
$275.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.08
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
OP
|
$336.46
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$336.46 |
| Rate for Payer: Aetna Commercial |
$302.81
|
| Rate for Payer: Aetna Medicare |
$168.23
|
| Rate for Payer: ASR ASR |
$326.37
|
| Rate for Payer: ASR Commercial |
$326.37
|
| Rate for Payer: BCBS Complete |
$134.58
|
| Rate for Payer: BCBS Trust/PPO |
$275.53
|
| Rate for Payer: BCN Commercial |
$260.86
|
| Rate for Payer: Cash Price |
$269.17
|
| Rate for Payer: Cash Price |
$269.17
|
| Rate for Payer: Cofinity Commercial |
$316.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.17
|
| Rate for Payer: Healthscope Commercial |
$336.46
|
| Rate for Payer: Healthscope Whirlpool |
$326.37
|
| Rate for Payer: Mclaren Commercial |
$302.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.99
|
| Rate for Payer: Nomi Health Commercial |
$275.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.25
|
| Rate for Payer: Priority Health Narrow Network |
$100.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.08
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
IP
|
$277.98
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.69 |
| Max. Negotiated Rate |
$277.98 |
| Rate for Payer: Aetna Commercial |
$250.18
|
| Rate for Payer: ASR ASR |
$269.64
|
| Rate for Payer: ASR Commercial |
$269.64
|
| Rate for Payer: BCBS Trust/PPO |
$226.53
|
| Rate for Payer: BCN Commercial |
$215.52
|
| Rate for Payer: Cash Price |
$222.38
|
| Rate for Payer: Cofinity Commercial |
$261.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.38
|
| Rate for Payer: Healthscope Commercial |
$277.98
|
| Rate for Payer: Healthscope Whirlpool |
$269.64
|
| Rate for Payer: Mclaren Commercial |
$250.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.28
|
| Rate for Payer: Nomi Health Commercial |
$227.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.62
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
OP
|
$277.98
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$277.98 |
| Rate for Payer: Aetna Commercial |
$250.18
|
| Rate for Payer: Aetna Medicare |
$138.99
|
| Rate for Payer: ASR ASR |
$269.64
|
| Rate for Payer: ASR Commercial |
$269.64
|
| Rate for Payer: BCBS Complete |
$111.19
|
| Rate for Payer: BCBS Trust/PPO |
$227.64
|
| Rate for Payer: BCN Commercial |
$215.52
|
| Rate for Payer: Cash Price |
$222.38
|
| Rate for Payer: Cash Price |
$222.38
|
| Rate for Payer: Cofinity Commercial |
$261.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.38
|
| Rate for Payer: Healthscope Commercial |
$277.98
|
| Rate for Payer: Healthscope Whirlpool |
$269.64
|
| Rate for Payer: Mclaren Commercial |
$250.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.28
|
| Rate for Payer: Nomi Health Commercial |
$227.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.25
|
| Rate for Payer: Priority Health Narrow Network |
$100.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.62
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
IP
|
$2,458.78
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,598.21 |
| Max. Negotiated Rate |
$2,458.78 |
| Rate for Payer: Aetna Commercial |
$2,212.90
|
| Rate for Payer: ASR ASR |
$2,385.02
|
| Rate for Payer: ASR Commercial |
$2,385.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,003.66
|
| Rate for Payer: BCN Commercial |
$1,906.29
|
| Rate for Payer: Cash Price |
$1,967.02
|
| Rate for Payer: Cofinity Commercial |
$2,311.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,967.02
|
| Rate for Payer: Healthscope Commercial |
$2,458.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,385.02
|
| Rate for Payer: Mclaren Commercial |
$2,212.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.96
|
| Rate for Payer: Nomi Health Commercial |
$2,016.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,163.73
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
OP
|
$2,458.78
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.64 |
| Max. Negotiated Rate |
$2,777.97 |
| Rate for Payer: Aetna Commercial |
$2,212.90
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$2,385.02
|
| Rate for Payer: ASR Commercial |
$2,385.02
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,013.49
|
| Rate for Payer: BCN Commercial |
$1,906.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,967.02
|
| Rate for Payer: Cash Price |
$1,967.02
|
| Rate for Payer: Cofinity Commercial |
$2,311.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,967.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$2,458.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,385.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$2,212.90
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.96
|
| Rate for Payer: Nomi Health Commercial |
$2,016.20
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,154.38
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,723.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,163.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
IP
|
$3,219.34
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,092.57 |
| Max. Negotiated Rate |
$3,219.34 |
| Rate for Payer: Aetna Commercial |
$2,897.41
|
| Rate for Payer: ASR ASR |
$3,122.76
|
| Rate for Payer: ASR Commercial |
$3,122.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,623.44
|
| Rate for Payer: BCN Commercial |
$2,495.95
|
| Rate for Payer: Cash Price |
$2,575.47
|
| Rate for Payer: Cofinity Commercial |
$3,026.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,575.47
|
| Rate for Payer: Healthscope Commercial |
$3,219.34
|
| Rate for Payer: Healthscope Whirlpool |
$3,122.76
|
| Rate for Payer: Mclaren Commercial |
$2,897.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,736.44
|
| Rate for Payer: Nomi Health Commercial |
$2,639.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,833.02
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
OP
|
$3,219.34
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.64 |
| Max. Negotiated Rate |
$3,219.34 |
| Rate for Payer: Aetna Commercial |
$2,897.41
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$3,122.76
|
| Rate for Payer: ASR Commercial |
$3,122.76
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,636.32
|
| Rate for Payer: BCN Commercial |
$2,495.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$2,575.47
|
| Rate for Payer: Cash Price |
$2,575.47
|
| Rate for Payer: Cofinity Commercial |
$3,026.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,575.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$3,219.34
|
| Rate for Payer: Healthscope Whirlpool |
$3,122.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$2,897.41
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,736.44
|
| Rate for Payer: Nomi Health Commercial |
$2,639.86
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,820.79
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,256.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,833.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Trust/PPO |
$41.81
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$42.02
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.93
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$26.34
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC GRANULOCYTES
|
Facility
|
OP
|
$1,925.76
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$770.30 |
| Max. Negotiated Rate |
$1,925.76 |
| Rate for Payer: Aetna Commercial |
$1,733.18
|
| Rate for Payer: Aetna Medicare |
$962.88
|
| Rate for Payer: ASR ASR |
$1,867.99
|
| Rate for Payer: ASR Commercial |
$1,867.99
|
| Rate for Payer: BCBS Complete |
$770.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.00
|
| Rate for Payer: BCN Commercial |
$1,493.04
|
| Rate for Payer: Cash Price |
$1,540.61
|
| Rate for Payer: Cofinity Commercial |
$1,810.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.61
|
| Rate for Payer: Healthscope Commercial |
$1,925.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,867.99
|
| Rate for Payer: Mclaren Commercial |
$1,733.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.90
|
| Rate for Payer: Nomi Health Commercial |
$1,579.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,687.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,349.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.67
|
|
|
HC GRANULOCYTES
|
Facility
|
IP
|
$1,925.76
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,251.74 |
| Max. Negotiated Rate |
$1,925.76 |
| Rate for Payer: Aetna Commercial |
$1,733.18
|
| Rate for Payer: ASR ASR |
$1,867.99
|
| Rate for Payer: ASR Commercial |
$1,867.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,569.30
|
| Rate for Payer: BCN Commercial |
$1,493.04
|
| Rate for Payer: Cash Price |
$1,540.61
|
| Rate for Payer: Cofinity Commercial |
$1,810.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.61
|
| Rate for Payer: Healthscope Commercial |
$1,925.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,867.99
|
| Rate for Payer: Mclaren Commercial |
$1,733.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.90
|
| Rate for Payer: Nomi Health Commercial |
$1,579.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.67
|
|
|
HC GRASS ALLERGEN PANEL
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
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 GRASS ALLERGEN PANEL
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
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 |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| 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 GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: ASR ASR |
$19.40
|
| Rate for Payer: ASR Commercial |
$19.40
|
| Rate for Payer: BCBS Trust/PPO |
$16.30
|
| Rate for Payer: BCN Commercial |
$15.51
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$20.00
|
| Rate for Payer: Healthscope Whirlpool |
$19.40
|
| Rate for Payer: Mclaren Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.60
|
|
|
HC GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: ASR ASR |
$19.40
|
| Rate for Payer: ASR Commercial |
$19.40
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCN Commercial |
$15.51
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$20.00
|
| Rate for Payer: Healthscope Whirlpool |
$19.40
|
| Rate for Payer: Mclaren Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.52
|
| Rate for Payer: Priority Health Narrow Network |
$14.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.60
|
|
|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
IP
|
$1,443.73
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$938.42 |
| Max. Negotiated Rate |
$1,443.73 |
| Rate for Payer: Aetna Commercial |
$1,299.36
|
| Rate for Payer: ASR ASR |
$1,400.42
|
| Rate for Payer: ASR Commercial |
$1,400.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,176.50
|
| Rate for Payer: BCN Commercial |
$1,119.32
|
| Rate for Payer: Cash Price |
$1,154.98
|
| Rate for Payer: Cofinity Commercial |
$1,357.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.98
|
| Rate for Payer: Healthscope Commercial |
$1,443.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,400.42
|
| Rate for Payer: Mclaren Commercial |
$1,299.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,227.17
|
| Rate for Payer: Nomi Health Commercial |
$1,183.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,270.48
|
|
|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
OP
|
$1,443.73
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,443.73 |
| Rate for Payer: Aetna Commercial |
$1,299.36
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$1,400.42
|
| Rate for Payer: ASR Commercial |
$1,400.42
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.27
|
| Rate for Payer: BCN Commercial |
$1,119.32
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,154.98
|
| Rate for Payer: Cash Price |
$1,154.98
|
| Rate for Payer: Cofinity Commercial |
$1,357.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,443.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,400.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,299.36
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,227.17
|
| Rate for Payer: Nomi Health Commercial |
$1,183.86
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,265.00
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.05
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,270.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
IP
|
$922.21
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$599.44 |
| Max. Negotiated Rate |
$922.21 |
| Rate for Payer: Aetna Commercial |
$829.99
|
| Rate for Payer: ASR ASR |
$894.54
|
| Rate for Payer: ASR Commercial |
$894.54
|
| Rate for Payer: BCBS Trust/PPO |
$751.51
|
| Rate for Payer: BCN Commercial |
$714.99
|
| Rate for Payer: Cash Price |
$737.77
|
| Rate for Payer: Cofinity Commercial |
$866.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.77
|
| Rate for Payer: Healthscope Commercial |
$922.21
|
| Rate for Payer: Healthscope Whirlpool |
$894.54
|
| Rate for Payer: Mclaren Commercial |
$829.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.88
|
| Rate for Payer: Nomi Health Commercial |
$756.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$811.54
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
OP
|
$922.21
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$922.21 |
| Rate for Payer: Aetna Commercial |
$829.99
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$894.54
|
| Rate for Payer: ASR Commercial |
$894.54
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$755.20
|
| Rate for Payer: BCN Commercial |
$714.99
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$737.77
|
| Rate for Payer: Cash Price |
$737.77
|
| Rate for Payer: Cofinity Commercial |
$866.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$922.21
|
| Rate for Payer: Healthscope Whirlpool |
$894.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$829.99
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.88
|
| Rate for Payer: Nomi Health Commercial |
$756.21
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$808.04
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$646.47
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$811.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC GROSHONG REPAIR KIT
|
Facility
|
IP
|
$464.18
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.72 |
| Max. Negotiated Rate |
$464.18 |
| Rate for Payer: Aetna Commercial |
$417.76
|
| Rate for Payer: ASR ASR |
$450.25
|
| Rate for Payer: ASR Commercial |
$450.25
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: BCN Commercial |
$359.88
|
| Rate for Payer: Cash Price |
$371.34
|
| Rate for Payer: Cofinity Commercial |
$436.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.34
|
| Rate for Payer: Healthscope Commercial |
$464.18
|
| Rate for Payer: Healthscope Whirlpool |
$450.25
|
| Rate for Payer: Mclaren Commercial |
$417.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.55
|
| Rate for Payer: Nomi Health Commercial |
$380.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.48
|
|
