|
HC PULSERIDER
|
Facility
|
IP
|
$16,734.38
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,714.07 |
| Max. Negotiated Rate |
$16,734.38 |
| Rate for Payer: Aetna Commercial |
$15,060.94
|
| Rate for Payer: ASR ASR |
$16,232.35
|
| Rate for Payer: BCBS Trust/PPO |
$12,974.16
|
| Rate for Payer: BCN Commercial |
$12,974.16
|
| Rate for Payer: Cash Price |
$13,387.50
|
| Rate for Payer: Cofinity Commercial |
$15,730.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,387.50
|
| Rate for Payer: Healthscope Commercial |
$16,734.38
|
| Rate for Payer: Healthscope Whirlpool |
$16,232.35
|
| Rate for Payer: Mclaren Commercial |
$15,060.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,224.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,714.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,726.25
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
OP
|
$448.28
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$179.31 |
| Max. Negotiated Rate |
$448.28 |
| Rate for Payer: Aetna Commercial |
$403.45
|
| Rate for Payer: ASR ASR |
$434.83
|
| Rate for Payer: BCBS Complete |
$179.31
|
| Rate for Payer: BCBS Trust/PPO |
$347.55
|
| Rate for Payer: BCN Commercial |
$347.55
|
| Rate for Payer: Cash Price |
$358.62
|
| Rate for Payer: Cofinity Commercial |
$421.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.62
|
| Rate for Payer: Healthscope Commercial |
$448.28
|
| Rate for Payer: Healthscope Whirlpool |
$434.83
|
| Rate for Payer: Mclaren Commercial |
$403.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.93
|
| Rate for Payer: Priority Health Narrow Network |
$318.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$394.49
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
IP
|
$448.28
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$448.28 |
| Rate for Payer: Aetna Commercial |
$403.45
|
| Rate for Payer: ASR ASR |
$434.83
|
| Rate for Payer: BCBS Trust/PPO |
$347.55
|
| Rate for Payer: BCN Commercial |
$347.55
|
| Rate for Payer: Cash Price |
$358.62
|
| Rate for Payer: Cofinity Commercial |
$421.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.62
|
| Rate for Payer: Healthscope Commercial |
$448.28
|
| Rate for Payer: Healthscope Whirlpool |
$434.83
|
| Rate for Payer: Mclaren Commercial |
$403.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$394.49
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$81.91
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$81.91 |
| Rate for Payer: Aetna Commercial |
$73.72
|
| Rate for Payer: ASR ASR |
$79.45
|
| Rate for Payer: BCBS Complete |
$32.76
|
| Rate for Payer: BCBS Trust/PPO |
$63.50
|
| Rate for Payer: BCN Commercial |
$63.50
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.53
|
| Rate for Payer: Healthscope Commercial |
$81.91
|
| Rate for Payer: Healthscope Whirlpool |
$79.45
|
| Rate for Payer: Mclaren Commercial |
$73.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.54
|
| Rate for Payer: Priority Health Narrow Network |
$58.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.08
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$81.91
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.34 |
| Max. Negotiated Rate |
$81.91 |
| Rate for Payer: Aetna Commercial |
$73.72
|
| Rate for Payer: ASR ASR |
$79.45
|
| Rate for Payer: BCBS Trust/PPO |
$63.50
|
| Rate for Payer: BCN Commercial |
$63.50
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.53
|
| Rate for Payer: Healthscope Commercial |
$81.91
|
| Rate for Payer: Healthscope Whirlpool |
$79.45
|
| Rate for Payer: Mclaren Commercial |
$73.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.08
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$270.30
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.04 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$243.27
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$262.19
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$209.56
|
| Rate for Payer: BCN Commercial |
$209.56
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$254.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$270.30
|
| Rate for Payer: Healthscope Whirlpool |
$262.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$243.27
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.80
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$151.04
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.86
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$270.30
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.21 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Aetna Commercial |
$243.27
|
| Rate for Payer: ASR ASR |
$262.19
|
| Rate for Payer: BCBS Trust/PPO |
$209.56
|
| Rate for Payer: BCN Commercial |
$209.56
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$254.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Healthscope Commercial |
$270.30
|
| Rate for Payer: Healthscope Whirlpool |
$262.19
|
| Rate for Payer: Mclaren Commercial |
$243.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.86
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
OP
|
$933.32
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.09 |
| Max. Negotiated Rate |
$933.32 |
| Rate for Payer: Aetna Commercial |
$839.99
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$905.32
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$723.60
|
| Rate for Payer: BCN Commercial |
$723.60
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$746.66
|
| Rate for Payer: Cash Price |
$746.66
|
| Rate for Payer: Cofinity Commercial |
$877.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$933.32
|
| Rate for Payer: Healthscope Whirlpool |
$905.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$839.99
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$793.32
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$849.32
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$662.66
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$821.32
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
IP
|
$933.32
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.32 |
| Max. Negotiated Rate |
$933.32 |
| Rate for Payer: Aetna Commercial |
$839.99
|
| Rate for Payer: ASR ASR |
$905.32
|
| Rate for Payer: BCBS Trust/PPO |
$723.60
|
| Rate for Payer: BCN Commercial |
$723.60
|
| Rate for Payer: Cash Price |
$746.66
|
| Rate for Payer: Cofinity Commercial |
$877.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.66
|
| Rate for Payer: Healthscope Commercial |
$933.32
|
| Rate for Payer: Healthscope Whirlpool |
$905.32
|
| Rate for Payer: Mclaren Commercial |
$839.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$793.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$821.32
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
IP
|
$269.89
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.92 |
| Max. Negotiated Rate |
$269.89 |
| Rate for Payer: Aetna Commercial |
$242.90
|
| Rate for Payer: ASR ASR |
$261.79
|
| Rate for Payer: BCBS Trust/PPO |
$209.25
|
| Rate for Payer: BCN Commercial |
$209.25
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cofinity Commercial |
$253.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.91
|
| Rate for Payer: Healthscope Commercial |
$269.89
|
| Rate for Payer: Healthscope Whirlpool |
$261.79
|
| Rate for Payer: Mclaren Commercial |
$242.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.50
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
OP
|
$269.89
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.29 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$242.90
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$261.79
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$209.25
|
| Rate for Payer: BCN Commercial |
$209.25
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cofinity Commercial |
$253.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$269.89
|
| Rate for Payer: Healthscope Whirlpool |
$261.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$242.90
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.41
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.36
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$168.29
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.50
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
IP
|
$762.46
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$533.72 |
| Max. Negotiated Rate |
$762.46 |
| Rate for Payer: Aetna Commercial |
$686.21
|
| Rate for Payer: ASR ASR |
$739.59
|
| Rate for Payer: BCBS Trust/PPO |
$591.14
|
| Rate for Payer: BCN Commercial |
$591.14
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$716.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Healthscope Commercial |
$762.46
|
| Rate for Payer: Healthscope Whirlpool |
$739.59
|
| Rate for Payer: Mclaren Commercial |
$686.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$670.96
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
OP
|
$762.46
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$762.46 |
| Rate for Payer: Aetna Commercial |
$686.21
|
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: ASR ASR |
$739.59
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$591.14
|
| Rate for Payer: BCN Commercial |
$591.14
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$716.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$762.46
|
| Rate for Payer: Healthscope Whirlpool |
$739.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$686.21
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$693.84
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$541.35
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$670.96
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
OP
|
$762.46
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$762.46 |
| Rate for Payer: Aetna Commercial |
$686.21
|
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: ASR ASR |
$739.59
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$591.14
|
| Rate for Payer: BCN Commercial |
$591.14
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$716.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$762.46
|
| Rate for Payer: Healthscope Whirlpool |
$739.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$686.21
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$693.84
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$541.35
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$670.96
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
IP
|
$762.46
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$533.72 |
| Max. Negotiated Rate |
$762.46 |
| Rate for Payer: Aetna Commercial |
$686.21
|
| Rate for Payer: ASR ASR |
$739.59
|
| Rate for Payer: BCBS Trust/PPO |
$591.14
|
| Rate for Payer: BCN Commercial |
$591.14
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$716.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Healthscope Commercial |
$762.46
|
| Rate for Payer: Healthscope Whirlpool |
$739.59
|
| Rate for Payer: Mclaren Commercial |
$686.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$670.96
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$722.93
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$506.05 |
| Max. Negotiated Rate |
$722.93 |
| Rate for Payer: Aetna Commercial |
$650.64
|
| Rate for Payer: ASR ASR |
$701.24
|
| Rate for Payer: BCBS Trust/PPO |
$560.49
|
| Rate for Payer: BCN Commercial |
$560.49
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cofinity Commercial |
$679.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.34
|
| Rate for Payer: Healthscope Commercial |
$722.93
|
| Rate for Payer: Healthscope Whirlpool |
$701.24
|
| Rate for Payer: Mclaren Commercial |
$650.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$614.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$636.18
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$722.93
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$289.17 |
| Max. Negotiated Rate |
$722.93 |
| Rate for Payer: Aetna Commercial |
$650.64
|
| Rate for Payer: ASR ASR |
$701.24
|
| Rate for Payer: BCBS Complete |
$289.17
|
| Rate for Payer: BCBS Trust/PPO |
$560.49
|
| Rate for Payer: BCN Commercial |
$560.49
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cofinity Commercial |
$679.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.34
|
| Rate for Payer: Healthscope Commercial |
$722.93
|
| Rate for Payer: Healthscope Whirlpool |
$701.24
|
| Rate for Payer: Mclaren Commercial |
$650.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$614.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$657.87
|
| Rate for Payer: Priority Health Narrow Network |
$513.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$636.18
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
OP
|
$502.03
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.81 |
| Max. Negotiated Rate |
$502.03 |
| Rate for Payer: Aetna Commercial |
$451.83
|
| Rate for Payer: ASR ASR |
$486.97
|
| Rate for Payer: BCBS Complete |
$200.81
|
| Rate for Payer: BCBS Trust/PPO |
$389.22
|
| Rate for Payer: BCN Commercial |
$389.22
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$471.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Healthscope Commercial |
$502.03
|
| Rate for Payer: Healthscope Whirlpool |
$486.97
|
| Rate for Payer: Mclaren Commercial |
$451.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.85
|
| Rate for Payer: Priority Health Narrow Network |
$356.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.79
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
IP
|
$502.03
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$351.42 |
| Max. Negotiated Rate |
$502.03 |
| Rate for Payer: Aetna Commercial |
$451.83
|
| Rate for Payer: ASR ASR |
$486.97
|
| Rate for Payer: BCBS Trust/PPO |
$389.22
|
| Rate for Payer: BCN Commercial |
$389.22
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$471.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Healthscope Commercial |
$502.03
|
| Rate for Payer: Healthscope Whirlpool |
$486.97
|
| Rate for Payer: Mclaren Commercial |
$451.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.79
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
IP
|
$317.95
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$222.56 |
| Max. Negotiated Rate |
$317.95 |
| Rate for Payer: Aetna Commercial |
$286.16
|
| Rate for Payer: ASR ASR |
$308.41
|
| Rate for Payer: BCBS Trust/PPO |
$246.51
|
| Rate for Payer: BCN Commercial |
$246.51
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cofinity Commercial |
$298.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.36
|
| Rate for Payer: Healthscope Commercial |
$317.95
|
| Rate for Payer: Healthscope Whirlpool |
$308.41
|
| Rate for Payer: Mclaren Commercial |
$286.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.80
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
OP
|
$317.95
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$317.95 |
| Rate for Payer: Aetna Commercial |
$286.16
|
| Rate for Payer: ASR ASR |
$308.41
|
| Rate for Payer: BCBS Complete |
$127.18
|
| Rate for Payer: BCBS Trust/PPO |
$246.51
|
| Rate for Payer: BCN Commercial |
$246.51
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cofinity Commercial |
$298.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.36
|
| Rate for Payer: Healthscope Commercial |
$317.95
|
| Rate for Payer: Healthscope Whirlpool |
$308.41
|
| Rate for Payer: Mclaren Commercial |
$286.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.33
|
| Rate for Payer: Priority Health Narrow Network |
$225.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.80
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
OP
|
$265.63
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$265.63 |
| Rate for Payer: Aetna Commercial |
$239.07
|
| Rate for Payer: ASR ASR |
$257.66
|
| Rate for Payer: BCBS Complete |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$205.94
|
| Rate for Payer: BCN Commercial |
$205.94
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$249.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Healthscope Commercial |
$265.63
|
| Rate for Payer: Healthscope Whirlpool |
$257.66
|
| Rate for Payer: Mclaren Commercial |
$239.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.72
|
| Rate for Payer: Priority Health Narrow Network |
$188.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.75
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
IP
|
$265.63
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.94 |
| Max. Negotiated Rate |
$265.63 |
| Rate for Payer: Aetna Commercial |
$239.07
|
| Rate for Payer: ASR ASR |
$257.66
|
| Rate for Payer: BCBS Trust/PPO |
$205.94
|
| Rate for Payer: BCN Commercial |
$205.94
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$249.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Healthscope Commercial |
$265.63
|
| Rate for Payer: Healthscope Whirlpool |
$257.66
|
| Rate for Payer: Mclaren Commercial |
$239.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.75
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$217.47
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.26
|
| Rate for Payer: Priority Health Narrow Network |
$199.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: BCBS Trust/PPO |
$217.47
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
