|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$215.97
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$194.37
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$209.49
|
| Rate for Payer: ASR Commercial |
$209.49
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$176.86
|
| Rate for Payer: BCN Commercial |
$167.44
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cofinity Commercial |
$203.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$215.97
|
| Rate for Payer: Healthscope Whirlpool |
$209.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$194.37
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.57
|
| Rate for Payer: Nomi Health Commercial |
$177.10
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
IP
|
$215.97
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.38 |
| Max. Negotiated Rate |
$215.97 |
| Rate for Payer: Aetna Commercial |
$194.37
|
| Rate for Payer: ASR ASR |
$209.49
|
| Rate for Payer: ASR Commercial |
$209.49
|
| Rate for Payer: BCBS Trust/PPO |
$175.99
|
| Rate for Payer: BCN Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cofinity Commercial |
$203.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.78
|
| Rate for Payer: Healthscope Commercial |
$215.97
|
| Rate for Payer: Healthscope Whirlpool |
$209.49
|
| Rate for Payer: Mclaren Commercial |
$194.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.57
|
| Rate for Payer: Nomi Health Commercial |
$177.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.05
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$616.44
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$616.44 |
| Rate for Payer: Aetna Commercial |
$554.80
|
| Rate for Payer: Aetna Medicare |
$308.22
|
| Rate for Payer: ASR ASR |
$597.95
|
| Rate for Payer: ASR Commercial |
$597.95
|
| Rate for Payer: BCBS Complete |
$246.58
|
| Rate for Payer: BCBS Trust/PPO |
$504.80
|
| Rate for Payer: BCN Commercial |
$477.93
|
| Rate for Payer: Cash Price |
$493.15
|
| Rate for Payer: Cash Price |
$493.15
|
| Rate for Payer: Cofinity Commercial |
$579.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.15
|
| Rate for Payer: Healthscope Commercial |
$616.44
|
| Rate for Payer: Healthscope Whirlpool |
$597.95
|
| Rate for Payer: Mclaren Commercial |
$554.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.97
|
| Rate for Payer: Nomi Health Commercial |
$505.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.15
|
| Rate for Payer: Priority Health Narrow Network |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.47
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$616.44
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$400.69 |
| Max. Negotiated Rate |
$616.44 |
| Rate for Payer: Aetna Commercial |
$554.80
|
| Rate for Payer: ASR ASR |
$597.95
|
| Rate for Payer: ASR Commercial |
$597.95
|
| Rate for Payer: BCBS Trust/PPO |
$502.34
|
| Rate for Payer: BCN Commercial |
$477.93
|
| Rate for Payer: Cash Price |
$493.15
|
| Rate for Payer: Cofinity Commercial |
$579.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.15
|
| Rate for Payer: Healthscope Commercial |
$616.44
|
| Rate for Payer: Healthscope Whirlpool |
$597.95
|
| Rate for Payer: Mclaren Commercial |
$554.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.97
|
| Rate for Payer: Nomi Health Commercial |
$505.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.47
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$328.97
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.83 |
| Max. Negotiated Rate |
$328.97 |
| Rate for Payer: Aetna Commercial |
$296.07
|
| Rate for Payer: ASR ASR |
$319.10
|
| Rate for Payer: ASR Commercial |
$319.10
|
| Rate for Payer: BCBS Trust/PPO |
$268.08
|
| Rate for Payer: BCN Commercial |
$255.05
|
| Rate for Payer: Cash Price |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$309.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.18
|
| Rate for Payer: Healthscope Commercial |
$328.97
|
| Rate for Payer: Healthscope Whirlpool |
$319.10
|
| Rate for Payer: Mclaren Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.62
|
| Rate for Payer: Nomi Health Commercial |
$269.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.49
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$328.97
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$328.97 |
| Rate for Payer: Aetna Commercial |
$296.07
|
| Rate for Payer: Aetna Medicare |
$164.48
|
| Rate for Payer: ASR ASR |
$319.10
|
| Rate for Payer: ASR Commercial |
$319.10
|
| Rate for Payer: BCBS Complete |
$131.59
|
| Rate for Payer: BCBS Trust/PPO |
$269.39
|
| Rate for Payer: BCN Commercial |
$255.05
|
| Rate for Payer: Cash Price |
$263.18
|
| Rate for Payer: Cash Price |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$309.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.18
|
| Rate for Payer: Healthscope Commercial |
$328.97
|
| Rate for Payer: Healthscope Whirlpool |
$319.10
|
| Rate for Payer: Mclaren Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.62
|
| Rate for Payer: Nomi Health Commercial |
$269.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.15
|
| Rate for Payer: Priority Health Narrow Network |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.49
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.77 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: ASR ASR |
$299.61
|
| Rate for Payer: ASR Commercial |
$299.61
|
| Rate for Payer: BCBS Trust/PPO |
$251.71
|
| Rate for Payer: BCN Commercial |
$239.47
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$290.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Healthscope Whirlpool |
$299.61
|
| Rate for Payer: Mclaren Commercial |
$277.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: Nomi Health Commercial |
$253.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.81
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Medicare |
$154.44
|
| Rate for Payer: ASR ASR |
$299.61
|
| Rate for Payer: ASR Commercial |
$299.61
|
| Rate for Payer: BCBS Complete |
$123.55
|
| Rate for Payer: BCBS Trust/PPO |
$252.94
|
| Rate for Payer: BCN Commercial |
$239.47
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$290.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Healthscope Whirlpool |
$299.61
|
| Rate for Payer: Mclaren Commercial |
$277.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: Nomi Health Commercial |
$253.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.15
|
| Rate for Payer: Priority Health Narrow Network |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.81
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.72 |
| Max. Negotiated Rate |
$298.03 |
| Rate for Payer: Aetna Commercial |
$268.23
|
| Rate for Payer: ASR ASR |
$289.09
|
| Rate for Payer: ASR Commercial |
$289.09
|
| Rate for Payer: BCBS Trust/PPO |
$242.86
|
| Rate for Payer: BCN Commercial |
$231.06
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$280.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Healthscope Commercial |
$298.03
|
| Rate for Payer: Healthscope Whirlpool |
$289.09
|
| Rate for Payer: Mclaren Commercial |
$268.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.27
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$298.03 |
| Rate for Payer: Aetna Commercial |
$268.23
|
| Rate for Payer: Aetna Medicare |
$149.02
|
| Rate for Payer: ASR ASR |
$289.09
|
| Rate for Payer: ASR Commercial |
$289.09
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS Trust/PPO |
$244.06
|
| Rate for Payer: BCN Commercial |
$231.06
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$280.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Healthscope Commercial |
$298.03
|
| Rate for Payer: Healthscope Whirlpool |
$289.09
|
| Rate for Payer: Mclaren Commercial |
$268.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.15
|
| Rate for Payer: Priority Health Narrow Network |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.27
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.57 |
| Max. Negotiated Rate |
$231.65 |
| Rate for Payer: Aetna Commercial |
$208.48
|
| Rate for Payer: ASR ASR |
$224.70
|
| Rate for Payer: ASR Commercial |
$224.70
|
| Rate for Payer: BCBS Trust/PPO |
$188.77
|
| Rate for Payer: BCN Commercial |
$179.60
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$217.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$231.65
|
| Rate for Payer: Healthscope Whirlpool |
$224.70
|
| Rate for Payer: Mclaren Commercial |
$208.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Nomi Health Commercial |
$189.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.85
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$231.65 |
| Rate for Payer: Aetna Commercial |
$208.48
|
| Rate for Payer: Aetna Medicare |
$115.82
|
| Rate for Payer: ASR ASR |
$224.70
|
| Rate for Payer: ASR Commercial |
$224.70
|
| Rate for Payer: BCBS Complete |
$92.66
|
| Rate for Payer: BCBS Trust/PPO |
$189.70
|
| Rate for Payer: BCN Commercial |
$179.60
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$217.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$231.65
|
| Rate for Payer: Healthscope Whirlpool |
$224.70
|
| Rate for Payer: Mclaren Commercial |
$208.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Nomi Health Commercial |
$189.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.15
|
| Rate for Payer: Priority Health Narrow Network |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.85
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$162.57 |
| Rate for Payer: Aetna Commercial |
$146.31
|
| Rate for Payer: Aetna Medicare |
$81.28
|
| Rate for Payer: ASR ASR |
$157.69
|
| Rate for Payer: ASR Commercial |
$157.69
|
| Rate for Payer: BCBS Complete |
$65.03
|
| Rate for Payer: BCBS Trust/PPO |
$133.13
|
| Rate for Payer: BCN Commercial |
$126.04
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$152.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$162.57
|
| Rate for Payer: Healthscope Whirlpool |
$157.69
|
| Rate for Payer: Mclaren Commercial |
$146.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.15
|
| Rate for Payer: Priority Health Narrow Network |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.06
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.67 |
| Max. Negotiated Rate |
$162.57 |
| Rate for Payer: Aetna Commercial |
$146.31
|
| Rate for Payer: ASR ASR |
$157.69
|
| Rate for Payer: ASR Commercial |
$157.69
|
| Rate for Payer: BCBS Trust/PPO |
$132.48
|
| Rate for Payer: BCN Commercial |
$126.04
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$152.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$162.57
|
| Rate for Payer: Healthscope Whirlpool |
$157.69
|
| Rate for Payer: Mclaren Commercial |
$146.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.06
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
IP
|
$143.93
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.55 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna Commercial |
$129.54
|
| Rate for Payer: ASR ASR |
$139.61
|
| Rate for Payer: ASR Commercial |
$139.61
|
| Rate for Payer: BCBS Trust/PPO |
$117.29
|
| Rate for Payer: BCN Commercial |
$111.59
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$135.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.14
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: Healthscope Whirlpool |
$139.61
|
| Rate for Payer: Mclaren Commercial |
$129.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.34
|
| Rate for Payer: Nomi Health Commercial |
$118.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.66
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$143.93
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.57 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna Commercial |
$129.54
|
| Rate for Payer: Aetna Medicare |
$71.96
|
| Rate for Payer: ASR ASR |
$139.61
|
| Rate for Payer: ASR Commercial |
$139.61
|
| Rate for Payer: BCBS Complete |
$57.57
|
| Rate for Payer: BCBS Trust/PPO |
$117.86
|
| Rate for Payer: BCN Commercial |
$111.59
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$135.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.14
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: Healthscope Whirlpool |
$139.61
|
| Rate for Payer: Mclaren Commercial |
$129.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.34
|
| Rate for Payer: Nomi Health Commercial |
$118.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.15
|
| Rate for Payer: Priority Health Narrow Network |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.66
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
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 NUT ALLERGEN PANEL
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
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 NVU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$118.81
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC OAK IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
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 OAK IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
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 OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
IP
|
$54.19
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: ASR ASR |
$52.56
|
| Rate for Payer: ASR Commercial |
$52.56
|
| Rate for Payer: BCBS Trust/PPO |
$44.16
|
| Rate for Payer: BCN Commercial |
$42.01
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$50.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Whirlpool |
$52.56
|
| Rate for Payer: Mclaren Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.69
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
OP
|
$54.19
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: Aetna Medicare |
$27.10
|
| Rate for Payer: ASR ASR |
$52.56
|
| Rate for Payer: ASR Commercial |
$52.56
|
| Rate for Payer: BCBS Complete |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$44.38
|
| Rate for Payer: BCN Commercial |
$42.01
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$50.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Whirlpool |
$52.56
|
| Rate for Payer: Mclaren Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.48
|
| Rate for Payer: Priority Health Narrow Network |
$37.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.69
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
OP
|
$31.92
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$31.92 |
| Rate for Payer: Aetna Commercial |
$28.73
|
| Rate for Payer: Aetna Medicare |
$15.96
|
| Rate for Payer: ASR ASR |
$30.96
|
| Rate for Payer: ASR Commercial |
$30.96
|
| Rate for Payer: BCBS Complete |
$12.77
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| Rate for Payer: BCN Commercial |
$24.75
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$30.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Healthscope Commercial |
$31.92
|
| Rate for Payer: Healthscope Whirlpool |
$30.96
|
| Rate for Payer: Mclaren Commercial |
$28.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Nomi Health Commercial |
$26.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.46
|
| Rate for Payer: Priority Health Narrow Network |
$9.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.09
|
|
