|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
OP
|
$951.99
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.50 |
| Max. Negotiated Rate |
$1,068.51 |
| Rate for Payer: Aetna Commercial |
$856.79
|
| Rate for Payer: Aetna Medicare |
$689.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: ASR ASR |
$923.43
|
| Rate for Payer: ASR Commercial |
$923.43
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$779.58
|
| Rate for Payer: BCN Commercial |
$738.08
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$761.59
|
| Rate for Payer: Cash Price |
$761.59
|
| Rate for Payer: Cofinity Commercial |
$894.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$951.99
|
| Rate for Payer: Healthscope Whirlpool |
$923.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$856.79
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.19
|
| Rate for Payer: Nomi Health Commercial |
$780.63
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$758.30
|
| Rate for Payer: PHP Medicaid |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$834.13
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$667.34
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$837.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,068.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP DNSP |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
IP
|
$951.99
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.79 |
| Max. Negotiated Rate |
$951.99 |
| Rate for Payer: Aetna Commercial |
$856.79
|
| Rate for Payer: ASR ASR |
$923.43
|
| Rate for Payer: ASR Commercial |
$923.43
|
| Rate for Payer: BCBS Trust/PPO |
$775.78
|
| Rate for Payer: BCN Commercial |
$738.08
|
| Rate for Payer: Cash Price |
$761.59
|
| Rate for Payer: Cofinity Commercial |
$894.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.59
|
| Rate for Payer: Healthscope Commercial |
$951.99
|
| Rate for Payer: Healthscope Whirlpool |
$923.43
|
| Rate for Payer: Mclaren Commercial |
$856.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.19
|
| Rate for Payer: Nomi Health Commercial |
$780.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$837.75
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
IP
|
$275.29
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.94 |
| Max. Negotiated Rate |
$275.29 |
| Rate for Payer: Aetna Commercial |
$247.76
|
| Rate for Payer: ASR ASR |
$267.03
|
| Rate for Payer: ASR Commercial |
$267.03
|
| Rate for Payer: BCBS Trust/PPO |
$224.33
|
| Rate for Payer: BCN Commercial |
$213.43
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$258.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.23
|
| Rate for Payer: Healthscope Commercial |
$275.29
|
| Rate for Payer: Healthscope Whirlpool |
$267.03
|
| Rate for Payer: Mclaren Commercial |
$247.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.00
|
| Rate for Payer: Nomi Health Commercial |
$225.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.26
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
OP
|
$275.29
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.94 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$247.76
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$267.03
|
| Rate for Payer: ASR Commercial |
$267.03
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$225.43
|
| Rate for Payer: BCN Commercial |
$213.43
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$258.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$275.29
|
| Rate for Payer: Healthscope Whirlpool |
$267.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$247.76
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.00
|
| Rate for Payer: Nomi Health Commercial |
$225.74
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.09
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$180.07
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$636.87
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$731.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$681.43
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$545.17
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Trust/PPO |
$633.76
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$731.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Trust/PPO |
$633.76
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$731.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$636.87
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$731.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$681.43
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$545.17
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$737.39
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.30 |
| Max. Negotiated Rate |
$737.39 |
| Rate for Payer: Aetna Commercial |
$663.65
|
| Rate for Payer: ASR ASR |
$715.27
|
| Rate for Payer: ASR Commercial |
$715.27
|
| Rate for Payer: BCBS Trust/PPO |
$600.90
|
| Rate for Payer: BCN Commercial |
$571.70
|
| Rate for Payer: Cash Price |
$589.91
|
| Rate for Payer: Cofinity Commercial |
$693.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.91
|
| Rate for Payer: Healthscope Commercial |
$737.39
|
| Rate for Payer: Healthscope Whirlpool |
$715.27
|
| Rate for Payer: Mclaren Commercial |
$663.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.78
|
| Rate for Payer: Nomi Health Commercial |
$604.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.90
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$737.39
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$737.39 |
| Rate for Payer: Aetna Commercial |
$663.65
|
| Rate for Payer: Aetna Medicare |
$368.70
|
| Rate for Payer: ASR ASR |
$715.27
|
| Rate for Payer: ASR Commercial |
$715.27
|
| Rate for Payer: BCBS Complete |
$294.96
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCN Commercial |
$571.70
|
| Rate for Payer: Cash Price |
$589.91
|
| Rate for Payer: Cash Price |
$589.91
|
| Rate for Payer: Cofinity Commercial |
$693.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.91
|
| Rate for Payer: Healthscope Commercial |
$737.39
|
| Rate for Payer: Healthscope Whirlpool |
$715.27
|
| Rate for Payer: Mclaren Commercial |
$663.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.78
|
| Rate for Payer: Nomi Health Commercial |
$604.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.90
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
OP
|
$512.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$512.07 |
| Rate for Payer: Aetna Commercial |
$460.86
|
| Rate for Payer: Aetna Medicare |
$256.04
|
| Rate for Payer: ASR ASR |
$496.71
|
| Rate for Payer: ASR Commercial |
$496.71
|
| Rate for Payer: BCBS Complete |
$204.83
|
| Rate for Payer: BCBS Trust/PPO |
$419.33
|
| Rate for Payer: BCN Commercial |
$397.01
|
| Rate for Payer: Cash Price |
$409.66
|
| Rate for Payer: Cash Price |
$409.66
|
| Rate for Payer: Cofinity Commercial |
$481.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.66
|
| Rate for Payer: Healthscope Commercial |
$512.07
|
| Rate for Payer: Healthscope Whirlpool |
$496.71
|
| Rate for Payer: Mclaren Commercial |
$460.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.26
|
| Rate for Payer: Nomi Health Commercial |
$419.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$450.62
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
IP
|
$512.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$332.85 |
| Max. Negotiated Rate |
$512.07 |
| Rate for Payer: Aetna Commercial |
$460.86
|
| Rate for Payer: ASR ASR |
$496.71
|
| Rate for Payer: ASR Commercial |
$496.71
|
| Rate for Payer: BCBS Trust/PPO |
$417.29
|
| Rate for Payer: BCN Commercial |
$397.01
|
| Rate for Payer: Cash Price |
$409.66
|
| Rate for Payer: Cofinity Commercial |
$481.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.66
|
| Rate for Payer: Healthscope Commercial |
$512.07
|
| Rate for Payer: Healthscope Whirlpool |
$496.71
|
| Rate for Payer: Mclaren Commercial |
$460.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.26
|
| Rate for Payer: Nomi Health Commercial |
$419.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$450.62
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
OP
|
$324.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$324.31 |
| Rate for Payer: Aetna Commercial |
$291.88
|
| Rate for Payer: Aetna Medicare |
$162.16
|
| Rate for Payer: ASR ASR |
$314.58
|
| Rate for Payer: ASR Commercial |
$314.58
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS Trust/PPO |
$265.58
|
| Rate for Payer: BCN Commercial |
$251.44
|
| Rate for Payer: Cash Price |
$259.45
|
| Rate for Payer: Cash Price |
$259.45
|
| Rate for Payer: Cofinity Commercial |
$304.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.45
|
| Rate for Payer: Healthscope Commercial |
$324.31
|
| Rate for Payer: Healthscope Whirlpool |
$314.58
|
| Rate for Payer: Mclaren Commercial |
$291.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.66
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.39
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
IP
|
$324.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$324.31 |
| Rate for Payer: Aetna Commercial |
$291.88
|
| Rate for Payer: ASR ASR |
$314.58
|
| Rate for Payer: ASR Commercial |
$314.58
|
| Rate for Payer: BCBS Trust/PPO |
$264.28
|
| Rate for Payer: BCN Commercial |
$251.44
|
| Rate for Payer: Cash Price |
$259.45
|
| Rate for Payer: Cofinity Commercial |
$304.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.45
|
| Rate for Payer: Healthscope Commercial |
$324.31
|
| Rate for Payer: Healthscope Whirlpool |
$314.58
|
| Rate for Payer: Mclaren Commercial |
$291.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.66
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.39
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
OP
|
$270.94
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$270.94 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna Medicare |
$135.47
|
| Rate for Payer: ASR ASR |
$262.81
|
| Rate for Payer: ASR Commercial |
$262.81
|
| Rate for Payer: BCBS Complete |
$108.38
|
| Rate for Payer: BCBS Trust/PPO |
$221.87
|
| Rate for Payer: BCN Commercial |
$210.06
|
| Rate for Payer: Cash Price |
$216.75
|
| Rate for Payer: Cash Price |
$216.75
|
| Rate for Payer: Cofinity Commercial |
$254.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.75
|
| Rate for Payer: Healthscope Commercial |
$270.94
|
| Rate for Payer: Healthscope Whirlpool |
$262.81
|
| Rate for Payer: Mclaren Commercial |
$243.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.30
|
| Rate for Payer: Nomi Health Commercial |
$222.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.43
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
IP
|
$270.94
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.11 |
| Max. Negotiated Rate |
$270.94 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: ASR ASR |
$262.81
|
| Rate for Payer: ASR Commercial |
$262.81
|
| Rate for Payer: BCBS Trust/PPO |
$220.79
|
| Rate for Payer: BCN Commercial |
$210.06
|
| Rate for Payer: Cash Price |
$216.75
|
| Rate for Payer: Cofinity Commercial |
$254.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.75
|
| Rate for Payer: Healthscope Commercial |
$270.94
|
| Rate for Payer: Healthscope Whirlpool |
$262.81
|
| Rate for Payer: Mclaren Commercial |
$243.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.30
|
| Rate for Payer: Nomi Health Commercial |
$222.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.43
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: ASR Commercial |
$277.53
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$221.82
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$286.11
|
| Rate for Payer: Healthscope Whirlpool |
$277.53
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.97 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: ASR Commercial |
$277.53
|
| Rate for Payer: BCBS Trust/PPO |
$233.15
|
| Rate for Payer: BCN Commercial |
$221.82
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$286.11
|
| Rate for Payer: Healthscope Whirlpool |
$277.53
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: Aetna Medicare |
$112.36
|
| Rate for Payer: ASR ASR |
$217.99
|
| Rate for Payer: ASR Commercial |
$217.99
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$184.03
|
| Rate for Payer: BCN Commercial |
$174.23
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Healthscope Whirlpool |
$217.99
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: ASR ASR |
$217.99
|
| Rate for Payer: ASR Commercial |
$217.99
|
| Rate for Payer: BCBS Trust/PPO |
$183.13
|
| Rate for Payer: BCN Commercial |
$174.23
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Healthscope Whirlpool |
$217.99
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: Aetna Medicare |
$112.36
|
| Rate for Payer: ASR ASR |
$217.99
|
| Rate for Payer: ASR Commercial |
$217.99
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$184.03
|
| Rate for Payer: BCN Commercial |
$174.23
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Healthscope Whirlpool |
$217.99
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: ASR ASR |
$217.99
|
| Rate for Payer: ASR Commercial |
$217.99
|
| Rate for Payer: BCBS Trust/PPO |
$183.13
|
| Rate for Payer: BCN Commercial |
$174.23
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Healthscope Whirlpool |
$217.99
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
IP
|
$155.62
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$155.62 |
| Rate for Payer: Aetna Commercial |
$140.06
|
| Rate for Payer: ASR ASR |
$150.95
|
| Rate for Payer: ASR Commercial |
$150.95
|
| Rate for Payer: BCBS Trust/PPO |
$126.81
|
| Rate for Payer: BCN Commercial |
$120.65
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cofinity Commercial |
$146.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.50
|
| Rate for Payer: Healthscope Commercial |
$155.62
|
| Rate for Payer: Healthscope Whirlpool |
$150.95
|
| Rate for Payer: Mclaren Commercial |
$140.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.28
|
| Rate for Payer: Nomi Health Commercial |
$127.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.95
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
OP
|
$155.62
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$155.62 |
| Rate for Payer: Aetna Commercial |
$140.06
|
| Rate for Payer: Aetna Medicare |
$77.81
|
| Rate for Payer: ASR ASR |
$150.95
|
| Rate for Payer: ASR Commercial |
$150.95
|
| Rate for Payer: BCBS Complete |
$62.25
|
| Rate for Payer: BCBS Trust/PPO |
$127.44
|
| Rate for Payer: BCN Commercial |
$120.65
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cofinity Commercial |
$146.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.50
|
| Rate for Payer: Healthscope Commercial |
$155.62
|
| Rate for Payer: Healthscope Whirlpool |
$150.95
|
| Rate for Payer: Mclaren Commercial |
$140.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.28
|
| Rate for Payer: Nomi Health Commercial |
$127.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.95
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
IP
|
$204.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.65 |
| Max. Negotiated Rate |
$204.07 |
| Rate for Payer: Aetna Commercial |
$183.66
|
| Rate for Payer: ASR ASR |
$197.95
|
| Rate for Payer: ASR Commercial |
$197.95
|
| Rate for Payer: BCBS Trust/PPO |
$166.30
|
| Rate for Payer: BCN Commercial |
$158.22
|
| Rate for Payer: Cash Price |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$191.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.26
|
| Rate for Payer: Healthscope Commercial |
$204.07
|
| Rate for Payer: Healthscope Whirlpool |
$197.95
|
| Rate for Payer: Mclaren Commercial |
$183.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.46
|
| Rate for Payer: Nomi Health Commercial |
$167.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.58
|
|
