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Service Code NDC 00338035703
Hospital Charge Code 4749
Hospital Revenue Code 250
Min. Negotiated Rate $39.32
Max. Negotiated Rate $98.31
Rate for Payer: Aetna Commercial $88.48
Rate for Payer: Aetna Medicare $49.16
Rate for Payer: ASR ASR $95.36
Rate for Payer: ASR Commercial $95.36
Rate for Payer: BCBS Complete $39.32
Rate for Payer: BCBS Trust/PPO $80.51
Rate for Payer: BCN Commercial $76.22
Rate for Payer: Cash Price $78.65
Rate for Payer: Cofinity Commercial $92.41
Rate for Payer: Encore Health Key Benefits Commercial $78.65
Rate for Payer: Healthscope Commercial $98.31
Rate for Payer: Healthscope Whirlpool $95.36
Rate for Payer: Mclaren Commercial $88.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial $83.56
Rate for Payer: Nomi Health Commercial $80.61
Rate for Payer: Priority Health Cigna Priority Health $63.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network $86.14
Rate for Payer: Priority Health Narrow Network $68.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core $86.51
Service Code NDC 00990771502
Hospital Charge Code 4749
Hospital Revenue Code 250
Min. Negotiated Rate $61.70
Max. Negotiated Rate $94.92
Rate for Payer: Aetna Commercial $85.43
Rate for Payer: ASR ASR $92.07
Rate for Payer: ASR Commercial $92.07
Rate for Payer: BCBS Trust/PPO $77.35
Rate for Payer: BCN Commercial $73.59
Rate for Payer: Cash Price $75.94
Rate for Payer: Cofinity Commercial $89.22
Rate for Payer: Encore Health Key Benefits Commercial $75.94
Rate for Payer: Healthscope Commercial $94.92
Rate for Payer: Healthscope Whirlpool $92.07
Rate for Payer: Mclaren Commercial $85.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial $80.68
Rate for Payer: Nomi Health Commercial $77.83
Rate for Payer: Priority Health Cigna Priority Health $61.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core $83.53
Service Code NDC 00990771513
Hospital Charge Code 4749
Hospital Revenue Code 250
Min. Negotiated Rate $42.04
Max. Negotiated Rate $105.09
Rate for Payer: Aetna Commercial $94.58
Rate for Payer: Aetna Medicare $52.54
Rate for Payer: ASR ASR $101.94
Rate for Payer: ASR Commercial $101.94
Rate for Payer: BCBS Complete $42.04
Rate for Payer: BCBS Trust/PPO $86.06
Rate for Payer: BCN Commercial $81.48
Rate for Payer: Cash Price $84.07
Rate for Payer: Cofinity Commercial $98.78
Rate for Payer: Encore Health Key Benefits Commercial $84.07
Rate for Payer: Healthscope Commercial $105.09
Rate for Payer: Healthscope Whirlpool $101.94
Rate for Payer: Mclaren Commercial $94.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial $89.33
Rate for Payer: Nomi Health Commercial $86.17
Rate for Payer: Priority Health Cigna Priority Health $68.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network $92.08
Rate for Payer: Priority Health Narrow Network $73.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core $92.48
Service Code NDC 00990771513
Hospital Charge Code 4749
Hospital Revenue Code 250
Min. Negotiated Rate $68.31
Max. Negotiated Rate $105.09
Rate for Payer: Aetna Commercial $94.58
Rate for Payer: ASR ASR $101.94
Rate for Payer: ASR Commercial $101.94
Rate for Payer: BCBS Trust/PPO $85.64
Rate for Payer: BCN Commercial $81.48
Rate for Payer: Cash Price $84.07
Rate for Payer: Cofinity Commercial $98.78
Rate for Payer: Encore Health Key Benefits Commercial $84.07
Rate for Payer: Healthscope Commercial $105.09
Rate for Payer: Healthscope Whirlpool $101.94
Rate for Payer: Mclaren Commercial $94.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial $89.33
Rate for Payer: Nomi Health Commercial $86.17
Rate for Payer: Priority Health Cigna Priority Health $68.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core $92.48
Service Code NDC 00990771512
Hospital Charge Code 4749
Hospital Revenue Code 250
Min. Negotiated Rate $37.97
Max. Negotiated Rate $94.92
Rate for Payer: Aetna Commercial $85.43
Rate for Payer: Aetna Medicare $47.46
Rate for Payer: ASR ASR $92.07
Rate for Payer: ASR Commercial $92.07
Rate for Payer: BCBS Complete $37.97
Rate for Payer: BCBS Trust/PPO $77.73
Rate for Payer: BCN Commercial $73.59
Rate for Payer: Cash Price $75.94
Rate for Payer: Cofinity Commercial $89.22
Rate for Payer: Encore Health Key Benefits Commercial $75.94
Rate for Payer: Healthscope Commercial $94.92
Rate for Payer: Healthscope Whirlpool $92.07
Rate for Payer: Mclaren Commercial $85.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial $80.68
Rate for Payer: Nomi Health Commercial $77.83
Rate for Payer: Priority Health Cigna Priority Health $61.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network $83.17
Rate for Payer: Priority Health Narrow Network $66.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core $83.53
Service Code NDC 00990771502
Hospital Charge Code 4749
Hospital Revenue Code 250
Min. Negotiated Rate $37.97
Max. Negotiated Rate $94.92
Rate for Payer: Aetna Commercial $85.43
Rate for Payer: Aetna Medicare $47.46
Rate for Payer: ASR ASR $92.07
Rate for Payer: ASR Commercial $92.07
Rate for Payer: BCBS Complete $37.97
Rate for Payer: BCBS Trust/PPO $77.73
Rate for Payer: BCN Commercial $73.59
Rate for Payer: Cash Price $75.94
Rate for Payer: Cofinity Commercial $89.22
Rate for Payer: Encore Health Key Benefits Commercial $75.94
Rate for Payer: Healthscope Commercial $94.92
Rate for Payer: Healthscope Whirlpool $92.07
Rate for Payer: Mclaren Commercial $85.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial $80.68
Rate for Payer: Nomi Health Commercial $77.83
Rate for Payer: Priority Health Cigna Priority Health $61.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network $83.17
Rate for Payer: Priority Health Narrow Network $66.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core $83.53
Service Code NDC 00338035703
Hospital Charge Code 4749
Hospital Revenue Code 250
Min. Negotiated Rate $63.90
Max. Negotiated Rate $98.31
Rate for Payer: Aetna Commercial $88.48
Rate for Payer: ASR ASR $95.36
Rate for Payer: ASR Commercial $95.36
Rate for Payer: BCBS Trust/PPO $80.11
Rate for Payer: BCN Commercial $76.22
Rate for Payer: Cash Price $78.65
Rate for Payer: Cofinity Commercial $92.41
Rate for Payer: Encore Health Key Benefits Commercial $78.65
Rate for Payer: Healthscope Commercial $98.31
Rate for Payer: Healthscope Whirlpool $95.36
Rate for Payer: Mclaren Commercial $88.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial $83.56
Rate for Payer: Nomi Health Commercial $80.61
Rate for Payer: Priority Health Cigna Priority Health $63.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core $86.51
Service Code NDC 00990771512
Hospital Charge Code 4749
Hospital Revenue Code 250
Min. Negotiated Rate $61.70
Max. Negotiated Rate $94.92
Rate for Payer: Aetna Commercial $85.43
Rate for Payer: ASR ASR $92.07
Rate for Payer: ASR Commercial $92.07
Rate for Payer: BCBS Trust/PPO $77.35
Rate for Payer: BCN Commercial $73.59
Rate for Payer: Cash Price $75.94
Rate for Payer: Cofinity Commercial $89.22
Rate for Payer: Encore Health Key Benefits Commercial $75.94
Rate for Payer: Healthscope Commercial $94.92
Rate for Payer: Healthscope Whirlpool $92.07
Rate for Payer: Mclaren Commercial $85.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial $80.68
Rate for Payer: Nomi Health Commercial $77.83
Rate for Payer: Priority Health Cigna Priority Health $61.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core $83.53
Service Code NDC 50268052315
Hospital Charge Code 12025
Hospital Revenue Code 637
Min. Negotiated Rate $56.26
Max. Negotiated Rate $140.64
Rate for Payer: Aetna Commercial $126.58
Rate for Payer: Aetna Medicare $70.32
Rate for Payer: ASR ASR $136.42
Rate for Payer: ASR Commercial $136.42
Rate for Payer: BCBS Complete $56.26
Rate for Payer: BCBS Trust/PPO $115.17
Rate for Payer: BCN Commercial $109.04
Rate for Payer: Cash Price $112.51
Rate for Payer: Cofinity Commercial $132.20
Rate for Payer: Encore Health Key Benefits Commercial $112.51
Rate for Payer: Healthscope Commercial $140.64
Rate for Payer: Healthscope Whirlpool $136.42
Rate for Payer: Mclaren Commercial $126.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial $119.54
Rate for Payer: Nomi Health Commercial $115.32
Rate for Payer: Priority Health Cigna Priority Health $91.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network $123.23
Rate for Payer: Priority Health Narrow Network $98.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core $123.76
Service Code NDC 50268052311
Hospital Charge Code 12025
Hospital Revenue Code 637
Min. Negotiated Rate $1.12
Max. Negotiated Rate $2.81
Rate for Payer: Aetna Commercial $2.53
Rate for Payer: Aetna Medicare $1.40
Rate for Payer: ASR ASR $2.73
Rate for Payer: ASR Commercial $2.73
Rate for Payer: BCBS Complete $1.12
Rate for Payer: BCBS Trust/PPO $2.30
Rate for Payer: BCN Commercial $2.18
Rate for Payer: Cash Price $2.25
Rate for Payer: Cofinity Commercial $2.64
Rate for Payer: Encore Health Key Benefits Commercial $2.25
Rate for Payer: Healthscope Commercial $2.81
Rate for Payer: Healthscope Whirlpool $2.73
Rate for Payer: Mclaren Commercial $2.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial $2.39
Rate for Payer: Nomi Health Commercial $2.30
Rate for Payer: Priority Health Cigna Priority Health $1.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network $2.46
Rate for Payer: Priority Health Narrow Network $1.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core $2.47
Service Code NDC 00904651761
Hospital Charge Code 12025
Hospital Revenue Code 637
Min. Negotiated Rate $247.62
Max. Negotiated Rate $380.95
Rate for Payer: Aetna Commercial $342.86
Rate for Payer: ASR ASR $369.52
Rate for Payer: ASR Commercial $369.52
Rate for Payer: BCBS Trust/PPO $310.44
Rate for Payer: BCN Commercial $295.35
Rate for Payer: Cash Price $304.76
Rate for Payer: Cofinity Commercial $358.09
Rate for Payer: Encore Health Key Benefits Commercial $304.76
Rate for Payer: Healthscope Commercial $380.95
Rate for Payer: Healthscope Whirlpool $369.52
Rate for Payer: Mclaren Commercial $342.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial $323.81
Rate for Payer: Nomi Health Commercial $312.38
Rate for Payer: Priority Health Cigna Priority Health $247.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core $335.24
Service Code NDC 50268052311
Hospital Charge Code 12025
Hospital Revenue Code 637
Min. Negotiated Rate $1.83
Max. Negotiated Rate $2.81
Rate for Payer: Aetna Commercial $2.53
Rate for Payer: ASR ASR $2.73
Rate for Payer: ASR Commercial $2.73
Rate for Payer: BCBS Trust/PPO $2.29
Rate for Payer: BCN Commercial $2.18
Rate for Payer: Cash Price $2.25
Rate for Payer: Cofinity Commercial $2.64
Rate for Payer: Encore Health Key Benefits Commercial $2.25
Rate for Payer: Healthscope Commercial $2.81
Rate for Payer: Healthscope Whirlpool $2.73
Rate for Payer: Mclaren Commercial $2.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial $2.39
Rate for Payer: Nomi Health Commercial $2.30
Rate for Payer: Priority Health Cigna Priority Health $1.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core $2.47
Service Code NDC 50268052315
Hospital Charge Code 12025
Hospital Revenue Code 637
Min. Negotiated Rate $91.42
Max. Negotiated Rate $140.64
Rate for Payer: Aetna Commercial $126.58
Rate for Payer: ASR ASR $136.42
Rate for Payer: ASR Commercial $136.42
Rate for Payer: BCBS Trust/PPO $114.61
Rate for Payer: BCN Commercial $109.04
Rate for Payer: Cash Price $112.51
Rate for Payer: Cofinity Commercial $132.20
Rate for Payer: Encore Health Key Benefits Commercial $112.51
Rate for Payer: Healthscope Commercial $140.64
Rate for Payer: Healthscope Whirlpool $136.42
Rate for Payer: Mclaren Commercial $126.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial $119.54
Rate for Payer: Nomi Health Commercial $115.32
Rate for Payer: Priority Health Cigna Priority Health $91.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core $123.76
Service Code NDC 00904737661
Hospital Charge Code 12025
Hospital Revenue Code 637
Min. Negotiated Rate $254.41
Max. Negotiated Rate $391.40
Rate for Payer: Aetna Commercial $352.26
Rate for Payer: ASR ASR $379.66
Rate for Payer: ASR Commercial $379.66
Rate for Payer: BCBS Trust/PPO $318.95
Rate for Payer: BCN Commercial $303.45
Rate for Payer: Cash Price $313.12
Rate for Payer: Cofinity Commercial $367.92
Rate for Payer: Encore Health Key Benefits Commercial $313.12
Rate for Payer: Healthscope Commercial $391.40
Rate for Payer: Healthscope Whirlpool $379.66
Rate for Payer: Mclaren Commercial $352.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial $332.69
Rate for Payer: Nomi Health Commercial $320.95
Rate for Payer: Priority Health Cigna Priority Health $254.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core $344.43
Service Code NDC 00904651761
Hospital Charge Code 12025
Hospital Revenue Code 637
Min. Negotiated Rate $152.38
Max. Negotiated Rate $380.95
Rate for Payer: Aetna Commercial $342.86
Rate for Payer: Aetna Medicare $190.48
Rate for Payer: ASR ASR $369.52
Rate for Payer: ASR Commercial $369.52
Rate for Payer: BCBS Complete $152.38
Rate for Payer: BCBS Trust/PPO $311.96
Rate for Payer: BCN Commercial $295.35
Rate for Payer: Cash Price $304.76
Rate for Payer: Cofinity Commercial $358.09
Rate for Payer: Encore Health Key Benefits Commercial $304.76
Rate for Payer: Healthscope Commercial $380.95
Rate for Payer: Healthscope Whirlpool $369.52
Rate for Payer: Mclaren Commercial $342.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial $323.81
Rate for Payer: Nomi Health Commercial $312.38
Rate for Payer: Priority Health Cigna Priority Health $247.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network $333.79
Rate for Payer: Priority Health Narrow Network $267.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core $335.24
Service Code NDC 00904737661
Hospital Charge Code 12025
Hospital Revenue Code 637
Min. Negotiated Rate $156.56
Max. Negotiated Rate $391.40
Rate for Payer: Aetna Commercial $352.26
Rate for Payer: Aetna Medicare $195.70
Rate for Payer: ASR ASR $379.66
Rate for Payer: ASR Commercial $379.66
Rate for Payer: BCBS Complete $156.56
Rate for Payer: BCBS Trust/PPO $320.52
Rate for Payer: BCN Commercial $303.45
Rate for Payer: Cash Price $313.12
Rate for Payer: Cofinity Commercial $367.92
Rate for Payer: Encore Health Key Benefits Commercial $313.12
Rate for Payer: Healthscope Commercial $391.40
Rate for Payer: Healthscope Whirlpool $379.66
Rate for Payer: Mclaren Commercial $352.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial $332.69
Rate for Payer: Nomi Health Commercial $320.95
Rate for Payer: Priority Health Cigna Priority Health $254.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network $342.94
Rate for Payer: Priority Health Narrow Network $274.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core $344.43
Service Code HCPCS 97602
Hospital Charge Code 300255
Hospital Revenue Code 636
Min. Negotiated Rate $568.75
Max. Negotiated Rate $875.00
Rate for Payer: Aetna Commercial $787.50
Rate for Payer: ASR ASR $848.75
Rate for Payer: ASR Commercial $848.75
Rate for Payer: BCBS Trust/PPO $713.04
Rate for Payer: BCN Commercial $678.39
Rate for Payer: Cash Price $700.00
Rate for Payer: Cofinity Commercial $822.50
Rate for Payer: Encore Health Key Benefits Commercial $700.00
Rate for Payer: Healthscope Commercial $875.00
Rate for Payer: Healthscope Whirlpool $848.75
Rate for Payer: Mclaren Commercial $787.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial $743.75
Rate for Payer: Nomi Health Commercial $717.50
Rate for Payer: Priority Health Cigna Priority Health $568.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core $770.00
Service Code HCPCS 97602
Hospital Charge Code 300255
Hospital Revenue Code 636
Min. Negotiated Rate $104.35
Max. Negotiated Rate $875.00
Rate for Payer: Aetna Commercial $787.50
Rate for Payer: Aetna Medicare $194.68
Rate for Payer: Allen County Amish Medical Aid Commercial $243.35
Rate for Payer: Amish Plain Church Group Commercial $243.35
Rate for Payer: ASR ASR $848.75
Rate for Payer: ASR Commercial $848.75
Rate for Payer: BCBS Complete $109.57
Rate for Payer: BCBS MAPPO $194.68
Rate for Payer: BCBS Trust/PPO $716.54
Rate for Payer: BCN Commercial $678.39
Rate for Payer: BCN Medicare Advantage $194.68
Rate for Payer: Cash Price $700.00
Rate for Payer: Cash Price $700.00
Rate for Payer: Cofinity Commercial $822.50
Rate for Payer: Encore Health Key Benefits Commercial $700.00
Rate for Payer: Health Alliance Plan Medicare Advantage $194.68
Rate for Payer: Healthscope Commercial $875.00
Rate for Payer: Healthscope Whirlpool $848.75
Rate for Payer: Humana Choice PPO Medicare $194.68
Rate for Payer: Mclaren Commercial $787.50
Rate for Payer: Mclaren Medicaid $104.35
Rate for Payer: Mclaren Medicare $194.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage $204.41
Rate for Payer: Meridian Medicaid $109.57
Rate for Payer: MI Amish Medical Board Commercial $223.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial $743.75
Rate for Payer: Nomi Health Commercial $717.50
Rate for Payer: PACE Medicare $184.95
Rate for Payer: PACE SWMI $194.68
Rate for Payer: PHP Commercial $214.15
Rate for Payer: PHP Medicaid $104.35
Rate for Payer: PHP Medicare Advantage $194.68
Rate for Payer: Priority Health Choice Medicaid $104.35
Rate for Payer: Priority Health Cigna Priority Health $568.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network $137.25
Rate for Payer: Priority Health Medicare $194.68
Rate for Payer: Priority Health Narrow Network $109.80
Rate for Payer: Railroad Medicare Medicare $194.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core $770.00
Rate for Payer: UHC Dual Complete DSNP $194.68
Rate for Payer: UHC Exchange $301.75
Rate for Payer: UHC Medicare Advantage $194.68
Rate for Payer: UHCCP DNSP $194.68
Rate for Payer: UHCCP Medicaid $104.35
Rate for Payer: VA VA $194.68
Service Code HCPCS J1050
Hospital Charge Code 19736
Hospital Revenue Code 636
Min. Negotiated Rate $71.14
Max. Negotiated Rate $109.44
Rate for Payer: Aetna Commercial $98.50
Rate for Payer: Aetna Commercial $163.94
Rate for Payer: Aetna Commercial $163.94
Rate for Payer: Aetna Commercial $98.57
Rate for Payer: Aetna Commercial $90.87
Rate for Payer: ASR ASR $176.70
Rate for Payer: ASR ASR $176.69
Rate for Payer: ASR ASR $106.23
Rate for Payer: ASR ASR $106.16
Rate for Payer: ASR ASR $97.94
Rate for Payer: ASR Commercial $106.23
Rate for Payer: ASR Commercial $176.70
Rate for Payer: ASR Commercial $176.69
Rate for Payer: ASR Commercial $106.16
Rate for Payer: ASR Commercial $97.94
Rate for Payer: BCBS Trust/PPO $148.44
Rate for Payer: BCBS Trust/PPO $82.28
Rate for Payer: BCBS Trust/PPO $89.18
Rate for Payer: BCBS Trust/PPO $148.43
Rate for Payer: BCBS Trust/PPO $89.25
Rate for Payer: BCN Commercial $84.85
Rate for Payer: BCN Commercial $141.23
Rate for Payer: BCN Commercial $78.28
Rate for Payer: BCN Commercial $84.91
Rate for Payer: BCN Commercial $141.22
Rate for Payer: Cash Price $87.56
Rate for Payer: Cash Price $87.61
Rate for Payer: Cash Price $145.72
Rate for Payer: Cash Price $145.73
Rate for Payer: Cash Price $80.78
Rate for Payer: Cofinity Commercial $102.87
Rate for Payer: Cofinity Commercial $102.95
Rate for Payer: Cofinity Commercial $94.91
Rate for Payer: Cofinity Commercial $171.22
Rate for Payer: Cofinity Commercial $171.23
Rate for Payer: Encore Health Key Benefits Commercial $145.72
Rate for Payer: Encore Health Key Benefits Commercial $145.73
Rate for Payer: Encore Health Key Benefits Commercial $87.62
Rate for Payer: Encore Health Key Benefits Commercial $80.78
Rate for Payer: Encore Health Key Benefits Commercial $87.55
Rate for Payer: Healthscope Commercial $109.52
Rate for Payer: Healthscope Commercial $182.15
Rate for Payer: Healthscope Commercial $109.44
Rate for Payer: Healthscope Commercial $100.97
Rate for Payer: Healthscope Commercial $182.16
Rate for Payer: Healthscope Whirlpool $176.70
Rate for Payer: Healthscope Whirlpool $97.94
Rate for Payer: Healthscope Whirlpool $106.23
Rate for Payer: Healthscope Whirlpool $106.16
Rate for Payer: Healthscope Whirlpool $176.69
Rate for Payer: Mclaren Commercial $98.50
Rate for Payer: Mclaren Commercial $98.57
Rate for Payer: Mclaren Commercial $90.87
Rate for Payer: Mclaren Commercial $163.94
Rate for Payer: Mclaren Commercial $163.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial $154.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial $93.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial $154.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $85.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial $93.09
Rate for Payer: Nomi Health Commercial $89.81
Rate for Payer: Nomi Health Commercial $82.80
Rate for Payer: Nomi Health Commercial $89.74
Rate for Payer: Nomi Health Commercial $149.37
Rate for Payer: Nomi Health Commercial $149.36
Rate for Payer: Priority Health Cigna Priority Health $118.40
Rate for Payer: Priority Health Cigna Priority Health $65.63
Rate for Payer: Priority Health Cigna Priority Health $71.19
Rate for Payer: Priority Health Cigna Priority Health $71.14
Rate for Payer: Priority Health Cigna Priority Health $118.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core $88.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core $96.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core $96.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core $160.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core $160.29
Service Code HCPCS J1050
Hospital Charge Code 19736
Hospital Revenue Code 636
Min. Negotiated Rate $0.01
Max. Negotiated Rate $109.44
Rate for Payer: Aetna Commercial $98.50
Rate for Payer: Aetna Commercial $163.94
Rate for Payer: Aetna Commercial $90.87
Rate for Payer: Aetna Commercial $163.94
Rate for Payer: Aetna Commercial $98.57
Rate for Payer: Aetna Medicare $54.76
Rate for Payer: Aetna Medicare $50.48
Rate for Payer: Aetna Medicare $54.72
Rate for Payer: Aetna Medicare $91.08
Rate for Payer: Aetna Medicare $91.08
Rate for Payer: ASR ASR $97.94
Rate for Payer: ASR ASR $176.69
Rate for Payer: ASR ASR $106.16
Rate for Payer: ASR ASR $106.23
Rate for Payer: ASR ASR $176.70
Rate for Payer: ASR Commercial $97.94
Rate for Payer: ASR Commercial $106.16
Rate for Payer: ASR Commercial $176.70
Rate for Payer: ASR Commercial $176.69
Rate for Payer: ASR Commercial $106.23
Rate for Payer: BCBS Complete $72.86
Rate for Payer: BCBS Complete $40.39
Rate for Payer: BCBS Complete $43.78
Rate for Payer: BCBS Complete $43.81
Rate for Payer: BCBS Complete $72.86
Rate for Payer: BCBS Trust/PPO $149.16
Rate for Payer: BCBS Trust/PPO $89.69
Rate for Payer: BCBS Trust/PPO $82.68
Rate for Payer: BCBS Trust/PPO $89.62
Rate for Payer: BCBS Trust/PPO $149.17
Rate for Payer: BCN Commercial $141.22
Rate for Payer: BCN Commercial $78.28
Rate for Payer: BCN Commercial $84.85
Rate for Payer: BCN Commercial $84.91
Rate for Payer: BCN Commercial $141.23
Rate for Payer: Cash Price $145.73
Rate for Payer: Cash Price $87.56
Rate for Payer: Cash Price $145.72
Rate for Payer: Cash Price $80.78
Rate for Payer: Cash Price $87.61
Rate for Payer: Cash Price $87.61
Rate for Payer: Cash Price $145.72
Rate for Payer: Cash Price $80.78
Rate for Payer: Cash Price $145.73
Rate for Payer: Cash Price $87.56
Rate for Payer: Cofinity Commercial $102.87
Rate for Payer: Cofinity Commercial $171.22
Rate for Payer: Cofinity Commercial $171.23
Rate for Payer: Cofinity Commercial $94.91
Rate for Payer: Cofinity Commercial $102.95
Rate for Payer: Encore Health Key Benefits Commercial $87.55
Rate for Payer: Encore Health Key Benefits Commercial $80.78
Rate for Payer: Encore Health Key Benefits Commercial $145.73
Rate for Payer: Encore Health Key Benefits Commercial $145.72
Rate for Payer: Encore Health Key Benefits Commercial $87.62
Rate for Payer: Healthscope Commercial $182.15
Rate for Payer: Healthscope Commercial $109.52
Rate for Payer: Healthscope Commercial $109.44
Rate for Payer: Healthscope Commercial $182.16
Rate for Payer: Healthscope Commercial $100.97
Rate for Payer: Healthscope Whirlpool $176.70
Rate for Payer: Healthscope Whirlpool $106.16
Rate for Payer: Healthscope Whirlpool $97.94
Rate for Payer: Healthscope Whirlpool $176.69
Rate for Payer: Healthscope Whirlpool $106.23
Rate for Payer: Mclaren Commercial $163.94
Rate for Payer: Mclaren Commercial $90.87
Rate for Payer: Mclaren Commercial $98.50
Rate for Payer: Mclaren Commercial $98.57
Rate for Payer: Mclaren Commercial $163.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial $85.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial $154.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial $93.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial $154.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial $93.09
Rate for Payer: Nomi Health Commercial $82.80
Rate for Payer: Nomi Health Commercial $89.74
Rate for Payer: Nomi Health Commercial $149.37
Rate for Payer: Nomi Health Commercial $149.36
Rate for Payer: Nomi Health Commercial $89.81
Rate for Payer: Priority Health Cigna Priority Health $118.40
Rate for Payer: Priority Health Cigna Priority Health $71.19
Rate for Payer: Priority Health Cigna Priority Health $71.14
Rate for Payer: Priority Health Cigna Priority Health $65.63
Rate for Payer: Priority Health Cigna Priority Health $118.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network $0.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network $0.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network $0.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network $0.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network $0.01
Rate for Payer: Priority Health Narrow Network $0.01
Rate for Payer: Priority Health Narrow Network $0.01
Rate for Payer: Priority Health Narrow Network $0.01
Rate for Payer: Priority Health Narrow Network $0.01
Rate for Payer: Priority Health Narrow Network $0.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core $88.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core $96.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core $160.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core $160.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core $96.38
Service Code NDC 00555087202
Hospital Charge Code 4855
Hospital Revenue Code 637
Min. Negotiated Rate $183.30
Max. Negotiated Rate $282.00
Rate for Payer: Aetna Commercial $253.80
Rate for Payer: ASR ASR $273.54
Rate for Payer: ASR Commercial $273.54
Rate for Payer: BCBS Trust/PPO $229.80
Rate for Payer: BCN Commercial $218.63
Rate for Payer: Cash Price $225.60
Rate for Payer: Cofinity Commercial $265.08
Rate for Payer: Encore Health Key Benefits Commercial $225.60
Rate for Payer: Healthscope Commercial $282.00
Rate for Payer: Healthscope Whirlpool $273.54
Rate for Payer: Mclaren Commercial $253.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial $239.70
Rate for Payer: Nomi Health Commercial $231.24
Rate for Payer: Priority Health Cigna Priority Health $183.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core $248.16
Service Code NDC 00555087202
Hospital Charge Code 4855
Hospital Revenue Code 637
Min. Negotiated Rate $112.80
Max. Negotiated Rate $282.00
Rate for Payer: Aetna Commercial $253.80
Rate for Payer: Aetna Medicare $141.00
Rate for Payer: ASR ASR $273.54
Rate for Payer: ASR Commercial $273.54
Rate for Payer: BCBS Complete $112.80
Rate for Payer: BCBS Trust/PPO $230.93
Rate for Payer: BCN Commercial $218.63
Rate for Payer: Cash Price $225.60
Rate for Payer: Cofinity Commercial $265.08
Rate for Payer: Encore Health Key Benefits Commercial $225.60
Rate for Payer: Healthscope Commercial $282.00
Rate for Payer: Healthscope Whirlpool $273.54
Rate for Payer: Mclaren Commercial $253.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial $239.70
Rate for Payer: Nomi Health Commercial $231.24
Rate for Payer: Priority Health Cigna Priority Health $183.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network $247.09
Rate for Payer: Priority Health Narrow Network $197.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core $248.16
Service Code NDC 50268052415
Hospital Charge Code 16830
Hospital Revenue Code 637
Min. Negotiated Rate $48.41
Max. Negotiated Rate $121.03
Rate for Payer: Aetna Commercial $108.93
Rate for Payer: Aetna Medicare $60.52
Rate for Payer: ASR ASR $117.40
Rate for Payer: ASR Commercial $117.40
Rate for Payer: BCBS Complete $48.41
Rate for Payer: BCBS Trust/PPO $99.11
Rate for Payer: BCN Commercial $93.83
Rate for Payer: Cash Price $96.82
Rate for Payer: Cofinity Commercial $113.77
Rate for Payer: Encore Health Key Benefits Commercial $96.82
Rate for Payer: Healthscope Commercial $121.03
Rate for Payer: Healthscope Whirlpool $117.40
Rate for Payer: Mclaren Commercial $108.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial $102.88
Rate for Payer: Nomi Health Commercial $99.24
Rate for Payer: Priority Health Cigna Priority Health $78.67
Rate for Payer: Priority Health HMO/PPO/Tiered Network $106.05
Rate for Payer: Priority Health Narrow Network $84.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core $106.51
Service Code NDC 20555003600
Hospital Charge Code 16830
Hospital Revenue Code 637
Min. Negotiated Rate $43.71
Max. Negotiated Rate $109.28
Rate for Payer: Aetna Commercial $98.35
Rate for Payer: Aetna Medicare $54.64
Rate for Payer: ASR ASR $106.00
Rate for Payer: ASR Commercial $106.00
Rate for Payer: BCBS Complete $43.71
Rate for Payer: BCBS Trust/PPO $89.49
Rate for Payer: BCN Commercial $84.72
Rate for Payer: Cash Price $87.42
Rate for Payer: Cofinity Commercial $102.72
Rate for Payer: Encore Health Key Benefits Commercial $87.42
Rate for Payer: Healthscope Commercial $109.28
Rate for Payer: Healthscope Whirlpool $106.00
Rate for Payer: Mclaren Commercial $98.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial $92.89
Rate for Payer: Nomi Health Commercial $89.61
Rate for Payer: Priority Health Cigna Priority Health $71.03
Rate for Payer: Priority Health HMO/PPO/Tiered Network $95.75
Rate for Payer: Priority Health Narrow Network $76.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core $96.17
Service Code NDC 50268052411
Hospital Charge Code 16830
Hospital Revenue Code 637
Min. Negotiated Rate $0.97
Max. Negotiated Rate $2.42
Rate for Payer: Aetna Commercial $2.18
Rate for Payer: Aetna Medicare $1.21
Rate for Payer: ASR ASR $2.35
Rate for Payer: ASR Commercial $2.35
Rate for Payer: BCBS Complete $0.97
Rate for Payer: BCBS Trust/PPO $1.98
Rate for Payer: BCN Commercial $1.88
Rate for Payer: Cash Price $1.94
Rate for Payer: Cofinity Commercial $2.27
Rate for Payer: Encore Health Key Benefits Commercial $1.94
Rate for Payer: Healthscope Commercial $2.42
Rate for Payer: Healthscope Whirlpool $2.35
Rate for Payer: Mclaren Commercial $2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial $2.06
Rate for Payer: Nomi Health Commercial $1.98
Rate for Payer: Priority Health Cigna Priority Health $1.57
Rate for Payer: Priority Health HMO/PPO/Tiered Network $2.12
Rate for Payer: Priority Health Narrow Network $1.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core $2.13