|
HC EPIDURAL PREP (OB)
|
Facility
|
OP
|
$659.01
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$258.99 |
| Max. Negotiated Rate |
$593.11 |
| Rate for Payer: Aetna Commercial |
$560.16
|
| Rate for Payer: Aetna Medicare |
$329.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.36
|
| Rate for Payer: BCBS Complete |
$263.60
|
| Rate for Payer: Cash Price |
$527.21
|
| Rate for Payer: Cofinity Advantage |
$461.31
|
| Rate for Payer: Cofinity Commercial |
$566.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.21
|
| Rate for Payer: Healthscope Commercial |
$593.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$527.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.26
|
| Rate for Payer: PHP Commercial |
$560.16
|
| Rate for Payer: Priority Health SBD |
$415.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$428.36
|
| Rate for Payer: UHC Core |
$343.34
|
| Rate for Payer: UHC Exchange |
$258.99
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
IP
|
$498.24
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$313.89 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cofinity Advantage |
$348.77
|
| Rate for Payer: Cofinity Commercial |
$428.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.59
|
| Rate for Payer: Healthscope Commercial |
$448.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.68
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: Priority Health SBD |
$313.89
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
OP
|
$498.24
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,108.42 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.14
|
| Rate for Payer: BCN Commercial |
$1,108.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cofinity Advantage |
$348.77
|
| Rate for Payer: Cofinity Commercial |
$428.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$448.42
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.50
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.68
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$313.89
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
OP
|
$723.74
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,108.42 |
| Rate for Payer: Aetna Commercial |
$615.18
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.14
|
| Rate for Payer: BCN Commercial |
$1,108.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$578.99
|
| Rate for Payer: Cash Price |
$578.99
|
| Rate for Payer: Cash Price |
$578.99
|
| Rate for Payer: Cofinity Advantage |
$506.62
|
| Rate for Payer: Cofinity Commercial |
$622.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$651.37
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.18
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$542.80
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$615.18
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$455.96
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
IP
|
$723.74
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.96 |
| Max. Negotiated Rate |
$651.37 |
| Rate for Payer: Aetna Commercial |
$615.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.43
|
| Rate for Payer: Cash Price |
$578.99
|
| Rate for Payer: Cofinity Advantage |
$506.62
|
| Rate for Payer: Cofinity Commercial |
$622.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.99
|
| Rate for Payer: Healthscope Commercial |
$651.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$542.80
|
| Rate for Payer: PHP Commercial |
$615.18
|
| Rate for Payer: Priority Health SBD |
$455.96
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
OP
|
$705.71
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,108.42 |
| Rate for Payer: Aetna Commercial |
$599.85
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.14
|
| Rate for Payer: BCN Commercial |
$1,108.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$564.57
|
| Rate for Payer: Cash Price |
$564.57
|
| Rate for Payer: Cash Price |
$564.57
|
| Rate for Payer: Cofinity Advantage |
$494.00
|
| Rate for Payer: Cofinity Commercial |
$606.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$635.14
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.85
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.28
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$599.85
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$444.60
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
IP
|
$705.71
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$444.60 |
| Max. Negotiated Rate |
$635.14 |
| Rate for Payer: Aetna Commercial |
$599.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.71
|
| Rate for Payer: Cash Price |
$564.57
|
| Rate for Payer: Cofinity Advantage |
$494.00
|
| Rate for Payer: Cofinity Commercial |
$606.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.57
|
| Rate for Payer: Healthscope Commercial |
$635.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.28
|
| Rate for Payer: PHP Commercial |
$599.85
|
| Rate for Payer: Priority Health SBD |
$444.60
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$505.84
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$318.68 |
| Max. Negotiated Rate |
$455.26 |
| Rate for Payer: Aetna Commercial |
$429.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.80
|
| Rate for Payer: Cash Price |
$404.67
|
| Rate for Payer: Cofinity Advantage |
$354.09
|
| Rate for Payer: Cofinity Commercial |
$435.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.67
|
| Rate for Payer: Healthscope Commercial |
$455.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.38
|
| Rate for Payer: PHP Commercial |
$429.96
|
| Rate for Payer: Priority Health SBD |
$318.68
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$505.84
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,108.42 |
| Rate for Payer: Aetna Commercial |
$429.96
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.14
|
| Rate for Payer: BCN Commercial |
$1,108.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$404.67
|
| Rate for Payer: Cash Price |
$404.67
|
| Rate for Payer: Cash Price |
$404.67
|
| Rate for Payer: Cofinity Advantage |
$354.09
|
| Rate for Payer: Cofinity Commercial |
$435.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$455.26
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.96
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.38
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$429.96
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$318.68
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
IP
|
$447.71
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.06 |
| Max. Negotiated Rate |
$402.94 |
| Rate for Payer: Aetna Commercial |
$380.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.01
|
| Rate for Payer: Cash Price |
$358.17
|
| Rate for Payer: Cofinity Advantage |
$313.40
|
| Rate for Payer: Cofinity Commercial |
$385.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.17
|
| Rate for Payer: Healthscope Commercial |
$402.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.78
|
| Rate for Payer: PHP Commercial |
$380.55
|
| Rate for Payer: Priority Health SBD |
$282.06
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
OP
|
$447.71
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,108.42 |
| Rate for Payer: Aetna Commercial |
$380.55
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.14
|
| Rate for Payer: BCN Commercial |
$1,108.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$358.17
|
| Rate for Payer: Cash Price |
$358.17
|
| Rate for Payer: Cash Price |
$358.17
|
| Rate for Payer: Cofinity Advantage |
$313.40
|
| Rate for Payer: Cofinity Commercial |
$385.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$402.94
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.55
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.78
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$380.55
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$282.06
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
IP
|
$420.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.09 |
| Max. Negotiated Rate |
$378.69 |
| Rate for Payer: Aetna Commercial |
$357.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.50
|
| Rate for Payer: Cash Price |
$336.62
|
| Rate for Payer: Cofinity Advantage |
$294.54
|
| Rate for Payer: Cofinity Commercial |
$361.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.62
|
| Rate for Payer: Healthscope Commercial |
$378.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.58
|
| Rate for Payer: PHP Commercial |
$357.65
|
| Rate for Payer: Priority Health SBD |
$265.09
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
OP
|
$420.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,108.42 |
| Rate for Payer: Aetna Commercial |
$357.65
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.14
|
| Rate for Payer: BCN Commercial |
$1,108.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$336.62
|
| Rate for Payer: Cash Price |
$336.62
|
| Rate for Payer: Cash Price |
$336.62
|
| Rate for Payer: Cofinity Advantage |
$294.54
|
| Rate for Payer: Cofinity Commercial |
$361.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$378.69
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.65
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.58
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$357.65
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$265.09
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
IP
|
$216.03
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.10 |
| Max. Negotiated Rate |
$194.43 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.42
|
| Rate for Payer: Cash Price |
$172.82
|
| Rate for Payer: Cofinity Advantage |
$151.22
|
| Rate for Payer: Cofinity Commercial |
$185.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.82
|
| Rate for Payer: Healthscope Commercial |
$194.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.02
|
| Rate for Payer: PHP Commercial |
$183.63
|
| Rate for Payer: Priority Health SBD |
$136.10
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
OP
|
$216.03
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,108.42 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.14
|
| Rate for Payer: BCN Commercial |
$1,108.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$172.82
|
| Rate for Payer: Cash Price |
$172.82
|
| Rate for Payer: Cash Price |
$172.82
|
| Rate for Payer: Cofinity Advantage |
$151.22
|
| Rate for Payer: Cofinity Commercial |
$185.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$194.43
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.02
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$183.63
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$136.10
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
OP
|
$404.73
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,108.42 |
| Rate for Payer: Aetna Commercial |
$344.02
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.14
|
| Rate for Payer: BCN Commercial |
$1,108.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cofinity Advantage |
$283.31
|
| Rate for Payer: Cofinity Commercial |
$348.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$364.26
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.02
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.55
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$344.02
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$254.98
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
IP
|
$404.73
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$254.98 |
| Max. Negotiated Rate |
$364.26 |
| Rate for Payer: Aetna Commercial |
$344.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.07
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cofinity Advantage |
$283.31
|
| Rate for Payer: Cofinity Commercial |
$348.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.78
|
| Rate for Payer: Healthscope Commercial |
$364.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.55
|
| Rate for Payer: PHP Commercial |
$344.02
|
| Rate for Payer: Priority Health SBD |
$254.98
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
OP
|
$303.56
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,108.42 |
| Rate for Payer: Aetna Commercial |
$258.03
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.14
|
| Rate for Payer: BCN Commercial |
$1,108.42
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$242.85
|
| Rate for Payer: Cash Price |
$242.85
|
| Rate for Payer: Cash Price |
$242.85
|
| Rate for Payer: Cofinity Advantage |
$212.49
|
| Rate for Payer: Cofinity Commercial |
$261.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$273.20
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.03
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.67
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$258.03
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$191.24
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
IP
|
$303.56
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$191.24 |
| Max. Negotiated Rate |
$273.20 |
| Rate for Payer: Aetna Commercial |
$258.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.31
|
| Rate for Payer: Cash Price |
$242.85
|
| Rate for Payer: Cofinity Advantage |
$212.49
|
| Rate for Payer: Cofinity Commercial |
$261.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.85
|
| Rate for Payer: Healthscope Commercial |
$273.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.67
|
| Rate for Payer: PHP Commercial |
$258.03
|
| Rate for Payer: Priority Health SBD |
$191.24
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
OP
|
$424.48
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.79 |
| Max. Negotiated Rate |
$382.03 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: Aetna Medicare |
$212.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.91
|
| Rate for Payer: BCBS Complete |
$169.79
|
| Rate for Payer: Cash Price |
$339.58
|
| Rate for Payer: Cofinity Advantage |
$297.14
|
| Rate for Payer: Cofinity Commercial |
$365.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.58
|
| Rate for Payer: Healthscope Commercial |
$382.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.36
|
| Rate for Payer: PHP Commercial |
$360.81
|
| Rate for Payer: Priority Health SBD |
$267.42
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
IP
|
$424.48
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.42 |
| Max. Negotiated Rate |
$382.03 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.91
|
| Rate for Payer: Cash Price |
$339.58
|
| Rate for Payer: Cofinity Advantage |
$297.14
|
| Rate for Payer: Cofinity Commercial |
$365.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.58
|
| Rate for Payer: Healthscope Commercial |
$382.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.36
|
| Rate for Payer: PHP Commercial |
$360.81
|
| Rate for Payer: Priority Health SBD |
$267.42
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$953.80
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$600.89 |
| Max. Negotiated Rate |
$858.42 |
| Rate for Payer: Aetna Commercial |
$810.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.97
|
| Rate for Payer: Cash Price |
$763.04
|
| Rate for Payer: Cofinity Advantage |
$667.66
|
| Rate for Payer: Cofinity Commercial |
$820.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.04
|
| Rate for Payer: Healthscope Commercial |
$858.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.35
|
| Rate for Payer: PHP Commercial |
$810.73
|
| Rate for Payer: Priority Health SBD |
$600.89
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$953.80
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$858.42 |
| Rate for Payer: Aetna Commercial |
$810.73
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$507.80
|
| Rate for Payer: BCN Commercial |
$507.80
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$763.04
|
| Rate for Payer: Cash Price |
$763.04
|
| Rate for Payer: Cofinity Advantage |
$667.66
|
| Rate for Payer: Cofinity Commercial |
$820.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$858.42
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.73
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.35
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$810.73
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$600.89
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$619.97
|
| Rate for Payer: UHC Core |
$496.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$374.84
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EP+PVI ABL
|
Facility
|
IP
|
$9,080.04
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,720.43 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
|
|
HC EP+PVI ABL
|
Facility
|
OP
|
$9,080.04
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,023.01 |
| Max. Negotiated Rate |
$84,223.52 |
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna Medicare |
$27,085.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,554.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,554.84
|
| Rate for Payer: BCBS Complete |
$14,303.29
|
| Rate for Payer: BCBS MAPPO |
$26,043.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.01
|
| Rate for Payer: BCN Commercial |
$1,023.01
|
| Rate for Payer: BCN Medicare Advantage |
$26,043.87
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,043.87
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: Mclaren Medicaid |
$13,620.94
|
| Rate for Payer: Mclaren Medicare |
$26,043.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27,346.06
|
| Rate for Payer: Meridian Medicaid |
$27,346.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,950.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,648.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Nomi Health Commercial |
$78,131.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PACE Medicare |
$24,741.68
|
| Rate for Payer: PACE SWMI |
$26,043.87
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: PHP Medicare Advantage |
$26,043.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,620.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$84,223.52
|
| Rate for Payer: Priority Health Medicare |
$26,043.87
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
| Rate for Payer: Priority Health Tiered Network |
$67,378.82
|
| Rate for Payer: Railroad Medicare Medicare |
$26,043.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26,043.87
|
| Rate for Payer: UHC Medicaid |
$13,620.94
|
| Rate for Payer: UHCCP Medicaid |
$13,620.94
|
| Rate for Payer: VA VA |
$26,043.87
|
|
