|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
OP
|
$695.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.21 |
| Max. Negotiated Rate |
$626.08 |
| Rate for Payer: Aetna Commercial |
$591.29
|
| Rate for Payer: Aetna Medicare |
$180.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.39
|
| Rate for Payer: BCBS Complete |
$278.26
|
| Rate for Payer: BCBS MAPPO |
$173.91
|
| Rate for Payer: BCBS Trust/PPO |
$540.86
|
| Rate for Payer: BCN Commercial |
$540.86
|
| Rate for Payer: BCN Medicare Advantage |
$173.91
|
| Rate for Payer: Cash Price |
$556.51
|
| Rate for Payer: Cofinity Commercial |
$598.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.91
|
| Rate for Payer: Healthscope Commercial |
$626.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$521.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$182.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$591.29
|
| Rate for Payer: PACE Senior Care Partners |
$165.21
|
| Rate for Payer: PACE SWMI |
$173.91
|
| Rate for Payer: PHP Commercial |
$591.29
|
| Rate for Payer: PHP Medicare Advantage |
$173.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$605.21
|
| Rate for Payer: Priority Health Medicare |
$173.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$424.27
|
| Rate for Payer: Railroad Medicare Medicare |
$173.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.16
|
| Rate for Payer: UHC Core |
$580.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.91
|
| Rate for Payer: UHC Medicare Advantage |
$179.13
|
| Rate for Payer: VA VA |
$173.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$521.73
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
IP
|
$695.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$424.27 |
| Max. Negotiated Rate |
$626.08 |
| Rate for Payer: Aetna Commercial |
$591.29
|
| Rate for Payer: BCBS Trust/PPO |
$537.59
|
| Rate for Payer: BCN Commercial |
$537.59
|
| Rate for Payer: Cash Price |
$556.51
|
| Rate for Payer: Cofinity Commercial |
$598.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.51
|
| Rate for Payer: Healthscope Commercial |
$626.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$521.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$591.29
|
| Rate for Payer: PHP Commercial |
$591.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$605.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$424.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.16
|
| Rate for Payer: UHC Core |
$580.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$521.73
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
IP
|
$678.30
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$413.70 |
| Max. Negotiated Rate |
$610.47 |
| Rate for Payer: Aetna Commercial |
$576.56
|
| Rate for Payer: BCBS Trust/PPO |
$524.19
|
| Rate for Payer: BCN Commercial |
$524.19
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$583.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Healthscope Commercial |
$610.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.56
|
| Rate for Payer: PHP Commercial |
$576.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.90
|
| Rate for Payer: UHC Core |
$566.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.72
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
OP
|
$678.30
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.10 |
| Max. Negotiated Rate |
$610.47 |
| Rate for Payer: Aetna Commercial |
$576.56
|
| Rate for Payer: Aetna Medicare |
$176.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.97
|
| Rate for Payer: BCBS Complete |
$271.32
|
| Rate for Payer: BCBS MAPPO |
$169.58
|
| Rate for Payer: BCBS Trust/PPO |
$527.38
|
| Rate for Payer: BCN Commercial |
$527.38
|
| Rate for Payer: BCN Medicare Advantage |
$169.58
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$583.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.58
|
| Rate for Payer: Healthscope Commercial |
$610.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$178.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.56
|
| Rate for Payer: PACE Senior Care Partners |
$161.10
|
| Rate for Payer: PACE SWMI |
$169.58
|
| Rate for Payer: PHP Commercial |
$576.56
|
| Rate for Payer: PHP Medicare Advantage |
$169.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.12
|
| Rate for Payer: Priority Health Medicare |
$169.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.70
|
| Rate for Payer: Railroad Medicare Medicare |
$169.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.90
|
| Rate for Payer: UHC Core |
$566.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.58
|
| Rate for Payer: UHC Medicare Advantage |
$174.66
|
| Rate for Payer: VA VA |
$169.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.72
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$486.20
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.47 |
| Max. Negotiated Rate |
$437.58 |
| Rate for Payer: Aetna Commercial |
$413.27
|
| Rate for Payer: Aetna Medicare |
$126.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.94
|
| Rate for Payer: BCBS Complete |
$194.48
|
| Rate for Payer: BCBS MAPPO |
$121.55
|
| Rate for Payer: BCBS Trust/PPO |
$378.02
|
| Rate for Payer: BCN Commercial |
$378.02
|
| Rate for Payer: BCN Medicare Advantage |
$121.55
|
| Rate for Payer: Cash Price |
$388.96
|
| Rate for Payer: Cofinity Commercial |
$418.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.55
|
| Rate for Payer: Healthscope Commercial |
$437.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$127.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$413.27
|
| Rate for Payer: PACE Senior Care Partners |
$115.47
|
| Rate for Payer: PACE SWMI |
$121.55
|
| Rate for Payer: PHP Commercial |
$413.27
|
| Rate for Payer: PHP Medicare Advantage |
$121.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.99
|
| Rate for Payer: Priority Health Medicare |
$121.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.53
|
| Rate for Payer: Railroad Medicare Medicare |
$121.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.86
|
| Rate for Payer: UHC Core |
$405.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.55
|
| Rate for Payer: UHC Medicare Advantage |
$125.20
|
| Rate for Payer: VA VA |
$121.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.65
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$486.20
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$296.53 |
| Max. Negotiated Rate |
$437.58 |
| Rate for Payer: Aetna Commercial |
$413.27
|
| Rate for Payer: BCBS Trust/PPO |
$375.74
|
| Rate for Payer: BCN Commercial |
$375.74
|
| Rate for Payer: Cash Price |
$388.96
|
| Rate for Payer: Cofinity Commercial |
$418.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.96
|
| Rate for Payer: Healthscope Commercial |
$437.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$413.27
|
| Rate for Payer: PHP Commercial |
$413.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.86
|
| Rate for Payer: UHC Core |
$405.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.65
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
OP
|
$430.32
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$387.29 |
| Rate for Payer: Aetna Commercial |
$365.77
|
| Rate for Payer: Aetna Medicare |
$111.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.48
|
| Rate for Payer: BCBS Complete |
$172.13
|
| Rate for Payer: BCBS MAPPO |
$107.58
|
| Rate for Payer: BCBS Trust/PPO |
$334.57
|
| Rate for Payer: BCN Commercial |
$334.57
|
| Rate for Payer: BCN Medicare Advantage |
$107.58
|
| Rate for Payer: Cash Price |
$344.26
|
| Rate for Payer: Cofinity Commercial |
$370.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.58
|
| Rate for Payer: Healthscope Commercial |
$387.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.77
|
| Rate for Payer: PACE Senior Care Partners |
$102.20
|
| Rate for Payer: PACE SWMI |
$107.58
|
| Rate for Payer: PHP Commercial |
$365.77
|
| Rate for Payer: PHP Medicare Advantage |
$107.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.38
|
| Rate for Payer: Priority Health Medicare |
$107.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.45
|
| Rate for Payer: Railroad Medicare Medicare |
$107.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.68
|
| Rate for Payer: UHC Core |
$359.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.58
|
| Rate for Payer: UHC Medicare Advantage |
$110.81
|
| Rate for Payer: VA VA |
$107.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.74
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
IP
|
$430.32
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.45 |
| Max. Negotiated Rate |
$387.29 |
| Rate for Payer: Aetna Commercial |
$365.77
|
| Rate for Payer: BCBS Trust/PPO |
$332.55
|
| Rate for Payer: BCN Commercial |
$332.55
|
| Rate for Payer: Cash Price |
$344.26
|
| Rate for Payer: Cofinity Commercial |
$370.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.26
|
| Rate for Payer: Healthscope Commercial |
$387.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.77
|
| Rate for Payer: PHP Commercial |
$365.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.68
|
| Rate for Payer: UHC Core |
$359.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.74
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
IP
|
$404.43
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$246.66 |
| Max. Negotiated Rate |
$363.99 |
| Rate for Payer: Aetna Commercial |
$343.77
|
| Rate for Payer: BCBS Trust/PPO |
$312.54
|
| Rate for Payer: BCN Commercial |
$312.54
|
| Rate for Payer: Cash Price |
$323.54
|
| Rate for Payer: Cofinity Commercial |
$347.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.54
|
| Rate for Payer: Healthscope Commercial |
$363.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.77
|
| Rate for Payer: PHP Commercial |
$343.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.90
|
| Rate for Payer: UHC Core |
$337.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.32
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
OP
|
$404.43
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.05 |
| Max. Negotiated Rate |
$363.99 |
| Rate for Payer: Aetna Commercial |
$343.77
|
| Rate for Payer: Aetna Medicare |
$105.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.38
|
| Rate for Payer: BCBS Complete |
$161.77
|
| Rate for Payer: BCBS MAPPO |
$101.11
|
| Rate for Payer: BCBS Trust/PPO |
$314.44
|
| Rate for Payer: BCN Commercial |
$314.44
|
| Rate for Payer: BCN Medicare Advantage |
$101.11
|
| Rate for Payer: Cash Price |
$323.54
|
| Rate for Payer: Cofinity Commercial |
$347.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.11
|
| Rate for Payer: Healthscope Commercial |
$363.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.77
|
| Rate for Payer: PACE Senior Care Partners |
$96.05
|
| Rate for Payer: PACE SWMI |
$101.11
|
| Rate for Payer: PHP Commercial |
$343.77
|
| Rate for Payer: PHP Medicare Advantage |
$101.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.85
|
| Rate for Payer: Priority Health Medicare |
$101.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.66
|
| Rate for Payer: Railroad Medicare Medicare |
$101.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.90
|
| Rate for Payer: UHC Core |
$337.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.11
|
| Rate for Payer: UHC Medicare Advantage |
$104.14
|
| Rate for Payer: VA VA |
$101.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.32
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
IP
|
$207.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.64 |
| Max. Negotiated Rate |
$186.88 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: BCBS Trust/PPO |
$160.46
|
| Rate for Payer: BCN Commercial |
$160.46
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Commercial |
$178.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Healthscope Commercial |
$186.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.49
|
| Rate for Payer: PHP Commercial |
$176.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.72
|
| Rate for Payer: UHC Core |
$173.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.73
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
OP
|
$207.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.31 |
| Max. Negotiated Rate |
$186.88 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Aetna Medicare |
$53.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.89
|
| Rate for Payer: BCBS Complete |
$83.06
|
| Rate for Payer: BCBS MAPPO |
$51.91
|
| Rate for Payer: BCBS Trust/PPO |
$161.44
|
| Rate for Payer: BCN Commercial |
$161.44
|
| Rate for Payer: BCN Medicare Advantage |
$51.91
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Commercial |
$178.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.91
|
| Rate for Payer: Healthscope Commercial |
$186.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.49
|
| Rate for Payer: PACE Senior Care Partners |
$49.31
|
| Rate for Payer: PACE SWMI |
$51.91
|
| Rate for Payer: PHP Commercial |
$176.49
|
| Rate for Payer: PHP Medicare Advantage |
$51.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.65
|
| Rate for Payer: Priority Health Medicare |
$51.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.64
|
| Rate for Payer: Railroad Medicare Medicare |
$51.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.72
|
| Rate for Payer: UHC Core |
$173.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.91
|
| Rate for Payer: UHC Medicare Advantage |
$53.47
|
| Rate for Payer: VA VA |
$51.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.73
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
OP
|
$389.01
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$350.11 |
| Rate for Payer: Aetna Commercial |
$330.66
|
| Rate for Payer: Aetna Medicare |
$101.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.57
|
| Rate for Payer: BCBS Complete |
$155.60
|
| Rate for Payer: BCBS MAPPO |
$97.25
|
| Rate for Payer: BCBS Trust/PPO |
$302.46
|
| Rate for Payer: BCN Commercial |
$302.46
|
| Rate for Payer: BCN Medicare Advantage |
$97.25
|
| Rate for Payer: Cash Price |
$311.21
|
| Rate for Payer: Cofinity Commercial |
$334.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.25
|
| Rate for Payer: Healthscope Commercial |
$350.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.66
|
| Rate for Payer: PACE Senior Care Partners |
$92.39
|
| Rate for Payer: PACE SWMI |
$97.25
|
| Rate for Payer: PHP Commercial |
$330.66
|
| Rate for Payer: PHP Medicare Advantage |
$97.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.44
|
| Rate for Payer: Priority Health Medicare |
$97.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.26
|
| Rate for Payer: Railroad Medicare Medicare |
$97.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.33
|
| Rate for Payer: UHC Core |
$324.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.25
|
| Rate for Payer: UHC Medicare Advantage |
$100.17
|
| Rate for Payer: VA VA |
$97.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.76
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
IP
|
$389.01
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.26 |
| Max. Negotiated Rate |
$350.11 |
| Rate for Payer: Aetna Commercial |
$330.66
|
| Rate for Payer: BCBS Trust/PPO |
$300.63
|
| Rate for Payer: BCN Commercial |
$300.63
|
| Rate for Payer: Cash Price |
$311.21
|
| Rate for Payer: Cofinity Commercial |
$334.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.21
|
| Rate for Payer: Healthscope Commercial |
$350.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.66
|
| Rate for Payer: PHP Commercial |
$330.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.33
|
| Rate for Payer: UHC Core |
$324.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.76
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
IP
|
$291.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.95 |
| Max. Negotiated Rate |
$262.59 |
| Rate for Payer: Aetna Commercial |
$248.00
|
| Rate for Payer: BCBS Trust/PPO |
$225.48
|
| Rate for Payer: BCN Commercial |
$225.48
|
| Rate for Payer: Cash Price |
$233.42
|
| Rate for Payer: Cofinity Commercial |
$250.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.42
|
| Rate for Payer: Healthscope Commercial |
$262.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.00
|
| Rate for Payer: PHP Commercial |
$248.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.76
|
| Rate for Payer: UHC Core |
$243.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.83
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
OP
|
$291.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$262.59 |
| Rate for Payer: Aetna Commercial |
$248.00
|
| Rate for Payer: Aetna Medicare |
$75.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.18
|
| Rate for Payer: BCBS Complete |
$116.71
|
| Rate for Payer: BCBS MAPPO |
$72.94
|
| Rate for Payer: BCBS Trust/PPO |
$226.85
|
| Rate for Payer: BCN Commercial |
$226.85
|
| Rate for Payer: BCN Medicare Advantage |
$72.94
|
| Rate for Payer: Cash Price |
$233.42
|
| Rate for Payer: Cofinity Commercial |
$250.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.94
|
| Rate for Payer: Healthscope Commercial |
$262.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.00
|
| Rate for Payer: PACE Senior Care Partners |
$69.30
|
| Rate for Payer: PACE SWMI |
$72.94
|
| Rate for Payer: PHP Commercial |
$248.00
|
| Rate for Payer: PHP Medicare Advantage |
$72.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.84
|
| Rate for Payer: Priority Health Medicare |
$72.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.95
|
| Rate for Payer: Railroad Medicare Medicare |
$72.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.76
|
| Rate for Payer: UHC Core |
$243.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.94
|
| Rate for Payer: UHC Medicare Advantage |
$75.13
|
| Rate for Payer: VA VA |
$72.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.83
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna Medicare |
$106.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.50
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$317.22
|
| Rate for Payer: BCN Commercial |
$317.22
|
| Rate for Payer: BCN Medicare Advantage |
$102.00
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.80
|
| Rate for Payer: PACE Senior Care Partners |
$96.90
|
| Rate for Payer: PACE SWMI |
$102.00
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: PHP Medicare Advantage |
$102.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.96
|
| Rate for Payer: Priority Health Medicare |
$102.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.84
|
| Rate for Payer: Railroad Medicare Medicare |
$102.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.04
|
| Rate for Payer: UHC Core |
$340.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.00
|
| Rate for Payer: UHC Medicare Advantage |
$105.06
|
| Rate for Payer: VA VA |
$102.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.84 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: BCBS Trust/PPO |
$315.30
|
| Rate for Payer: BCN Commercial |
$315.30
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.80
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.04
|
| Rate for Payer: UHC Core |
$340.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$916.76
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$559.13 |
| Max. Negotiated Rate |
$825.08 |
| Rate for Payer: Aetna Commercial |
$779.25
|
| Rate for Payer: BCBS Trust/PPO |
$708.47
|
| Rate for Payer: BCN Commercial |
$708.47
|
| Rate for Payer: Cash Price |
$733.41
|
| Rate for Payer: Cofinity Commercial |
$788.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.41
|
| Rate for Payer: Healthscope Commercial |
$825.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$779.25
|
| Rate for Payer: PHP Commercial |
$779.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$797.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$559.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$806.75
|
| Rate for Payer: UHC Core |
$765.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.57
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$916.76
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$825.08 |
| Rate for Payer: Aetna Commercial |
$779.25
|
| Rate for Payer: Aetna Medicare |
$238.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$286.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$286.49
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$229.19
|
| Rate for Payer: BCBS Trust/PPO |
$712.78
|
| Rate for Payer: BCN Commercial |
$712.78
|
| Rate for Payer: BCN Medicare Advantage |
$229.19
|
| Rate for Payer: Cash Price |
$733.41
|
| Rate for Payer: Cash Price |
$733.41
|
| Rate for Payer: Cofinity Commercial |
$788.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.19
|
| Rate for Payer: Healthscope Commercial |
$825.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.57
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$240.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$779.25
|
| Rate for Payer: PACE Senior Care Partners |
$217.73
|
| Rate for Payer: PACE SWMI |
$229.19
|
| Rate for Payer: PHP Commercial |
$779.25
|
| Rate for Payer: PHP Medicare Advantage |
$229.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$797.58
|
| Rate for Payer: Priority Health Medicare |
$229.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$559.13
|
| Rate for Payer: Railroad Medicare Medicare |
$229.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$806.75
|
| Rate for Payer: UHC Core |
$765.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.19
|
| Rate for Payer: UHC Medicare Advantage |
$236.07
|
| Rate for Payer: VA VA |
$229.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.57
|
|
|
HC EP+PVI ABL
|
Facility
|
OP
|
$8,727.45
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,072.77 |
| Max. Negotiated Rate |
$16,359.08 |
| Rate for Payer: Aetna Commercial |
$7,418.33
|
| Rate for Payer: Aetna Medicare |
$2,269.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,727.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,727.33
|
| Rate for Payer: BCBS Complete |
$16,359.08
|
| Rate for Payer: BCBS MAPPO |
$2,181.86
|
| Rate for Payer: BCBS Trust/PPO |
$6,785.59
|
| Rate for Payer: BCN Commercial |
$6,785.59
|
| Rate for Payer: BCN Medicare Advantage |
$2,181.86
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$7,505.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,181.86
|
| Rate for Payer: Healthscope Commercial |
$7,854.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,545.59
|
| Rate for Payer: Mclaren Medicaid |
$15,580.08
|
| Rate for Payer: Meridian Medicaid |
$16,359.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,290.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,509.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: PACE Senior Care Partners |
$2,072.77
|
| Rate for Payer: PACE SWMI |
$2,181.86
|
| Rate for Payer: PHP Commercial |
$7,418.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,181.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,580.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,592.88
|
| Rate for Payer: Priority Health Medicare |
$2,181.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,322.87
|
| Rate for Payer: Railroad Medicare Medicare |
$2,181.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,680.16
|
| Rate for Payer: UHC Core |
$7,287.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,181.86
|
| Rate for Payer: UHC Medicare Advantage |
$2,247.32
|
| Rate for Payer: VA VA |
$2,181.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,545.59
|
|
|
HC EP+PVI ABL
|
Facility
|
IP
|
$8,727.45
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,322.87 |
| Max. Negotiated Rate |
$7,854.70 |
| Rate for Payer: Aetna Commercial |
$7,418.33
|
| Rate for Payer: BCBS Trust/PPO |
$6,744.57
|
| Rate for Payer: BCN Commercial |
$6,744.57
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$7,505.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.96
|
| Rate for Payer: Healthscope Commercial |
$7,854.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,545.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: PHP Commercial |
$7,418.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,592.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,322.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,680.16
|
| Rate for Payer: UHC Core |
$7,287.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,545.59
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: BCBS Trust/PPO |
$28.38
|
| Rate for Payer: BCN Commercial |
$28.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.31
|
| Rate for Payer: UHC Core |
$30.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.54
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.48
|
| Rate for Payer: BCBS Complete |
$14.06
|
| Rate for Payer: BCBS MAPPO |
$9.18
|
| Rate for Payer: BCBS Trust/PPO |
$28.55
|
| Rate for Payer: BCN Commercial |
$28.55
|
| Rate for Payer: BCN Medicare Advantage |
$9.18
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.18
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$13.39
|
| Rate for Payer: Meridian Medicaid |
$14.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Senior Care Partners |
$8.72
|
| Rate for Payer: PACE SWMI |
$9.18
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Medicare Advantage |
$9.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.95
|
| Rate for Payer: Priority Health Medicare |
$9.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.40
|
| Rate for Payer: Railroad Medicare Medicare |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.31
|
| Rate for Payer: UHC Core |
$30.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.18
|
| Rate for Payer: UHC Medicare Advantage |
$9.46
|
| Rate for Payer: VA VA |
$9.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.54
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.48
|
| Rate for Payer: BCBS Complete |
$14.06
|
| Rate for Payer: BCBS MAPPO |
$9.18
|
| Rate for Payer: BCBS Trust/PPO |
$28.55
|
| Rate for Payer: BCN Commercial |
$28.55
|
| Rate for Payer: BCN Medicare Advantage |
$9.18
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.18
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$13.39
|
| Rate for Payer: Meridian Medicaid |
$14.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Senior Care Partners |
$8.72
|
| Rate for Payer: PACE SWMI |
$9.18
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Medicare Advantage |
$9.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.95
|
| Rate for Payer: Priority Health Medicare |
$9.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.40
|
| Rate for Payer: Railroad Medicare Medicare |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.31
|
| Rate for Payer: UHC Core |
$30.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.18
|
| Rate for Payer: UHC Medicare Advantage |
$9.46
|
| Rate for Payer: VA VA |
$9.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.54
|
|
