|
HC EPIDURAL PREP (OB)
|
Facility
|
IP
|
$659.01
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$458.67 |
| Max. Negotiated Rate |
$593.11 |
| Rate for Payer: Aetna Commercial |
$560.16
|
| Rate for Payer: BCBS Trust/PPO |
$544.28
|
| Rate for Payer: BCN Commercial |
$544.28
|
| Rate for Payer: Cash Price |
$527.21
|
| 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: Lakeland Regional Health Systems Commercial |
$494.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.16
|
| Rate for Payer: Nomi Health Commercial |
$540.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.26
|
| Rate for Payer: PHP Commercial |
$560.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$573.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$458.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.93
|
| Rate for Payer: UHC Core |
$550.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.26
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
OP
|
$659.01
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$116.18 |
| Max. Negotiated Rate |
$593.11 |
| Rate for Payer: Aetna Commercial |
$560.16
|
| Rate for Payer: Aetna Medicare |
$171.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.94
|
| Rate for Payer: BCBS Complete |
$121.98
|
| Rate for Payer: BCBS MAPPO |
$164.75
|
| Rate for Payer: BCBS Trust/PPO |
$541.77
|
| Rate for Payer: BCN Commercial |
$541.77
|
| Rate for Payer: BCN Medicare Advantage |
$164.75
|
| Rate for Payer: Cash Price |
$527.21
|
| Rate for Payer: Cofinity Commercial |
$566.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.75
|
| Rate for Payer: Healthscope Commercial |
$593.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.26
|
| Rate for Payer: Mclaren Medicaid |
$116.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.99
|
| Rate for Payer: Meridian Medicaid |
$121.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$181.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.16
|
| Rate for Payer: Nomi Health Commercial |
$540.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.26
|
| Rate for Payer: PACE Senior Care Partners |
$156.51
|
| Rate for Payer: PACE SWMI |
$164.75
|
| Rate for Payer: PHP Commercial |
$560.16
|
| Rate for Payer: PHP Medicare Advantage |
$164.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$573.34
|
| Rate for Payer: Priority Health Medicare |
$166.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$458.67
|
| Rate for Payer: Railroad Medicare Medicare |
$164.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.93
|
| Rate for Payer: UHC Core |
$550.27
|
| Rate for Payer: UHC Exchange |
$164.75
|
| Rate for Payer: UHC Medicaid |
$116.18
|
| Rate for Payer: UHC Medicare Advantage |
$164.75
|
| Rate for Payer: UHCCP Medicaid |
$116.18
|
| Rate for Payer: VA VA |
$164.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.26
|
|
|
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 |
$346.78 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: BCBS Trust/PPO |
$411.50
|
| Rate for Payer: BCN Commercial |
$411.50
|
| Rate for Payer: Cash Price |
$398.59
|
| 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: Lakeland Regional Health Systems Commercial |
$373.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.50
|
| Rate for Payer: Nomi Health Commercial |
$408.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.68
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$433.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.45
|
| Rate for Payer: UHC Core |
$416.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.68
|
|
|
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 |
$87.84 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Aetna Medicare |
$129.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.70
|
| Rate for Payer: BCBS Complete |
$92.22
|
| Rate for Payer: BCBS MAPPO |
$124.56
|
| Rate for Payer: BCBS Trust/PPO |
$409.60
|
| Rate for Payer: BCN Commercial |
$409.60
|
| Rate for Payer: BCN Medicare Advantage |
$124.56
|
| Rate for Payer: Cash Price |
$398.59
|
| 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 |
$124.56
|
| Rate for Payer: Healthscope Commercial |
$448.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.68
|
| Rate for Payer: Mclaren Medicaid |
$87.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.79
|
| Rate for Payer: Meridian Medicaid |
$92.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$137.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.50
|
| Rate for Payer: Nomi Health Commercial |
$408.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.68
|
| Rate for Payer: PACE Senior Care Partners |
$118.33
|
| Rate for Payer: PACE SWMI |
$124.56
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: PHP Medicare Advantage |
$124.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$433.47
|
| Rate for Payer: Priority Health Medicare |
$125.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.78
|
| Rate for Payer: Railroad Medicare Medicare |
$124.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.45
|
| Rate for Payer: UHC Core |
$416.03
|
| Rate for Payer: UHC Exchange |
$124.56
|
| Rate for Payer: UHC Medicaid |
$87.84
|
| Rate for Payer: UHC Medicare Advantage |
$124.56
|
| Rate for Payer: UHCCP Medicaid |
$87.84
|
| Rate for Payer: VA VA |
$124.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.68
|
|
|
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 |
$503.72 |
| Max. Negotiated Rate |
$651.37 |
| Rate for Payer: Aetna Commercial |
$615.18
|
| Rate for Payer: BCBS Trust/PPO |
$597.74
|
| Rate for Payer: BCN Commercial |
$597.74
|
| Rate for Payer: Cash Price |
$578.99
|
| 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: Lakeland Regional Health Systems Commercial |
$542.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.18
|
| Rate for Payer: Nomi Health Commercial |
$593.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$542.80
|
| Rate for Payer: PHP Commercial |
$615.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$629.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$636.89
|
| Rate for Payer: UHC Core |
$604.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.80
|
|
|
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 |
$127.60 |
| Max. Negotiated Rate |
$651.37 |
| Rate for Payer: Aetna Commercial |
$615.18
|
| Rate for Payer: Aetna Medicare |
$188.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.17
|
| Rate for Payer: BCBS Complete |
$133.96
|
| Rate for Payer: BCBS MAPPO |
$180.94
|
| Rate for Payer: BCBS Trust/PPO |
$594.99
|
| Rate for Payer: BCN Commercial |
$594.99
|
| Rate for Payer: BCN Medicare Advantage |
$180.94
|
| Rate for Payer: Cash Price |
$578.99
|
| 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 |
$180.94
|
| Rate for Payer: Healthscope Commercial |
$651.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.80
|
| Rate for Payer: Mclaren Medicaid |
$127.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.98
|
| Rate for Payer: Meridian Medicaid |
$133.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$199.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.18
|
| Rate for Payer: Nomi Health Commercial |
$593.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$542.80
|
| Rate for Payer: PACE Senior Care Partners |
$171.89
|
| Rate for Payer: PACE SWMI |
$180.94
|
| Rate for Payer: PHP Commercial |
$615.18
|
| Rate for Payer: PHP Medicare Advantage |
$180.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$629.65
|
| Rate for Payer: Priority Health Medicare |
$182.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.72
|
| Rate for Payer: Railroad Medicare Medicare |
$180.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$636.89
|
| Rate for Payer: UHC Core |
$604.32
|
| Rate for Payer: UHC Exchange |
$180.94
|
| Rate for Payer: UHC Medicaid |
$127.60
|
| Rate for Payer: UHC Medicare Advantage |
$180.94
|
| Rate for Payer: UHCCP Medicaid |
$127.60
|
| Rate for Payer: VA VA |
$180.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.80
|
|
|
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 |
$124.42 |
| Max. Negotiated Rate |
$635.14 |
| Rate for Payer: Aetna Commercial |
$599.85
|
| Rate for Payer: Aetna Medicare |
$183.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.53
|
| Rate for Payer: BCBS Complete |
$130.63
|
| Rate for Payer: BCBS MAPPO |
$176.43
|
| Rate for Payer: BCBS Trust/PPO |
$580.16
|
| Rate for Payer: BCN Commercial |
$580.16
|
| Rate for Payer: BCN Medicare Advantage |
$176.43
|
| Rate for Payer: Cash Price |
$564.57
|
| 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 |
$176.43
|
| Rate for Payer: Healthscope Commercial |
$635.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.28
|
| Rate for Payer: Mclaren Medicaid |
$124.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.25
|
| Rate for Payer: Meridian Medicaid |
$130.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.85
|
| Rate for Payer: Nomi Health Commercial |
$578.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.28
|
| Rate for Payer: PACE Senior Care Partners |
$167.61
|
| Rate for Payer: PACE SWMI |
$176.43
|
| Rate for Payer: PHP Commercial |
$599.85
|
| Rate for Payer: PHP Medicare Advantage |
$176.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$613.97
|
| Rate for Payer: Priority Health Medicare |
$178.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$491.17
|
| Rate for Payer: Railroad Medicare Medicare |
$176.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$621.02
|
| Rate for Payer: UHC Core |
$589.27
|
| Rate for Payer: UHC Exchange |
$176.43
|
| Rate for Payer: UHC Medicaid |
$124.42
|
| Rate for Payer: UHC Medicare Advantage |
$176.43
|
| Rate for Payer: UHCCP Medicaid |
$124.42
|
| Rate for Payer: VA VA |
$176.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.28
|
|
|
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 |
$491.17 |
| Max. Negotiated Rate |
$635.14 |
| Rate for Payer: Aetna Commercial |
$599.85
|
| Rate for Payer: BCBS Trust/PPO |
$582.85
|
| Rate for Payer: BCN Commercial |
$582.85
|
| Rate for Payer: Cash Price |
$564.57
|
| 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: Lakeland Regional Health Systems Commercial |
$529.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.85
|
| Rate for Payer: Nomi Health Commercial |
$578.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.28
|
| Rate for Payer: PHP Commercial |
$599.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$613.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$491.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$621.02
|
| Rate for Payer: UHC Core |
$589.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.28
|
|
|
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 |
$89.18 |
| Max. Negotiated Rate |
$455.26 |
| Rate for Payer: Aetna Commercial |
$429.96
|
| Rate for Payer: Aetna Medicare |
$131.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$158.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$158.07
|
| Rate for Payer: BCBS Complete |
$93.63
|
| Rate for Payer: BCBS MAPPO |
$126.46
|
| Rate for Payer: BCBS Trust/PPO |
$415.85
|
| Rate for Payer: BCN Commercial |
$415.85
|
| Rate for Payer: BCN Medicare Advantage |
$126.46
|
| Rate for Payer: Cash Price |
$404.67
|
| 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 |
$126.46
|
| Rate for Payer: Healthscope Commercial |
$455.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.38
|
| Rate for Payer: Mclaren Medicaid |
$89.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.78
|
| Rate for Payer: Meridian Medicaid |
$93.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.96
|
| Rate for Payer: Nomi Health Commercial |
$414.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.38
|
| Rate for Payer: PACE Senior Care Partners |
$120.14
|
| Rate for Payer: PACE SWMI |
$126.46
|
| Rate for Payer: PHP Commercial |
$429.96
|
| Rate for Payer: PHP Medicare Advantage |
$126.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$440.08
|
| Rate for Payer: Priority Health Medicare |
$127.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$352.06
|
| Rate for Payer: Railroad Medicare Medicare |
$126.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.14
|
| Rate for Payer: UHC Core |
$422.38
|
| Rate for Payer: UHC Exchange |
$126.46
|
| Rate for Payer: UHC Medicaid |
$89.18
|
| Rate for Payer: UHC Medicare Advantage |
$126.46
|
| Rate for Payer: UHCCP Medicaid |
$89.18
|
| Rate for Payer: VA VA |
$126.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.38
|
|
|
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 |
$352.06 |
| Max. Negotiated Rate |
$455.26 |
| Rate for Payer: Aetna Commercial |
$429.96
|
| Rate for Payer: BCBS Trust/PPO |
$417.77
|
| Rate for Payer: BCN Commercial |
$417.77
|
| Rate for Payer: Cash Price |
$404.67
|
| 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: Lakeland Regional Health Systems Commercial |
$379.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.96
|
| Rate for Payer: Nomi Health Commercial |
$414.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.38
|
| Rate for Payer: PHP Commercial |
$429.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$440.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$352.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.14
|
| Rate for Payer: UHC Core |
$422.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.38
|
|
|
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 |
$311.61 |
| Max. Negotiated Rate |
$402.94 |
| Rate for Payer: Aetna Commercial |
$380.55
|
| Rate for Payer: BCBS Trust/PPO |
$369.76
|
| Rate for Payer: BCN Commercial |
$369.76
|
| Rate for Payer: Cash Price |
$358.17
|
| 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: Lakeland Regional Health Systems Commercial |
$335.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.55
|
| Rate for Payer: Nomi Health Commercial |
$367.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.78
|
| Rate for Payer: PHP Commercial |
$380.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$389.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.98
|
| Rate for Payer: UHC Core |
$373.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.78
|
|
|
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 |
$78.93 |
| Max. Negotiated Rate |
$402.94 |
| Rate for Payer: Aetna Commercial |
$380.55
|
| Rate for Payer: Aetna Medicare |
$116.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.91
|
| Rate for Payer: BCBS Complete |
$82.87
|
| Rate for Payer: BCBS MAPPO |
$111.93
|
| Rate for Payer: BCBS Trust/PPO |
$368.06
|
| Rate for Payer: BCN Commercial |
$368.06
|
| Rate for Payer: BCN Medicare Advantage |
$111.93
|
| Rate for Payer: Cash Price |
$358.17
|
| 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 |
$111.93
|
| Rate for Payer: Healthscope Commercial |
$402.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.78
|
| Rate for Payer: Mclaren Medicaid |
$78.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.52
|
| Rate for Payer: Meridian Medicaid |
$82.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.55
|
| Rate for Payer: Nomi Health Commercial |
$367.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.78
|
| Rate for Payer: PACE Senior Care Partners |
$106.33
|
| Rate for Payer: PACE SWMI |
$111.93
|
| Rate for Payer: PHP Commercial |
$380.55
|
| Rate for Payer: PHP Medicare Advantage |
$111.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$389.51
|
| Rate for Payer: Priority Health Medicare |
$113.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.61
|
| Rate for Payer: Railroad Medicare Medicare |
$111.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.98
|
| Rate for Payer: UHC Core |
$373.84
|
| Rate for Payer: UHC Exchange |
$111.93
|
| Rate for Payer: UHC Medicaid |
$78.93
|
| Rate for Payer: UHC Medicare Advantage |
$111.93
|
| Rate for Payer: UHCCP Medicaid |
$78.93
|
| Rate for Payer: VA VA |
$111.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.78
|
|
|
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 |
$74.18 |
| Max. Negotiated Rate |
$378.69 |
| Rate for Payer: Aetna Commercial |
$357.65
|
| Rate for Payer: Aetna Medicare |
$109.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.49
|
| Rate for Payer: BCBS Complete |
$77.88
|
| Rate for Payer: BCBS MAPPO |
$105.19
|
| Rate for Payer: BCBS Trust/PPO |
$345.92
|
| Rate for Payer: BCN Commercial |
$345.92
|
| Rate for Payer: BCN Medicare Advantage |
$105.19
|
| Rate for Payer: Cash Price |
$336.62
|
| 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 |
$105.19
|
| Rate for Payer: Healthscope Commercial |
$378.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.58
|
| Rate for Payer: Mclaren Medicaid |
$74.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.45
|
| Rate for Payer: Meridian Medicaid |
$77.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.65
|
| Rate for Payer: Nomi Health Commercial |
$345.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.58
|
| Rate for Payer: PACE Senior Care Partners |
$99.93
|
| Rate for Payer: PACE SWMI |
$105.19
|
| Rate for Payer: PHP Commercial |
$357.65
|
| Rate for Payer: PHP Medicare Advantage |
$105.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$366.07
|
| Rate for Payer: Priority Health Medicare |
$106.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.86
|
| Rate for Payer: Railroad Medicare Medicare |
$105.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.28
|
| Rate for Payer: UHC Core |
$351.34
|
| Rate for Payer: UHC Exchange |
$105.19
|
| Rate for Payer: UHC Medicaid |
$74.18
|
| Rate for Payer: UHC Medicare Advantage |
$105.19
|
| Rate for Payer: UHCCP Medicaid |
$74.18
|
| Rate for Payer: VA VA |
$105.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.58
|
|
|
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 |
$292.86 |
| Max. Negotiated Rate |
$378.69 |
| Rate for Payer: Aetna Commercial |
$357.65
|
| Rate for Payer: BCBS Trust/PPO |
$347.51
|
| Rate for Payer: BCN Commercial |
$347.51
|
| Rate for Payer: Cash Price |
$336.62
|
| 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: Lakeland Regional Health Systems Commercial |
$315.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.65
|
| Rate for Payer: Nomi Health Commercial |
$345.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.58
|
| Rate for Payer: PHP Commercial |
$357.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$366.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.28
|
| Rate for Payer: UHC Core |
$351.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.58
|
|
|
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 |
$38.09 |
| Max. Negotiated Rate |
$194.43 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna Medicare |
$56.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.51
|
| Rate for Payer: BCBS Complete |
$39.99
|
| Rate for Payer: BCBS MAPPO |
$54.01
|
| Rate for Payer: BCBS Trust/PPO |
$177.60
|
| Rate for Payer: BCN Commercial |
$177.60
|
| Rate for Payer: BCN Medicare Advantage |
$54.01
|
| Rate for Payer: Cash Price |
$172.82
|
| 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 |
$54.01
|
| Rate for Payer: Healthscope Commercial |
$194.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.02
|
| Rate for Payer: Mclaren Medicaid |
$38.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.71
|
| Rate for Payer: Meridian Medicaid |
$39.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$177.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.02
|
| Rate for Payer: PACE Senior Care Partners |
$51.31
|
| Rate for Payer: PACE SWMI |
$54.01
|
| Rate for Payer: PHP Commercial |
$183.63
|
| Rate for Payer: PHP Medicare Advantage |
$54.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.95
|
| Rate for Payer: Priority Health Medicare |
$54.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.36
|
| Rate for Payer: Railroad Medicare Medicare |
$54.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.11
|
| Rate for Payer: UHC Core |
$180.39
|
| Rate for Payer: UHC Exchange |
$54.01
|
| Rate for Payer: UHC Medicaid |
$38.09
|
| Rate for Payer: UHC Medicare Advantage |
$54.01
|
| Rate for Payer: UHCCP Medicaid |
$38.09
|
| Rate for Payer: VA VA |
$54.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.02
|
|
|
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 |
$150.36 |
| Max. Negotiated Rate |
$194.43 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: BCBS Trust/PPO |
$178.42
|
| Rate for Payer: BCN Commercial |
$178.42
|
| Rate for Payer: Cash Price |
$172.82
|
| 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: Lakeland Regional Health Systems Commercial |
$162.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$177.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.02
|
| Rate for Payer: PHP Commercial |
$183.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.11
|
| Rate for Payer: UHC Core |
$180.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.02
|
|
|
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 |
$71.35 |
| Max. Negotiated Rate |
$364.26 |
| Rate for Payer: Aetna Commercial |
$344.02
|
| Rate for Payer: Aetna Medicare |
$105.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.48
|
| Rate for Payer: BCBS Complete |
$74.92
|
| Rate for Payer: BCBS MAPPO |
$101.18
|
| Rate for Payer: BCBS Trust/PPO |
$332.73
|
| Rate for Payer: BCN Commercial |
$332.73
|
| Rate for Payer: BCN Medicare Advantage |
$101.18
|
| Rate for Payer: Cash Price |
$323.78
|
| 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 |
$101.18
|
| Rate for Payer: Healthscope Commercial |
$364.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.55
|
| Rate for Payer: Mclaren Medicaid |
$71.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.24
|
| Rate for Payer: Meridian Medicaid |
$74.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.02
|
| Rate for Payer: Nomi Health Commercial |
$331.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.55
|
| Rate for Payer: PACE Senior Care Partners |
$96.12
|
| Rate for Payer: PACE SWMI |
$101.18
|
| Rate for Payer: PHP Commercial |
$344.02
|
| Rate for Payer: PHP Medicare Advantage |
$101.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.12
|
| Rate for Payer: Priority Health Medicare |
$102.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.69
|
| Rate for Payer: Railroad Medicare Medicare |
$101.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.16
|
| Rate for Payer: UHC Core |
$337.95
|
| Rate for Payer: UHC Exchange |
$101.18
|
| Rate for Payer: UHC Medicaid |
$71.35
|
| Rate for Payer: UHC Medicare Advantage |
$101.18
|
| Rate for Payer: UHCCP Medicaid |
$71.35
|
| Rate for Payer: VA VA |
$101.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.55
|
|
|
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 |
$281.69 |
| Max. Negotiated Rate |
$364.26 |
| Rate for Payer: Aetna Commercial |
$344.02
|
| Rate for Payer: BCBS Trust/PPO |
$334.27
|
| Rate for Payer: BCN Commercial |
$334.27
|
| Rate for Payer: Cash Price |
$323.78
|
| 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: Lakeland Regional Health Systems Commercial |
$303.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.02
|
| Rate for Payer: Nomi Health Commercial |
$331.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.55
|
| Rate for Payer: PHP Commercial |
$344.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.16
|
| Rate for Payer: UHC Core |
$337.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.55
|
|
|
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 |
$53.52 |
| Max. Negotiated Rate |
$273.20 |
| Rate for Payer: Aetna Commercial |
$258.03
|
| Rate for Payer: Aetna Medicare |
$78.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.86
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$75.89
|
| Rate for Payer: BCBS Trust/PPO |
$249.56
|
| Rate for Payer: BCN Commercial |
$249.56
|
| Rate for Payer: BCN Medicare Advantage |
$75.89
|
| Rate for Payer: Cash Price |
$242.85
|
| 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 |
$75.89
|
| Rate for Payer: Healthscope Commercial |
$273.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.67
|
| Rate for Payer: Mclaren Medicaid |
$53.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.68
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.03
|
| Rate for Payer: Nomi Health Commercial |
$248.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.67
|
| Rate for Payer: PACE Senior Care Partners |
$72.10
|
| Rate for Payer: PACE SWMI |
$75.89
|
| Rate for Payer: PHP Commercial |
$258.03
|
| Rate for Payer: PHP Medicare Advantage |
$75.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$264.10
|
| Rate for Payer: Priority Health Medicare |
$76.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.28
|
| Rate for Payer: Railroad Medicare Medicare |
$75.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.13
|
| Rate for Payer: UHC Core |
$253.47
|
| Rate for Payer: UHC Exchange |
$75.89
|
| Rate for Payer: UHC Medicaid |
$53.52
|
| Rate for Payer: UHC Medicare Advantage |
$75.89
|
| Rate for Payer: UHCCP Medicaid |
$53.52
|
| Rate for Payer: VA VA |
$75.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.67
|
|
|
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 |
$211.28 |
| Max. Negotiated Rate |
$273.20 |
| Rate for Payer: Aetna Commercial |
$258.03
|
| Rate for Payer: BCBS Trust/PPO |
$250.71
|
| Rate for Payer: BCN Commercial |
$250.71
|
| Rate for Payer: Cash Price |
$242.85
|
| 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: Lakeland Regional Health Systems Commercial |
$227.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.03
|
| Rate for Payer: Nomi Health Commercial |
$248.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.67
|
| Rate for Payer: PHP Commercial |
$258.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$264.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.13
|
| Rate for Payer: UHC Core |
$253.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.67
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
OP
|
$424.48
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.84 |
| Max. Negotiated Rate |
$382.03 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: Aetna Medicare |
$110.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.65
|
| Rate for Payer: BCBS Complete |
$78.57
|
| Rate for Payer: BCBS MAPPO |
$106.12
|
| Rate for Payer: BCBS Trust/PPO |
$348.97
|
| Rate for Payer: BCN Commercial |
$348.97
|
| Rate for Payer: BCN Medicare Advantage |
$106.12
|
| Rate for Payer: Cash Price |
$339.58
|
| Rate for Payer: Cofinity Commercial |
$365.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.12
|
| Rate for Payer: Healthscope Commercial |
$382.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.36
|
| Rate for Payer: Mclaren Medicaid |
$74.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.43
|
| Rate for Payer: Meridian Medicaid |
$78.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.81
|
| Rate for Payer: Nomi Health Commercial |
$348.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.36
|
| Rate for Payer: PACE Senior Care Partners |
$100.81
|
| Rate for Payer: PACE SWMI |
$106.12
|
| Rate for Payer: PHP Commercial |
$360.81
|
| Rate for Payer: PHP Medicare Advantage |
$106.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$369.30
|
| Rate for Payer: Priority Health Medicare |
$107.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.44
|
| Rate for Payer: Railroad Medicare Medicare |
$106.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.54
|
| Rate for Payer: UHC Core |
$354.44
|
| Rate for Payer: UHC Exchange |
$106.12
|
| Rate for Payer: UHC Medicaid |
$74.84
|
| Rate for Payer: UHC Medicare Advantage |
$106.12
|
| Rate for Payer: UHCCP Medicaid |
$74.84
|
| Rate for Payer: VA VA |
$106.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.36
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
IP
|
$424.48
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$295.44 |
| Max. Negotiated Rate |
$382.03 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: BCBS Trust/PPO |
$350.58
|
| Rate for Payer: BCN Commercial |
$350.58
|
| Rate for Payer: Cash Price |
$339.58
|
| 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: Lakeland Regional Health Systems Commercial |
$318.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.81
|
| Rate for Payer: Nomi Health Commercial |
$348.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.36
|
| Rate for Payer: PHP Commercial |
$360.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$369.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.54
|
| Rate for Payer: UHC Core |
$354.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.36
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$953.80
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$168.15 |
| Max. Negotiated Rate |
$858.42 |
| Rate for Payer: Aetna Commercial |
$810.73
|
| Rate for Payer: Aetna Medicare |
$247.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.06
|
| Rate for Payer: BCBS Complete |
$176.55
|
| Rate for Payer: BCBS MAPPO |
$238.45
|
| Rate for Payer: BCBS Trust/PPO |
$784.12
|
| Rate for Payer: BCN Commercial |
$784.12
|
| Rate for Payer: BCN Medicare Advantage |
$238.45
|
| Rate for Payer: Cash Price |
$763.04
|
| 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 |
$238.45
|
| Rate for Payer: Healthscope Commercial |
$858.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$715.35
|
| Rate for Payer: Mclaren Medicaid |
$168.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.37
|
| Rate for Payer: Meridian Medicaid |
$176.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$262.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.73
|
| Rate for Payer: Nomi Health Commercial |
$782.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.35
|
| Rate for Payer: PACE Senior Care Partners |
$226.53
|
| Rate for Payer: PACE SWMI |
$238.45
|
| Rate for Payer: PHP Commercial |
$810.73
|
| Rate for Payer: PHP Medicare Advantage |
$238.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$829.81
|
| Rate for Payer: Priority Health Medicare |
$240.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$663.84
|
| Rate for Payer: Railroad Medicare Medicare |
$238.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.34
|
| Rate for Payer: UHC Core |
$796.42
|
| Rate for Payer: UHC Exchange |
$238.45
|
| Rate for Payer: UHC Medicaid |
$168.15
|
| Rate for Payer: UHC Medicare Advantage |
$238.45
|
| Rate for Payer: UHCCP Medicaid |
$168.15
|
| Rate for Payer: VA VA |
$238.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$715.35
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$953.80
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$663.84 |
| Max. Negotiated Rate |
$858.42 |
| Rate for Payer: Aetna Commercial |
$810.73
|
| Rate for Payer: BCBS Trust/PPO |
$787.74
|
| Rate for Payer: BCN Commercial |
$787.74
|
| Rate for Payer: Cash Price |
$763.04
|
| 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: Lakeland Regional Health Systems Commercial |
$715.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.73
|
| Rate for Payer: Nomi Health Commercial |
$782.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.35
|
| Rate for Payer: PHP Commercial |
$810.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$829.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$663.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.34
|
| Rate for Payer: UHC Core |
$796.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$715.35
|
|
|
HC EP+PVI ABL
|
Facility
|
OP
|
$9,080.04
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,600.81 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna Medicare |
$2,360.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,837.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,837.51
|
| Rate for Payer: BCBS Complete |
$1,680.72
|
| Rate for Payer: BCBS MAPPO |
$2,270.01
|
| Rate for Payer: BCBS Trust/PPO |
$7,464.70
|
| Rate for Payer: BCN Commercial |
$7,464.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,270.01
|
| Rate for Payer: Cash Price |
$7,264.03
|
| 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 |
$2,270.01
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,810.03
|
| Rate for Payer: Mclaren Medicaid |
$1,600.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,383.51
|
| Rate for Payer: Meridian Medicaid |
$1,680.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,610.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,497.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Nomi Health Commercial |
$7,445.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PACE Senior Care Partners |
$2,156.51
|
| Rate for Payer: PACE SWMI |
$2,270.01
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: PHP Medicare Advantage |
$2,270.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,600.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,899.63
|
| Rate for Payer: Priority Health Medicare |
$2,292.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,319.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,270.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,990.44
|
| Rate for Payer: UHC Core |
$7,581.83
|
| Rate for Payer: UHC Exchange |
$2,270.01
|
| Rate for Payer: UHC Medicaid |
$1,600.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,270.01
|
| Rate for Payer: UHCCP Medicaid |
$1,600.81
|
| Rate for Payer: VA VA |
$2,270.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,810.03
|
|
