|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
OP
|
$691.87
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.32 |
| Max. Negotiated Rate |
$622.68 |
| Rate for Payer: Aetna Commercial |
$588.09
|
| Rate for Payer: Aetna Medicare |
$179.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.21
|
| Rate for Payer: BCBS Complete |
$276.75
|
| Rate for Payer: BCBS MAPPO |
$172.97
|
| Rate for Payer: BCBS Trust/PPO |
$568.79
|
| Rate for Payer: BCN Commercial |
$537.93
|
| Rate for Payer: BCN Medicare Advantage |
$172.97
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cofinity Commercial |
$595.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.97
|
| Rate for Payer: Healthscope Commercial |
$622.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.09
|
| Rate for Payer: Nomi Health Commercial |
$567.33
|
| Rate for Payer: PACE Senior Care Partners |
$164.32
|
| Rate for Payer: PACE SWMI |
$172.97
|
| Rate for Payer: PHP Commercial |
$588.09
|
| Rate for Payer: PHP Medicare Advantage |
$172.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.72
|
| Rate for Payer: Priority Health HMO/PPO |
$601.93
|
| Rate for Payer: Priority Health Medicare |
$174.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.55
|
| Rate for Payer: Railroad Medicare Medicare |
$172.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.85
|
| Rate for Payer: UHC Core |
$577.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.97
|
| Rate for Payer: UHC Exchange |
$172.97
|
| Rate for Payer: UHC Medicare Advantage |
$172.97
|
| Rate for Payer: VA VA |
$172.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.90
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
IP
|
$691.87
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$449.72 |
| Max. Negotiated Rate |
$622.68 |
| Rate for Payer: Aetna Commercial |
$588.09
|
| Rate for Payer: BCBS Trust/PPO |
$564.77
|
| Rate for Payer: BCN Commercial |
$534.68
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cofinity Commercial |
$595.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.50
|
| Rate for Payer: Healthscope Commercial |
$622.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.09
|
| Rate for Payer: Nomi Health Commercial |
$567.33
|
| Rate for Payer: PHP Commercial |
$588.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.72
|
| Rate for Payer: Priority Health HMO/PPO |
$601.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.85
|
| Rate for Payer: UHC Core |
$577.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.90
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.35 |
| Max. Negotiated Rate |
$446.33 |
| Rate for Payer: Aetna Commercial |
$421.53
|
| Rate for Payer: BCBS Trust/PPO |
$404.82
|
| Rate for Payer: BCN Commercial |
$383.25
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$426.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Healthscope Commercial |
$446.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: Nomi Health Commercial |
$406.65
|
| Rate for Payer: PHP Commercial |
$421.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: Priority Health HMO/PPO |
$431.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.41
|
| Rate for Payer: UHC Core |
$414.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.94
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.78 |
| Max. Negotiated Rate |
$446.33 |
| Rate for Payer: Aetna Commercial |
$421.53
|
| Rate for Payer: Aetna Medicare |
$128.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.98
|
| Rate for Payer: BCBS Complete |
$198.37
|
| Rate for Payer: BCBS MAPPO |
$123.98
|
| Rate for Payer: BCBS Trust/PPO |
$407.70
|
| Rate for Payer: BCN Commercial |
$385.58
|
| Rate for Payer: BCN Medicare Advantage |
$123.98
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$426.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.98
|
| Rate for Payer: Healthscope Commercial |
$446.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: Nomi Health Commercial |
$406.65
|
| Rate for Payer: PACE Senior Care Partners |
$117.78
|
| Rate for Payer: PACE SWMI |
$123.98
|
| Rate for Payer: PHP Commercial |
$421.53
|
| Rate for Payer: PHP Medicare Advantage |
$123.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: Priority Health HMO/PPO |
$431.45
|
| Rate for Payer: Priority Health Medicare |
$125.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.27
|
| Rate for Payer: Railroad Medicare Medicare |
$123.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.41
|
| Rate for Payer: UHC Core |
$414.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.98
|
| Rate for Payer: UHC Exchange |
$123.98
|
| Rate for Payer: UHC Medicare Advantage |
$123.98
|
| Rate for Payer: VA VA |
$123.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.94
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
OP
|
$438.93
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$395.04 |
| Rate for Payer: Aetna Commercial |
$373.09
|
| Rate for Payer: Aetna Medicare |
$114.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.17
|
| Rate for Payer: BCBS Complete |
$175.57
|
| Rate for Payer: BCBS MAPPO |
$109.73
|
| Rate for Payer: BCBS Trust/PPO |
$360.84
|
| Rate for Payer: BCN Commercial |
$341.27
|
| Rate for Payer: BCN Medicare Advantage |
$109.73
|
| Rate for Payer: Cash Price |
$351.14
|
| Rate for Payer: Cofinity Commercial |
$377.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.73
|
| Rate for Payer: Healthscope Commercial |
$395.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.09
|
| Rate for Payer: Nomi Health Commercial |
$359.92
|
| Rate for Payer: PACE Senior Care Partners |
$104.25
|
| Rate for Payer: PACE SWMI |
$109.73
|
| Rate for Payer: PHP Commercial |
$373.09
|
| Rate for Payer: PHP Medicare Advantage |
$109.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.30
|
| Rate for Payer: Priority Health HMO/PPO |
$381.87
|
| Rate for Payer: Priority Health Medicare |
$110.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.08
|
| Rate for Payer: Railroad Medicare Medicare |
$109.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.26
|
| Rate for Payer: UHC Core |
$366.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.73
|
| Rate for Payer: UHC Exchange |
$109.73
|
| Rate for Payer: UHC Medicare Advantage |
$109.73
|
| Rate for Payer: VA VA |
$109.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.20
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
IP
|
$438.93
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.30 |
| Max. Negotiated Rate |
$395.04 |
| Rate for Payer: Aetna Commercial |
$373.09
|
| Rate for Payer: BCBS Trust/PPO |
$358.30
|
| Rate for Payer: BCN Commercial |
$339.21
|
| Rate for Payer: Cash Price |
$351.14
|
| Rate for Payer: Cofinity Commercial |
$377.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.14
|
| Rate for Payer: Healthscope Commercial |
$395.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.09
|
| Rate for Payer: Nomi Health Commercial |
$359.92
|
| Rate for Payer: PHP Commercial |
$373.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.30
|
| Rate for Payer: Priority Health HMO/PPO |
$381.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.26
|
| Rate for Payer: UHC Core |
$366.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.20
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
IP
|
$412.52
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.14 |
| Max. Negotiated Rate |
$371.27 |
| Rate for Payer: Aetna Commercial |
$350.64
|
| Rate for Payer: BCBS Trust/PPO |
$336.74
|
| Rate for Payer: BCN Commercial |
$318.80
|
| Rate for Payer: Cash Price |
$330.02
|
| Rate for Payer: Cofinity Commercial |
$354.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.02
|
| Rate for Payer: Healthscope Commercial |
$371.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.64
|
| Rate for Payer: Nomi Health Commercial |
$338.27
|
| Rate for Payer: PHP Commercial |
$350.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: Priority Health HMO/PPO |
$358.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.02
|
| Rate for Payer: UHC Core |
$344.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.39
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
OP
|
$412.52
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.97 |
| Max. Negotiated Rate |
$371.27 |
| Rate for Payer: Aetna Commercial |
$350.64
|
| Rate for Payer: Aetna Medicare |
$107.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.91
|
| Rate for Payer: BCBS Complete |
$165.01
|
| Rate for Payer: BCBS MAPPO |
$103.13
|
| Rate for Payer: BCBS Trust/PPO |
$339.13
|
| Rate for Payer: BCN Commercial |
$320.73
|
| Rate for Payer: BCN Medicare Advantage |
$103.13
|
| Rate for Payer: Cash Price |
$330.02
|
| Rate for Payer: Cofinity Commercial |
$354.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.13
|
| Rate for Payer: Healthscope Commercial |
$371.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.64
|
| Rate for Payer: Nomi Health Commercial |
$338.27
|
| Rate for Payer: PACE Senior Care Partners |
$97.97
|
| Rate for Payer: PACE SWMI |
$103.13
|
| Rate for Payer: PHP Commercial |
$350.64
|
| Rate for Payer: PHP Medicare Advantage |
$103.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: Priority Health HMO/PPO |
$358.89
|
| Rate for Payer: Priority Health Medicare |
$104.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.39
|
| Rate for Payer: Railroad Medicare Medicare |
$103.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.02
|
| Rate for Payer: UHC Core |
$344.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.13
|
| Rate for Payer: UHC Exchange |
$103.13
|
| Rate for Payer: UHC Medicare Advantage |
$103.13
|
| Rate for Payer: VA VA |
$103.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.39
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
OP
|
$211.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.30 |
| Max. Negotiated Rate |
$190.61 |
| Rate for Payer: Aetna Commercial |
$180.02
|
| Rate for Payer: Aetna Medicare |
$55.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.18
|
| Rate for Payer: BCBS Complete |
$84.72
|
| Rate for Payer: BCBS MAPPO |
$52.95
|
| Rate for Payer: BCBS Trust/PPO |
$174.11
|
| Rate for Payer: BCN Commercial |
$164.67
|
| Rate for Payer: BCN Medicare Advantage |
$52.95
|
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Cofinity Commercial |
$182.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.95
|
| Rate for Payer: Healthscope Commercial |
$190.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.02
|
| Rate for Payer: Nomi Health Commercial |
$173.67
|
| Rate for Payer: PACE Senior Care Partners |
$50.30
|
| Rate for Payer: PACE SWMI |
$52.95
|
| Rate for Payer: PHP Commercial |
$180.02
|
| Rate for Payer: PHP Medicare Advantage |
$52.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: Priority Health HMO/PPO |
$184.26
|
| Rate for Payer: Priority Health Medicare |
$53.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.90
|
| Rate for Payer: Railroad Medicare Medicare |
$52.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.38
|
| Rate for Payer: UHC Core |
$176.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.95
|
| Rate for Payer: UHC Exchange |
$52.95
|
| Rate for Payer: UHC Medicare Advantage |
$52.95
|
| Rate for Payer: VA VA |
$52.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.84
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
IP
|
$211.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$190.61 |
| Rate for Payer: Aetna Commercial |
$180.02
|
| Rate for Payer: BCBS Trust/PPO |
$172.88
|
| Rate for Payer: BCN Commercial |
$163.67
|
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Cofinity Commercial |
$182.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.43
|
| Rate for Payer: Healthscope Commercial |
$190.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.02
|
| Rate for Payer: Nomi Health Commercial |
$173.67
|
| Rate for Payer: PHP Commercial |
$180.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: Priority Health HMO/PPO |
$184.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.38
|
| Rate for Payer: UHC Core |
$176.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.84
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
IP
|
$396.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.91 |
| Max. Negotiated Rate |
$357.11 |
| Rate for Payer: Aetna Commercial |
$337.27
|
| Rate for Payer: BCBS Trust/PPO |
$323.90
|
| Rate for Payer: BCN Commercial |
$306.64
|
| Rate for Payer: Cash Price |
$317.43
|
| Rate for Payer: Cofinity Commercial |
$341.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.43
|
| Rate for Payer: Healthscope Commercial |
$357.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.27
|
| Rate for Payer: Nomi Health Commercial |
$325.37
|
| Rate for Payer: PHP Commercial |
$337.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.91
|
| Rate for Payer: Priority Health HMO/PPO |
$345.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.18
|
| Rate for Payer: UHC Core |
$331.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.59
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
OP
|
$396.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.24 |
| Max. Negotiated Rate |
$357.11 |
| Rate for Payer: Aetna Commercial |
$337.27
|
| Rate for Payer: Aetna Medicare |
$103.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.00
|
| Rate for Payer: BCBS Complete |
$158.72
|
| Rate for Payer: BCBS MAPPO |
$99.20
|
| Rate for Payer: BCBS Trust/PPO |
$326.20
|
| Rate for Payer: BCN Commercial |
$308.50
|
| Rate for Payer: BCN Medicare Advantage |
$99.20
|
| Rate for Payer: Cash Price |
$317.43
|
| Rate for Payer: Cofinity Commercial |
$341.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$357.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.27
|
| Rate for Payer: Nomi Health Commercial |
$325.37
|
| Rate for Payer: PACE Senior Care Partners |
$94.24
|
| Rate for Payer: PACE SWMI |
$99.20
|
| Rate for Payer: PHP Commercial |
$337.27
|
| Rate for Payer: PHP Medicare Advantage |
$99.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.91
|
| Rate for Payer: Priority Health HMO/PPO |
$345.21
|
| Rate for Payer: Priority Health Medicare |
$100.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.85
|
| Rate for Payer: Railroad Medicare Medicare |
$99.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.18
|
| Rate for Payer: UHC Core |
$331.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.20
|
| Rate for Payer: UHC Exchange |
$99.20
|
| Rate for Payer: UHC Medicare Advantage |
$99.20
|
| Rate for Payer: VA VA |
$99.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.59
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
OP
|
$297.61
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$267.85 |
| Rate for Payer: Aetna Commercial |
$252.97
|
| Rate for Payer: Aetna Medicare |
$77.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.00
|
| Rate for Payer: BCBS Complete |
$119.04
|
| Rate for Payer: BCBS MAPPO |
$74.40
|
| Rate for Payer: BCBS Trust/PPO |
$244.67
|
| Rate for Payer: BCN Commercial |
$231.39
|
| Rate for Payer: BCN Medicare Advantage |
$74.40
|
| Rate for Payer: Cash Price |
$238.09
|
| Rate for Payer: Cofinity Commercial |
$255.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.40
|
| Rate for Payer: Healthscope Commercial |
$267.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.97
|
| Rate for Payer: Nomi Health Commercial |
$244.04
|
| Rate for Payer: PACE Senior Care Partners |
$70.68
|
| Rate for Payer: PACE SWMI |
$74.40
|
| Rate for Payer: PHP Commercial |
$252.97
|
| Rate for Payer: PHP Medicare Advantage |
$74.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.45
|
| Rate for Payer: Priority Health HMO/PPO |
$258.92
|
| Rate for Payer: Priority Health Medicare |
$75.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.40
|
| Rate for Payer: Railroad Medicare Medicare |
$74.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.90
|
| Rate for Payer: UHC Core |
$248.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.40
|
| Rate for Payer: UHC Exchange |
$74.40
|
| Rate for Payer: UHC Medicare Advantage |
$74.40
|
| Rate for Payer: VA VA |
$74.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.21
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
IP
|
$297.61
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.45 |
| Max. Negotiated Rate |
$267.85 |
| Rate for Payer: Aetna Commercial |
$252.97
|
| Rate for Payer: BCBS Trust/PPO |
$242.94
|
| Rate for Payer: BCN Commercial |
$229.99
|
| Rate for Payer: Cash Price |
$238.09
|
| Rate for Payer: Cofinity Commercial |
$255.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.09
|
| Rate for Payer: Healthscope Commercial |
$267.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.97
|
| Rate for Payer: Nomi Health Commercial |
$244.04
|
| Rate for Payer: PHP Commercial |
$252.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.45
|
| Rate for Payer: Priority Health HMO/PPO |
$258.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.90
|
| Rate for Payer: UHC Core |
$248.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.21
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
OP
|
$416.16
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.84 |
| Max. Negotiated Rate |
$374.54 |
| Rate for Payer: Aetna Commercial |
$353.74
|
| Rate for Payer: Aetna Medicare |
$108.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.05
|
| Rate for Payer: BCBS Complete |
$166.46
|
| Rate for Payer: BCBS MAPPO |
$104.04
|
| Rate for Payer: BCBS Trust/PPO |
$342.13
|
| Rate for Payer: BCN Commercial |
$323.56
|
| Rate for Payer: BCN Medicare Advantage |
$104.04
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Commercial |
$357.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$374.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Nomi Health Commercial |
$341.25
|
| Rate for Payer: PACE Senior Care Partners |
$98.84
|
| Rate for Payer: PACE SWMI |
$104.04
|
| Rate for Payer: PHP Commercial |
$353.74
|
| Rate for Payer: PHP Medicare Advantage |
$104.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.50
|
| Rate for Payer: Priority Health HMO/PPO |
$362.06
|
| Rate for Payer: Priority Health Medicare |
$105.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.83
|
| Rate for Payer: Railroad Medicare Medicare |
$104.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.22
|
| Rate for Payer: UHC Core |
$347.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.04
|
| Rate for Payer: UHC Exchange |
$104.04
|
| Rate for Payer: UHC Medicare Advantage |
$104.04
|
| Rate for Payer: VA VA |
$104.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.12
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
IP
|
$416.16
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$270.50 |
| Max. Negotiated Rate |
$374.54 |
| Rate for Payer: Aetna Commercial |
$353.74
|
| Rate for Payer: BCBS Trust/PPO |
$339.71
|
| Rate for Payer: BCN Commercial |
$321.61
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Commercial |
$357.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$374.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Nomi Health Commercial |
$341.25
|
| Rate for Payer: PHP Commercial |
$353.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.50
|
| Rate for Payer: Priority Health HMO/PPO |
$362.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.22
|
| Rate for Payer: UHC Core |
$347.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.12
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$935.10
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$607.82 |
| Max. Negotiated Rate |
$841.59 |
| Rate for Payer: Aetna Commercial |
$794.84
|
| Rate for Payer: BCBS Trust/PPO |
$763.32
|
| Rate for Payer: BCN Commercial |
$722.65
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cofinity Commercial |
$804.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.08
|
| Rate for Payer: Healthscope Commercial |
$841.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$701.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.84
|
| Rate for Payer: Nomi Health Commercial |
$766.78
|
| Rate for Payer: PHP Commercial |
$794.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.82
|
| Rate for Payer: Priority Health HMO/PPO |
$813.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$626.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.89
|
| Rate for Payer: UHC Core |
$780.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$701.32
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$935.10
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$841.59 |
| Rate for Payer: Aetna Commercial |
$794.84
|
| Rate for Payer: Aetna Medicare |
$243.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.22
|
| Rate for Payer: BCBS Complete |
$231.63
|
| Rate for Payer: BCBS MAPPO |
$233.78
|
| Rate for Payer: BCBS Trust/PPO |
$768.75
|
| Rate for Payer: BCN Commercial |
$727.04
|
| Rate for Payer: BCN Medicare Advantage |
$233.78
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cofinity Commercial |
$804.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.78
|
| Rate for Payer: Healthscope Commercial |
$841.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$701.32
|
| Rate for Payer: Mclaren Medicaid |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.46
|
| Rate for Payer: Meridian Medicaid |
$231.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.84
|
| Rate for Payer: Nomi Health Commercial |
$766.78
|
| Rate for Payer: PACE Senior Care Partners |
$222.09
|
| Rate for Payer: PACE SWMI |
$233.78
|
| Rate for Payer: PHP Commercial |
$794.84
|
| Rate for Payer: PHP Medicare Advantage |
$233.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.82
|
| Rate for Payer: Priority Health HMO/PPO |
$813.54
|
| Rate for Payer: Priority Health Medicare |
$236.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$626.52
|
| Rate for Payer: Railroad Medicare Medicare |
$233.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.89
|
| Rate for Payer: UHC Core |
$780.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.78
|
| Rate for Payer: UHC Exchange |
$233.78
|
| Rate for Payer: UHC Medicare Advantage |
$233.78
|
| Rate for Payer: UHCCP Medicaid |
$220.59
|
| Rate for Payer: VA VA |
$233.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$701.32
|
|
|
HC EP+PVI ABL
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,786.30 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: BCBS Trust/PPO |
$7,266.70
|
| Rate for Payer: BCN Commercial |
$6,879.47
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC EP+PVI ABL
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,114.22 |
| Max. Negotiated Rate |
$18,248.33 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna Medicare |
$2,314.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,781.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,781.88
|
| Rate for Payer: BCBS Complete |
$18,248.33
|
| Rate for Payer: BCBS MAPPO |
$2,225.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,318.33
|
| Rate for Payer: BCN Commercial |
$6,921.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,225.50
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,225.50
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Mclaren Medicaid |
$17,378.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,336.78
|
| Rate for Payer: Meridian Medicaid |
$18,248.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,559.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PACE Senior Care Partners |
$2,114.22
|
| Rate for Payer: PACE SWMI |
$2,225.50
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,225.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,378.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Medicare |
$2,247.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,225.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,225.50
|
| Rate for Payer: UHC Exchange |
$2,225.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,225.50
|
| Rate for Payer: UHCCP Medicaid |
$17,378.22
|
| Rate for Payer: VA VA |
$2,225.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.57
|
| Rate for Payer: BCN Commercial |
$28.94
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$9.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: BCBS Complete |
$13.77
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$30.79
|
| Rate for Payer: BCN Commercial |
$29.12
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$13.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: Meridian Medicaid |
$13.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PACE Senior Care Partners |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Medicare |
$9.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.09
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.36
|
| Rate for Payer: UHC Exchange |
$9.36
|
| Rate for Payer: UHC Medicare Advantage |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$13.12
|
| Rate for Payer: VA VA |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.57
|
| Rate for Payer: BCN Commercial |
$28.94
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$9.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: BCBS Complete |
$13.77
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$30.79
|
| Rate for Payer: BCN Commercial |
$29.12
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$13.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: Meridian Medicaid |
$13.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PACE Senior Care Partners |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Medicare |
$9.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.09
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.36
|
| Rate for Payer: UHC Exchange |
$9.36
|
| Rate for Payer: UHC Medicare Advantage |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$13.12
|
| Rate for Payer: VA VA |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.57
|
| Rate for Payer: BCN Commercial |
$28.94
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
