|
HC EP AFTER DRUGS
|
Facility
|
IP
|
$7,423.93
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,825.55 |
| Max. Negotiated Rate |
$6,681.54 |
| Rate for Payer: Aetna Commercial |
$6,310.34
|
| Rate for Payer: BCBS Trust/PPO |
$6,060.15
|
| Rate for Payer: BCN Commercial |
$5,737.21
|
| Rate for Payer: Cash Price |
$5,939.14
|
| Rate for Payer: Cofinity Commercial |
$6,384.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,939.14
|
| Rate for Payer: Healthscope Commercial |
$6,681.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,567.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,310.34
|
| Rate for Payer: Nomi Health Commercial |
$6,087.62
|
| Rate for Payer: PHP Commercial |
$6,310.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,825.55
|
| Rate for Payer: Priority Health HMO/PPO |
$6,458.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,974.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,533.06
|
| Rate for Payer: UHC Core |
$6,198.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,567.95
|
|
|
HC EP AFTER DRUGS
|
Facility
|
OP
|
$7,423.93
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,763.18 |
| Max. Negotiated Rate |
$6,681.54 |
| Rate for Payer: Aetna Commercial |
$6,310.34
|
| Rate for Payer: Aetna Medicare |
$1,930.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,319.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,319.98
|
| Rate for Payer: BCBS Complete |
$2,969.57
|
| Rate for Payer: BCBS MAPPO |
$1,855.98
|
| Rate for Payer: BCBS Trust/PPO |
$6,103.21
|
| Rate for Payer: BCN Commercial |
$5,772.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,855.98
|
| Rate for Payer: Cash Price |
$5,939.14
|
| Rate for Payer: Cofinity Commercial |
$6,384.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,939.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,855.98
|
| Rate for Payer: Healthscope Commercial |
$6,681.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,567.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,948.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,134.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,310.34
|
| Rate for Payer: Nomi Health Commercial |
$6,087.62
|
| Rate for Payer: PACE Senior Care Partners |
$1,763.18
|
| Rate for Payer: PACE SWMI |
$1,855.98
|
| Rate for Payer: PHP Commercial |
$6,310.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,855.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,825.55
|
| Rate for Payer: Priority Health HMO/PPO |
$6,458.82
|
| Rate for Payer: Priority Health Medicare |
$1,874.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,974.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,855.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,533.06
|
| Rate for Payer: UHC Core |
$6,198.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,855.98
|
| Rate for Payer: UHC Exchange |
$1,855.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,855.98
|
| Rate for Payer: VA VA |
$1,855.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,567.95
|
|
|
HC EP EVAL OF SQ ICD
|
Facility
|
OP
|
$3,342.81
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
48000027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$793.92 |
| Max. Negotiated Rate |
$3,008.53 |
| Rate for Payer: Aetna Commercial |
$2,841.39
|
| Rate for Payer: Aetna Medicare |
$869.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,044.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,044.63
|
| Rate for Payer: BCBS Complete |
$1,337.12
|
| Rate for Payer: BCBS MAPPO |
$835.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,748.12
|
| Rate for Payer: BCN Commercial |
$2,599.03
|
| Rate for Payer: BCN Medicare Advantage |
$835.70
|
| Rate for Payer: Cash Price |
$2,674.25
|
| Rate for Payer: Cofinity Commercial |
$2,874.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.70
|
| Rate for Payer: Healthscope Commercial |
$3,008.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$961.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.39
|
| Rate for Payer: Nomi Health Commercial |
$2,741.10
|
| Rate for Payer: PACE Senior Care Partners |
$793.92
|
| Rate for Payer: PACE SWMI |
$835.70
|
| Rate for Payer: PHP Commercial |
$2,841.39
|
| Rate for Payer: PHP Medicare Advantage |
$835.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.83
|
| Rate for Payer: Priority Health HMO/PPO |
$2,908.24
|
| Rate for Payer: Priority Health Medicare |
$844.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,239.68
|
| Rate for Payer: Railroad Medicare Medicare |
$835.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,941.67
|
| Rate for Payer: UHC Core |
$2,791.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.70
|
| Rate for Payer: UHC Exchange |
$835.70
|
| Rate for Payer: UHC Medicare Advantage |
$835.70
|
| Rate for Payer: VA VA |
$835.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.11
|
|
|
HC EP EVAL OF SQ ICD
|
Facility
|
IP
|
$3,342.81
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
48000027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,172.83 |
| Max. Negotiated Rate |
$3,008.53 |
| Rate for Payer: Aetna Commercial |
$2,841.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,728.74
|
| Rate for Payer: BCN Commercial |
$2,583.32
|
| Rate for Payer: Cash Price |
$2,674.25
|
| Rate for Payer: Cofinity Commercial |
$2,874.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.25
|
| Rate for Payer: Healthscope Commercial |
$3,008.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.39
|
| Rate for Payer: Nomi Health Commercial |
$2,741.10
|
| Rate for Payer: PHP Commercial |
$2,841.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.83
|
| Rate for Payer: Priority Health HMO/PPO |
$2,908.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,239.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,941.67
|
| Rate for Payer: UHC Core |
$2,791.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.11
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
OP
|
$2,388.64
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$567.30 |
| Max. Negotiated Rate |
$2,149.78 |
| Rate for Payer: Aetna Commercial |
$2,030.34
|
| Rate for Payer: Aetna Medicare |
$621.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.45
|
| Rate for Payer: BCBS Complete |
$955.46
|
| Rate for Payer: BCBS MAPPO |
$597.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,963.70
|
| Rate for Payer: BCN Commercial |
$1,857.17
|
| Rate for Payer: BCN Medicare Advantage |
$597.16
|
| Rate for Payer: Cash Price |
$1,910.91
|
| Rate for Payer: Cofinity Commercial |
$2,054.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,910.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.16
|
| Rate for Payer: Healthscope Commercial |
$2,149.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,791.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,030.34
|
| Rate for Payer: Nomi Health Commercial |
$1,958.68
|
| Rate for Payer: PACE Senior Care Partners |
$567.30
|
| Rate for Payer: PACE SWMI |
$597.16
|
| Rate for Payer: PHP Commercial |
$2,030.34
|
| Rate for Payer: PHP Medicare Advantage |
$597.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.62
|
| Rate for Payer: Priority Health HMO/PPO |
$2,078.12
|
| Rate for Payer: Priority Health Medicare |
$603.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,600.39
|
| Rate for Payer: Railroad Medicare Medicare |
$597.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,102.00
|
| Rate for Payer: UHC Core |
$1,994.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.16
|
| Rate for Payer: UHC Exchange |
$597.16
|
| Rate for Payer: UHC Medicare Advantage |
$597.16
|
| Rate for Payer: VA VA |
$597.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,791.48
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
IP
|
$2,388.64
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,552.62 |
| Max. Negotiated Rate |
$2,149.78 |
| Rate for Payer: Aetna Commercial |
$2,030.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.85
|
| Rate for Payer: BCN Commercial |
$1,845.94
|
| Rate for Payer: Cash Price |
$1,910.91
|
| Rate for Payer: Cofinity Commercial |
$2,054.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,910.91
|
| Rate for Payer: Healthscope Commercial |
$2,149.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,791.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,030.34
|
| Rate for Payer: Nomi Health Commercial |
$1,958.68
|
| Rate for Payer: PHP Commercial |
$2,030.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.62
|
| Rate for Payer: Priority Health HMO/PPO |
$2,078.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,600.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,102.00
|
| Rate for Payer: UHC Core |
$1,994.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,791.48
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
OP
|
$2,189.46
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,970.51 |
| Rate for Payer: Aetna Commercial |
$1,861.04
|
| Rate for Payer: Aetna Medicare |
$569.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$684.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$684.21
|
| Rate for Payer: BCBS Complete |
$875.78
|
| Rate for Payer: BCBS MAPPO |
$547.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.96
|
| Rate for Payer: BCN Commercial |
$1,702.31
|
| Rate for Payer: BCN Medicare Advantage |
$547.37
|
| Rate for Payer: Cash Price |
$1,751.57
|
| Rate for Payer: Cofinity Commercial |
$1,882.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.37
|
| Rate for Payer: Healthscope Commercial |
$1,970.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,642.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$629.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.04
|
| Rate for Payer: Nomi Health Commercial |
$1,795.36
|
| Rate for Payer: PACE Senior Care Partners |
$520.00
|
| Rate for Payer: PACE SWMI |
$547.37
|
| Rate for Payer: PHP Commercial |
$1,861.04
|
| Rate for Payer: PHP Medicare Advantage |
$547.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,904.83
|
| Rate for Payer: Priority Health Medicare |
$552.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,466.94
|
| Rate for Payer: Railroad Medicare Medicare |
$547.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,926.72
|
| Rate for Payer: UHC Core |
$1,828.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$547.37
|
| Rate for Payer: UHC Exchange |
$547.37
|
| Rate for Payer: UHC Medicare Advantage |
$547.37
|
| Rate for Payer: VA VA |
$547.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,642.10
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
IP
|
$2,189.46
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,423.15 |
| Max. Negotiated Rate |
$1,970.51 |
| Rate for Payer: Aetna Commercial |
$1,861.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,787.26
|
| Rate for Payer: BCN Commercial |
$1,692.01
|
| Rate for Payer: Cash Price |
$1,751.57
|
| Rate for Payer: Cofinity Commercial |
$1,882.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.57
|
| Rate for Payer: Healthscope Commercial |
$1,970.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,642.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.04
|
| Rate for Payer: Nomi Health Commercial |
$1,795.36
|
| Rate for Payer: PHP Commercial |
$1,861.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,904.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,466.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,926.72
|
| Rate for Payer: UHC Core |
$1,828.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,642.10
|
|
|
HC EPIDURAL/LOCAL FLAT
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
37000023
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: Aetna Medicare |
$175.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.94
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: BCBS MAPPO |
$168.75
|
| Rate for Payer: BCBS Trust/PPO |
$554.92
|
| Rate for Payer: BCN Commercial |
$524.81
|
| Rate for Payer: BCN Medicare Advantage |
$168.75
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.75
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.75
|
| Rate for Payer: Nomi Health Commercial |
$553.50
|
| Rate for Payer: PACE Senior Care Partners |
$160.31
|
| Rate for Payer: PACE SWMI |
$168.75
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: PHP Medicare Advantage |
$168.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: Priority Health HMO/PPO |
$587.25
|
| Rate for Payer: Priority Health Medicare |
$170.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$452.25
|
| Rate for Payer: Railroad Medicare Medicare |
$168.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.00
|
| Rate for Payer: UHC Core |
$563.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.75
|
| Rate for Payer: UHC Exchange |
$168.75
|
| Rate for Payer: UHC Medicare Advantage |
$168.75
|
| Rate for Payer: VA VA |
$168.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.25
|
|
|
HC EPIDURAL/LOCAL FLAT
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
37000023
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: BCBS Trust/PPO |
$551.00
|
| Rate for Payer: BCN Commercial |
$521.64
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.75
|
| Rate for Payer: Nomi Health Commercial |
$553.50
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: Priority Health HMO/PPO |
$587.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$452.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.00
|
| Rate for Payer: UHC Core |
$563.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.25
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
IP
|
$646.09
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$419.96 |
| Max. Negotiated Rate |
$581.48 |
| Rate for Payer: Aetna Commercial |
$549.18
|
| Rate for Payer: BCBS Trust/PPO |
$527.40
|
| Rate for Payer: BCN Commercial |
$499.30
|
| Rate for Payer: Cash Price |
$516.87
|
| Rate for Payer: Cofinity Commercial |
$555.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.87
|
| Rate for Payer: Healthscope Commercial |
$581.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.18
|
| Rate for Payer: Nomi Health Commercial |
$529.79
|
| Rate for Payer: PHP Commercial |
$549.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.96
|
| Rate for Payer: Priority Health HMO/PPO |
$562.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$432.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$568.56
|
| Rate for Payer: UHC Core |
$539.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.57
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
OP
|
$646.09
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$153.45 |
| Max. Negotiated Rate |
$581.48 |
| Rate for Payer: Aetna Commercial |
$549.18
|
| Rate for Payer: Aetna Medicare |
$167.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.90
|
| Rate for Payer: BCBS Complete |
$258.44
|
| Rate for Payer: BCBS MAPPO |
$161.52
|
| Rate for Payer: BCBS Trust/PPO |
$531.15
|
| Rate for Payer: BCN Commercial |
$502.33
|
| Rate for Payer: BCN Medicare Advantage |
$161.52
|
| Rate for Payer: Cash Price |
$516.87
|
| Rate for Payer: Cofinity Commercial |
$555.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.52
|
| Rate for Payer: Healthscope Commercial |
$581.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.18
|
| Rate for Payer: Nomi Health Commercial |
$529.79
|
| Rate for Payer: PACE Senior Care Partners |
$153.45
|
| Rate for Payer: PACE SWMI |
$161.52
|
| Rate for Payer: PHP Commercial |
$549.18
|
| Rate for Payer: PHP Medicare Advantage |
$161.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.96
|
| Rate for Payer: Priority Health HMO/PPO |
$562.10
|
| Rate for Payer: Priority Health Medicare |
$163.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$432.88
|
| Rate for Payer: Railroad Medicare Medicare |
$161.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$568.56
|
| Rate for Payer: UHC Core |
$539.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.52
|
| Rate for Payer: UHC Exchange |
$161.52
|
| Rate for Payer: UHC Medicare Advantage |
$161.52
|
| Rate for Payer: VA VA |
$161.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.57
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
OP
|
$488.47
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$439.62 |
| Rate for Payer: Aetna Commercial |
$415.20
|
| Rate for Payer: Aetna Medicare |
$127.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.65
|
| Rate for Payer: BCBS Complete |
$195.39
|
| Rate for Payer: BCBS MAPPO |
$122.12
|
| Rate for Payer: BCBS Trust/PPO |
$401.57
|
| Rate for Payer: BCN Commercial |
$379.79
|
| Rate for Payer: BCN Medicare Advantage |
$122.12
|
| Rate for Payer: Cash Price |
$390.78
|
| Rate for Payer: Cofinity Commercial |
$420.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.12
|
| Rate for Payer: Healthscope Commercial |
$439.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.20
|
| Rate for Payer: Nomi Health Commercial |
$400.55
|
| Rate for Payer: PACE Senior Care Partners |
$116.01
|
| Rate for Payer: PACE SWMI |
$122.12
|
| Rate for Payer: PHP Commercial |
$415.20
|
| Rate for Payer: PHP Medicare Advantage |
$122.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.51
|
| Rate for Payer: Priority Health HMO/PPO |
$424.97
|
| Rate for Payer: Priority Health Medicare |
$123.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.27
|
| Rate for Payer: Railroad Medicare Medicare |
$122.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.85
|
| Rate for Payer: UHC Core |
$407.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.12
|
| Rate for Payer: UHC Exchange |
$122.12
|
| Rate for Payer: UHC Medicare Advantage |
$122.12
|
| Rate for Payer: VA VA |
$122.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.35
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
IP
|
$488.47
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.51 |
| Max. Negotiated Rate |
$439.62 |
| Rate for Payer: Aetna Commercial |
$415.20
|
| Rate for Payer: BCBS Trust/PPO |
$398.74
|
| Rate for Payer: BCN Commercial |
$377.49
|
| Rate for Payer: Cash Price |
$390.78
|
| Rate for Payer: Cofinity Commercial |
$420.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.78
|
| Rate for Payer: Healthscope Commercial |
$439.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.20
|
| Rate for Payer: Nomi Health Commercial |
$400.55
|
| Rate for Payer: PHP Commercial |
$415.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.51
|
| Rate for Payer: Priority Health HMO/PPO |
$424.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.85
|
| Rate for Payer: UHC Core |
$407.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.35
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
OP
|
$709.55
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.52 |
| Max. Negotiated Rate |
$638.60 |
| Rate for Payer: Aetna Commercial |
$603.12
|
| Rate for Payer: Aetna Medicare |
$184.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.73
|
| Rate for Payer: BCBS Complete |
$283.82
|
| Rate for Payer: BCBS MAPPO |
$177.39
|
| Rate for Payer: BCBS Trust/PPO |
$583.32
|
| Rate for Payer: BCN Commercial |
$551.68
|
| Rate for Payer: BCN Medicare Advantage |
$177.39
|
| Rate for Payer: Cash Price |
$567.64
|
| Rate for Payer: Cofinity Commercial |
$610.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.39
|
| Rate for Payer: Healthscope Commercial |
$638.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.12
|
| Rate for Payer: Nomi Health Commercial |
$581.83
|
| Rate for Payer: PACE Senior Care Partners |
$168.52
|
| Rate for Payer: PACE SWMI |
$177.39
|
| Rate for Payer: PHP Commercial |
$603.12
|
| Rate for Payer: PHP Medicare Advantage |
$177.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.21
|
| Rate for Payer: Priority Health HMO/PPO |
$617.31
|
| Rate for Payer: Priority Health Medicare |
$179.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$475.40
|
| Rate for Payer: Railroad Medicare Medicare |
$177.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.40
|
| Rate for Payer: UHC Core |
$592.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.39
|
| Rate for Payer: UHC Exchange |
$177.39
|
| Rate for Payer: UHC Medicare Advantage |
$177.39
|
| Rate for Payer: VA VA |
$177.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.16
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
IP
|
$709.55
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$461.21 |
| Max. Negotiated Rate |
$638.60 |
| Rate for Payer: Aetna Commercial |
$603.12
|
| Rate for Payer: BCBS Trust/PPO |
$579.21
|
| Rate for Payer: BCN Commercial |
$548.34
|
| Rate for Payer: Cash Price |
$567.64
|
| Rate for Payer: Cofinity Commercial |
$610.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.64
|
| Rate for Payer: Healthscope Commercial |
$638.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.12
|
| Rate for Payer: Nomi Health Commercial |
$581.83
|
| Rate for Payer: PHP Commercial |
$603.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.21
|
| Rate for Payer: Priority Health HMO/PPO |
$617.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$475.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.40
|
| Rate for Payer: UHC Core |
$592.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.16
|
|
|
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 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 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 |
$154.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.97
|
| 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 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 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
|
|
