|
HC EP+ABL VT
|
Facility
|
OP
|
$17,391.67
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
48100092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$963.33 |
| Max. Negotiated Rate |
$66,459.11 |
| Rate for Payer: Aetna American Axle |
$11,304.59
|
| Rate for Payer: Aetna Commercial |
$14,782.92
|
| Rate for Payer: Aetna Medicare |
$21,955.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,304.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,389.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,389.02
|
| Rate for Payer: BCBS Complete |
$12,126.28
|
| Rate for Payer: BCBS MAPPO |
$21,111.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,281.84
|
| Rate for Payer: BCN Medicare Advantage |
$21,111.22
|
| Rate for Payer: Cash Price |
$13,913.34
|
| Rate for Payer: Cash Price |
$13,913.34
|
| Rate for Payer: Cofinity Commercial |
$12,174.17
|
| Rate for Payer: Cofinity Commercial |
$14,956.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,913.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,111.22
|
| Rate for Payer: Healthscope Commercial |
$15,652.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,174.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,043.75
|
| Rate for Payer: Mclaren Medicaid |
$11,547.84
|
| Rate for Payer: Mclaren Medicare |
$21,111.22
|
| Rate for Payer: Meridian Medicaid |
$12,126.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,166.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,277.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,782.92
|
| Rate for Payer: PACE Medicare |
$20,055.66
|
| Rate for Payer: PACE SWMI |
$21,111.22
|
| Rate for Payer: PHP Commercial |
$14,782.92
|
| Rate for Payer: PHP Medicare Advantage |
$21,111.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,547.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,174.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66,459.11
|
| Rate for Payer: Priority Health Medicare |
$21,111.22
|
| Rate for Payer: Priority Health Narrow Network |
$53,167.29
|
| Rate for Payer: Priority Health SBD |
$10,956.75
|
| Rate for Payer: Railroad Medicare Medicare |
$21,111.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,059.66
|
| Rate for Payer: UHC Core |
$18,337.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,111.22
|
| Rate for Payer: UHC Exchange |
$963.33
|
| Rate for Payer: UHC Medicare Advantage |
$21,744.56
|
| Rate for Payer: UMR Bronson Commercial |
$6,434.92
|
| Rate for Payer: VA VA |
$21,111.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,043.75
|
|
|
HC EP+ABL VT
|
Facility
|
IP
|
$17,391.67
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
48100092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,652.33 |
| Max. Negotiated Rate |
$15,652.50 |
| Rate for Payer: Aetna American Axle |
$11,304.59
|
| Rate for Payer: Aetna Commercial |
$14,782.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,304.59
|
| Rate for Payer: Cash Price |
$13,913.34
|
| Rate for Payer: Cofinity Commercial |
$12,174.17
|
| Rate for Payer: Cofinity Commercial |
$14,956.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,913.34
|
| Rate for Payer: Healthscope Commercial |
$15,652.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,174.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,043.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,782.92
|
| Rate for Payer: PHP Commercial |
$14,782.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,174.17
|
| Rate for Payer: Priority Health SBD |
$10,956.75
|
| Rate for Payer: UMR Bronson Commercial |
$7,652.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,043.75
|
|
|
HC EP AFTER DRUGS
|
Facility
|
IP
|
$7,278.36
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,202.48 |
| Max. Negotiated Rate |
$6,550.52 |
| Rate for Payer: Aetna American Axle |
$4,730.93
|
| Rate for Payer: Aetna Commercial |
$6,186.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,730.93
|
| Rate for Payer: Cash Price |
$5,822.69
|
| Rate for Payer: Cofinity Commercial |
$5,094.85
|
| Rate for Payer: Cofinity Commercial |
$6,259.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,822.69
|
| Rate for Payer: Healthscope Commercial |
$6,550.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,094.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,458.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,186.61
|
| Rate for Payer: PHP Commercial |
$6,186.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,094.85
|
| Rate for Payer: Priority Health SBD |
$4,585.37
|
| Rate for Payer: UMR Bronson Commercial |
$3,202.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,458.77
|
|
|
HC EP AFTER DRUGS
|
Facility
|
OP
|
$7,278.36
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$6,550.52 |
| Rate for Payer: Aetna American Axle |
$4,730.93
|
| Rate for Payer: Aetna Commercial |
$6,186.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,730.93
|
| Rate for Payer: BCBS Complete |
$2,911.34
|
| Rate for Payer: BCBS Trust/PPO |
$5,095.34
|
| Rate for Payer: Cash Price |
$5,822.69
|
| Rate for Payer: Cash Price |
$5,822.69
|
| Rate for Payer: Cofinity Commercial |
$6,259.39
|
| Rate for Payer: Cofinity Commercial |
$5,094.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,822.69
|
| Rate for Payer: Healthscope Commercial |
$6,550.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,094.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,458.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,186.61
|
| Rate for Payer: PHP Commercial |
$6,186.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,094.85
|
| Rate for Payer: Priority Health SBD |
$4,585.37
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,692.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,458.77
|
|
|
HC EP EVAL OF SQ ICD
|
Facility
|
OP
|
$3,277.26
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
48000027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$186.31 |
| Max. Negotiated Rate |
$2,949.53 |
| Rate for Payer: Aetna American Axle |
$2,130.22
|
| Rate for Payer: Aetna Commercial |
$2,785.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,130.22
|
| Rate for Payer: BCBS Complete |
$1,310.90
|
| Rate for Payer: Cash Price |
$2,621.81
|
| Rate for Payer: Cash Price |
$2,621.81
|
| Rate for Payer: Cash Price |
$2,621.81
|
| Rate for Payer: Cofinity Commercial |
$2,294.08
|
| Rate for Payer: Cofinity Commercial |
$2,818.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,621.81
|
| Rate for Payer: Healthscope Commercial |
$2,949.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,294.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,457.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,785.67
|
| Rate for Payer: PHP Commercial |
$2,785.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,294.08
|
| Rate for Payer: Priority Health SBD |
$2,064.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.94
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Exchange |
$186.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,212.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,457.94
|
|
|
HC EP EVAL OF SQ ICD
|
Facility
|
IP
|
$3,277.26
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
48000027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,441.99 |
| Max. Negotiated Rate |
$2,949.53 |
| Rate for Payer: Aetna American Axle |
$2,130.22
|
| Rate for Payer: Aetna Commercial |
$2,785.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,130.22
|
| Rate for Payer: Cash Price |
$2,621.81
|
| Rate for Payer: Cofinity Commercial |
$2,818.44
|
| Rate for Payer: Cofinity Commercial |
$2,294.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,621.81
|
| Rate for Payer: Healthscope Commercial |
$2,949.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,294.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,457.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,785.67
|
| Rate for Payer: PHP Commercial |
$2,785.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,294.08
|
| Rate for Payer: Priority Health SBD |
$2,064.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,441.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,457.94
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
OP
|
$2,341.80
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,107.62 |
| Rate for Payer: Aetna American Axle |
$1,522.17
|
| Rate for Payer: Aetna Commercial |
$1,990.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,522.17
|
| Rate for Payer: BCBS Complete |
$936.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,348.86
|
| Rate for Payer: Cash Price |
$1,873.44
|
| Rate for Payer: Cash Price |
$1,873.44
|
| Rate for Payer: Cofinity Commercial |
$1,639.26
|
| Rate for Payer: Cofinity Commercial |
$2,013.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,873.44
|
| Rate for Payer: Healthscope Commercial |
$2,107.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,639.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,756.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,990.53
|
| Rate for Payer: PHP Commercial |
$1,990.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,639.26
|
| Rate for Payer: Priority Health SBD |
$1,475.33
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UMR Bronson Commercial |
$866.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,756.35
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
IP
|
$2,341.80
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,030.39 |
| Max. Negotiated Rate |
$2,107.62 |
| Rate for Payer: Aetna American Axle |
$1,522.17
|
| Rate for Payer: Aetna Commercial |
$1,990.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,522.17
|
| Rate for Payer: Cash Price |
$1,873.44
|
| Rate for Payer: Cofinity Commercial |
$1,639.26
|
| Rate for Payer: Cofinity Commercial |
$2,013.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,873.44
|
| Rate for Payer: Healthscope Commercial |
$2,107.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,639.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,756.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,990.53
|
| Rate for Payer: PHP Commercial |
$1,990.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,639.26
|
| Rate for Payer: Priority Health SBD |
$1,475.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,030.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,756.35
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
IP
|
$2,146.53
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$944.47 |
| Max. Negotiated Rate |
$1,931.88 |
| Rate for Payer: Aetna American Axle |
$1,395.24
|
| Rate for Payer: Aetna Commercial |
$1,824.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,395.24
|
| Rate for Payer: Cash Price |
$1,717.22
|
| Rate for Payer: Cofinity Commercial |
$1,846.02
|
| Rate for Payer: Cofinity Commercial |
$1,502.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.22
|
| Rate for Payer: Healthscope Commercial |
$1,931.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,502.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,824.55
|
| Rate for Payer: PHP Commercial |
$1,824.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,502.57
|
| Rate for Payer: Priority Health SBD |
$1,352.31
|
| Rate for Payer: UMR Bronson Commercial |
$944.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.90
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
OP
|
$2,146.53
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,931.88 |
| Rate for Payer: Aetna American Axle |
$1,395.24
|
| Rate for Payer: Aetna Commercial |
$1,824.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,395.24
|
| Rate for Payer: BCBS Complete |
$858.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.91
|
| Rate for Payer: Cash Price |
$1,717.22
|
| Rate for Payer: Cash Price |
$1,717.22
|
| Rate for Payer: Cofinity Commercial |
$1,846.02
|
| Rate for Payer: Cofinity Commercial |
$1,502.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.22
|
| Rate for Payer: Healthscope Commercial |
$1,931.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,502.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,824.55
|
| Rate for Payer: PHP Commercial |
$1,824.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,502.57
|
| Rate for Payer: Priority Health SBD |
$1,352.31
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UMR Bronson Commercial |
$794.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.90
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
OP
|
$633.42
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$234.37 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna American Axle |
$411.72
|
| Rate for Payer: Aetna Commercial |
$538.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.72
|
| Rate for Payer: BCBS Complete |
$253.37
|
| Rate for Payer: Cash Price |
$506.74
|
| Rate for Payer: Cofinity Commercial |
$443.39
|
| Rate for Payer: Cofinity Commercial |
$544.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.74
|
| Rate for Payer: Healthscope Commercial |
$570.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$443.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$538.41
|
| Rate for Payer: PHP Commercial |
$538.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.39
|
| Rate for Payer: Priority Health SBD |
$399.05
|
| Rate for Payer: UMR Bronson Commercial |
$234.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.06
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
IP
|
$633.42
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$278.70 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna American Axle |
$411.72
|
| Rate for Payer: Aetna Commercial |
$538.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.72
|
| Rate for Payer: Cash Price |
$506.74
|
| Rate for Payer: Cofinity Commercial |
$443.39
|
| Rate for Payer: Cofinity Commercial |
$544.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.74
|
| Rate for Payer: Healthscope Commercial |
$570.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$443.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$538.41
|
| Rate for Payer: PHP Commercial |
$538.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.39
|
| Rate for Payer: Priority Health SBD |
$399.05
|
| Rate for Payer: UMR Bronson Commercial |
$278.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.06
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
OP
|
$478.89
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.19 |
| Max. Negotiated Rate |
$481.38 |
| Rate for Payer: Aetna American Axle |
$311.28
|
| Rate for Payer: Aetna Commercial |
$407.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.28
|
| Rate for Payer: BCBS Complete |
$191.56
|
| Rate for Payer: BCBS Trust/PPO |
$481.38
|
| Rate for Payer: Cash Price |
$383.11
|
| Rate for Payer: Cash Price |
$383.11
|
| Rate for Payer: Cofinity Commercial |
$335.22
|
| Rate for Payer: Cofinity Commercial |
$411.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.11
|
| Rate for Payer: Healthscope Commercial |
$431.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.06
|
| Rate for Payer: PHP Commercial |
$407.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.22
|
| Rate for Payer: Priority Health SBD |
$301.70
|
| Rate for Payer: UMR Bronson Commercial |
$177.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.17
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
IP
|
$478.89
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.71 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna American Axle |
$311.28
|
| Rate for Payer: Aetna Commercial |
$407.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.28
|
| Rate for Payer: Cash Price |
$383.11
|
| Rate for Payer: Cofinity Commercial |
$411.85
|
| Rate for Payer: Cofinity Commercial |
$335.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.11
|
| Rate for Payer: Healthscope Commercial |
$431.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.06
|
| Rate for Payer: PHP Commercial |
$407.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.22
|
| Rate for Payer: Priority Health SBD |
$301.70
|
| Rate for Payer: UMR Bronson Commercial |
$210.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.17
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
IP
|
$695.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$306.08 |
| Max. Negotiated Rate |
$626.08 |
| Rate for Payer: Aetna American Axle |
$452.17
|
| Rate for Payer: Aetna Commercial |
$591.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.17
|
| Rate for Payer: Cash Price |
$556.51
|
| Rate for Payer: Cofinity Commercial |
$486.95
|
| Rate for Payer: Cofinity Commercial |
$598.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.51
|
| Rate for Payer: Healthscope Commercial |
$626.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$486.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$521.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$591.29
|
| Rate for Payer: PHP Commercial |
$591.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.95
|
| Rate for Payer: Priority Health SBD |
$438.25
|
| Rate for Payer: UMR Bronson Commercial |
$306.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$521.73
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
OP
|
$695.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.39 |
| Max. Negotiated Rate |
$626.08 |
| Rate for Payer: Aetna American Axle |
$452.17
|
| Rate for Payer: Aetna Commercial |
$591.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.17
|
| Rate for Payer: BCBS Complete |
$278.26
|
| Rate for Payer: BCBS Trust/PPO |
$481.38
|
| Rate for Payer: Cash Price |
$556.51
|
| Rate for Payer: Cash Price |
$556.51
|
| Rate for Payer: Cofinity Commercial |
$486.95
|
| Rate for Payer: Cofinity Commercial |
$598.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.51
|
| Rate for Payer: Healthscope Commercial |
$626.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$486.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$521.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$591.29
|
| Rate for Payer: PHP Commercial |
$591.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.95
|
| Rate for Payer: Priority Health SBD |
$438.25
|
| Rate for Payer: UMR Bronson Commercial |
$257.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$521.73
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
IP
|
$678.30
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.45 |
| Max. Negotiated Rate |
$610.47 |
| Rate for Payer: Aetna American Axle |
$440.90
|
| Rate for Payer: Aetna Commercial |
$576.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.90
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$474.81
|
| Rate for Payer: Cofinity Commercial |
$583.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Healthscope Commercial |
$610.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$474.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.56
|
| Rate for Payer: PHP Commercial |
$576.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.81
|
| Rate for Payer: Priority Health SBD |
$427.33
|
| Rate for Payer: UMR Bronson Commercial |
$298.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.72
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
OP
|
$678.30
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.97 |
| Max. Negotiated Rate |
$610.47 |
| Rate for Payer: Aetna American Axle |
$440.90
|
| Rate for Payer: Aetna Commercial |
$576.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.90
|
| Rate for Payer: BCBS Complete |
$271.32
|
| Rate for Payer: BCBS Trust/PPO |
$481.38
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$474.81
|
| Rate for Payer: Cofinity Commercial |
$583.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Healthscope Commercial |
$610.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$474.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.56
|
| Rate for Payer: PHP Commercial |
$576.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.81
|
| Rate for Payer: Priority Health SBD |
$427.33
|
| Rate for Payer: UMR Bronson Commercial |
$250.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.72
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$486.20
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.93 |
| Max. Negotiated Rate |
$437.58 |
| Rate for Payer: Aetna American Axle |
$316.03
|
| Rate for Payer: Aetna Commercial |
$413.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.03
|
| Rate for Payer: Cash Price |
$388.96
|
| Rate for Payer: Cofinity Commercial |
$340.34
|
| Rate for Payer: Cofinity Commercial |
$418.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.96
|
| Rate for Payer: Healthscope Commercial |
$437.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$413.27
|
| Rate for Payer: PHP Commercial |
$413.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.34
|
| Rate for Payer: Priority Health SBD |
$306.31
|
| Rate for Payer: UMR Bronson Commercial |
$213.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.65
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$486.20
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$481.38 |
| Rate for Payer: Aetna American Axle |
$316.03
|
| Rate for Payer: Aetna Commercial |
$413.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.03
|
| Rate for Payer: BCBS Complete |
$194.48
|
| Rate for Payer: BCBS Trust/PPO |
$481.38
|
| Rate for Payer: Cash Price |
$388.96
|
| Rate for Payer: Cash Price |
$388.96
|
| Rate for Payer: Cofinity Commercial |
$340.34
|
| Rate for Payer: Cofinity Commercial |
$418.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.96
|
| Rate for Payer: Healthscope Commercial |
$437.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$413.27
|
| Rate for Payer: PHP Commercial |
$413.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.34
|
| Rate for Payer: Priority Health SBD |
$306.31
|
| Rate for Payer: UMR Bronson Commercial |
$179.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.65
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
IP
|
$430.32
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.34 |
| Max. Negotiated Rate |
$387.29 |
| Rate for Payer: Aetna American Axle |
$279.71
|
| Rate for Payer: Aetna Commercial |
$365.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.71
|
| Rate for Payer: Cash Price |
$344.26
|
| Rate for Payer: Cofinity Commercial |
$301.22
|
| Rate for Payer: Cofinity Commercial |
$370.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.26
|
| Rate for Payer: Healthscope Commercial |
$387.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.77
|
| Rate for Payer: PHP Commercial |
$365.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.22
|
| Rate for Payer: Priority Health SBD |
$271.10
|
| Rate for Payer: UMR Bronson Commercial |
$189.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.74
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
OP
|
$430.32
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.22 |
| Max. Negotiated Rate |
$481.38 |
| Rate for Payer: Aetna American Axle |
$279.71
|
| Rate for Payer: Aetna Commercial |
$365.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.71
|
| Rate for Payer: BCBS Complete |
$172.13
|
| Rate for Payer: BCBS Trust/PPO |
$481.38
|
| Rate for Payer: Cash Price |
$344.26
|
| Rate for Payer: Cash Price |
$344.26
|
| Rate for Payer: Cofinity Commercial |
$301.22
|
| Rate for Payer: Cofinity Commercial |
$370.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.26
|
| Rate for Payer: Healthscope Commercial |
$387.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.77
|
| Rate for Payer: PHP Commercial |
$365.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.22
|
| Rate for Payer: Priority Health SBD |
$271.10
|
| Rate for Payer: UMR Bronson Commercial |
$159.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.74
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
IP
|
$404.43
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.95 |
| Max. Negotiated Rate |
$363.99 |
| Rate for Payer: Aetna American Axle |
$262.88
|
| Rate for Payer: Aetna Commercial |
$343.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.88
|
| Rate for Payer: Cash Price |
$323.54
|
| Rate for Payer: Cofinity Commercial |
$283.10
|
| Rate for Payer: Cofinity Commercial |
$347.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.54
|
| Rate for Payer: Healthscope Commercial |
$363.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.77
|
| Rate for Payer: PHP Commercial |
$343.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.10
|
| Rate for Payer: Priority Health SBD |
$254.79
|
| Rate for Payer: UMR Bronson Commercial |
$177.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.32
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
OP
|
$404.43
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.64 |
| Max. Negotiated Rate |
$481.38 |
| Rate for Payer: Aetna American Axle |
$262.88
|
| Rate for Payer: Aetna Commercial |
$343.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.88
|
| Rate for Payer: BCBS Complete |
$161.77
|
| Rate for Payer: BCBS Trust/PPO |
$481.38
|
| Rate for Payer: Cash Price |
$323.54
|
| Rate for Payer: Cash Price |
$323.54
|
| Rate for Payer: Cofinity Commercial |
$283.10
|
| Rate for Payer: Cofinity Commercial |
$347.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.54
|
| Rate for Payer: Healthscope Commercial |
$363.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.77
|
| Rate for Payer: PHP Commercial |
$343.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.10
|
| Rate for Payer: Priority Health SBD |
$254.79
|
| Rate for Payer: UMR Bronson Commercial |
$149.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.32
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
IP
|
$207.64
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.36 |
| Max. Negotiated Rate |
$186.88 |
| Rate for Payer: Aetna American Axle |
$134.97
|
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.97
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Commercial |
$145.35
|
| Rate for Payer: Cofinity Commercial |
$178.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Healthscope Commercial |
$186.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.49
|
| Rate for Payer: PHP Commercial |
$176.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.35
|
| Rate for Payer: Priority Health SBD |
$130.81
|
| Rate for Payer: UMR Bronson Commercial |
$91.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.73
|
|
