|
HC EP EVAL OF SQ ICD
|
Facility
|
OP
|
$3,409.67
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
48000027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,261.58 |
| Max. Negotiated Rate |
$3,068.70 |
| Rate for Payer: Aetna American Axle |
$2,216.29
|
| Rate for Payer: Aetna Commercial |
$2,898.22
|
| Rate for Payer: Aetna Medicare |
$1,704.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,216.29
|
| Rate for Payer: BCBS Complete |
$1,363.87
|
| Rate for Payer: Cash Price |
$2,727.74
|
| Rate for Payer: Cofinity Advantage |
$2,386.77
|
| Rate for Payer: Cofinity Commercial |
$2,932.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,727.74
|
| Rate for Payer: Healthscope Commercial |
$3,068.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,386.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,557.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,727.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,898.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,557.25
|
| Rate for Payer: PHP Commercial |
$2,898.22
|
| Rate for Payer: Priority Health SBD |
$2,148.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,216.29
|
| Rate for Payer: UHC Core |
$1,776.44
|
| Rate for Payer: UHC Exchange |
$1,340.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,261.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,557.25
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
OP
|
$2,436.41
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$2,192.77 |
| Rate for Payer: Aetna American Axle |
$1,583.67
|
| Rate for Payer: Aetna Commercial |
$2,070.95
|
| Rate for Payer: Aetna Medicare |
$1,218.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,583.67
|
| Rate for Payer: BCBS Complete |
$974.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.28
|
| Rate for Payer: BCN Commercial |
$1,124.28
|
| Rate for Payer: Cash Price |
$1,949.13
|
| Rate for Payer: Cash Price |
$1,949.13
|
| Rate for Payer: Cofinity Advantage |
$1,705.49
|
| Rate for Payer: Cofinity Commercial |
$2,095.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,949.13
|
| Rate for Payer: Healthscope Commercial |
$2,192.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,705.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,827.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,949.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,070.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,827.31
|
| Rate for Payer: PHP Commercial |
$2,070.95
|
| Rate for Payer: Priority Health SBD |
$1,534.94
|
| Rate for Payer: UMR Bronson Commercial |
$901.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,827.31
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
IP
|
$2,436.41
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,072.02 |
| Max. Negotiated Rate |
$2,192.77 |
| Rate for Payer: Aetna American Axle |
$1,583.67
|
| Rate for Payer: Aetna Commercial |
$2,070.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,583.67
|
| Rate for Payer: Cash Price |
$1,949.13
|
| Rate for Payer: Cofinity Advantage |
$1,705.49
|
| Rate for Payer: Cofinity Commercial |
$2,095.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,949.13
|
| Rate for Payer: Healthscope Commercial |
$2,192.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,705.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,827.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,070.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,827.31
|
| Rate for Payer: PHP Commercial |
$2,070.95
|
| Rate for Payer: Priority Health SBD |
$1,534.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,072.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,827.31
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
IP
|
$2,233.25
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$982.63 |
| Max. Negotiated Rate |
$2,009.92 |
| Rate for Payer: Aetna American Axle |
$1,451.61
|
| Rate for Payer: Aetna Commercial |
$1,898.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,451.61
|
| Rate for Payer: Cash Price |
$1,786.60
|
| Rate for Payer: Cofinity Advantage |
$1,563.28
|
| Rate for Payer: Cofinity Commercial |
$1,920.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,786.60
|
| Rate for Payer: Healthscope Commercial |
$2,009.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,563.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,674.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,898.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,674.94
|
| Rate for Payer: PHP Commercial |
$1,898.26
|
| Rate for Payer: Priority Health SBD |
$1,406.95
|
| Rate for Payer: UMR Bronson Commercial |
$982.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,674.94
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
OP
|
$2,233.25
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$826.30 |
| Max. Negotiated Rate |
$2,009.92 |
| Rate for Payer: Aetna American Axle |
$1,451.61
|
| Rate for Payer: Aetna Commercial |
$1,898.26
|
| Rate for Payer: Aetna Medicare |
$1,116.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,451.61
|
| Rate for Payer: BCBS Complete |
$893.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.84
|
| Rate for Payer: BCN Commercial |
$1,084.84
|
| Rate for Payer: Cash Price |
$1,786.60
|
| Rate for Payer: Cash Price |
$1,786.60
|
| Rate for Payer: Cofinity Advantage |
$1,563.28
|
| Rate for Payer: Cofinity Commercial |
$1,920.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,786.60
|
| Rate for Payer: Healthscope Commercial |
$2,009.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,563.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,674.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,786.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,898.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,674.94
|
| Rate for Payer: PHP Commercial |
$1,898.26
|
| Rate for Payer: Priority Health SBD |
$1,406.95
|
| Rate for Payer: UMR Bronson Commercial |
$826.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,674.94
|
|
|
HC EPIDURAL/LOCAL FLAT
|
Facility
|
IP
|
$688.50
|
|
| Hospital Charge Code |
37000023
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$302.94 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna American Axle |
$447.52
|
| Rate for Payer: Aetna Commercial |
$585.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.52
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Advantage |
$481.95
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.38
|
| Rate for Payer: PHP Commercial |
$585.23
|
| Rate for Payer: Priority Health SBD |
$433.75
|
| Rate for Payer: UMR Bronson Commercial |
$302.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.38
|
|
|
HC EPIDURAL/LOCAL FLAT
|
Facility
|
OP
|
$688.50
|
|
| Hospital Charge Code |
37000023
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$254.75 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna American Axle |
$447.52
|
| Rate for Payer: Aetna Commercial |
$585.23
|
| Rate for Payer: Aetna Medicare |
$344.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.52
|
| Rate for Payer: BCBS Complete |
$275.40
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Advantage |
$481.95
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.38
|
| Rate for Payer: PHP Commercial |
$585.23
|
| Rate for Payer: Priority Health SBD |
$433.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.52
|
| Rate for Payer: UHC Core |
$358.71
|
| Rate for Payer: UHC Exchange |
$270.58
|
| Rate for Payer: UMR Bronson Commercial |
$254.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.38
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
IP
|
$659.01
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$289.96 |
| Max. Negotiated Rate |
$593.11 |
| Rate for Payer: Aetna American Axle |
$428.36
|
| Rate for Payer: Aetna Commercial |
$560.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.36
|
| Rate for Payer: Cash Price |
$527.21
|
| Rate for Payer: Cofinity Advantage |
$461.31
|
| Rate for Payer: Cofinity Commercial |
$566.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.21
|
| Rate for Payer: Healthscope Commercial |
$593.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$461.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.26
|
| Rate for Payer: PHP Commercial |
$560.16
|
| Rate for Payer: Priority Health SBD |
$415.18
|
| Rate for Payer: UMR Bronson Commercial |
$289.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.26
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
OP
|
$659.01
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$243.83 |
| Max. Negotiated Rate |
$593.11 |
| Rate for Payer: Aetna American Axle |
$428.36
|
| Rate for Payer: Aetna Commercial |
$560.16
|
| Rate for Payer: Aetna Medicare |
$329.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.36
|
| Rate for Payer: BCBS Complete |
$263.60
|
| Rate for Payer: Cash Price |
$527.21
|
| Rate for Payer: Cofinity Advantage |
$461.31
|
| Rate for Payer: Cofinity Commercial |
$566.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.21
|
| Rate for Payer: Healthscope Commercial |
$593.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$461.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$527.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.26
|
| Rate for Payer: PHP Commercial |
$560.16
|
| Rate for Payer: Priority Health SBD |
$415.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$428.36
|
| Rate for Payer: UHC Core |
$343.34
|
| Rate for Payer: UHC Exchange |
$258.99
|
| Rate for Payer: UMR Bronson Commercial |
$243.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.26
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
IP
|
$498.24
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.23 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna American Axle |
$323.86
|
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cofinity Advantage |
$348.77
|
| Rate for Payer: Cofinity Commercial |
$428.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.59
|
| Rate for Payer: Healthscope Commercial |
$448.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.68
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: Priority Health SBD |
$313.89
|
| Rate for Payer: UMR Bronson Commercial |
$219.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.68
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
OP
|
$498.24
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,432.62 |
| Rate for Payer: Aetna American Axle |
$323.86
|
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.62
|
| Rate for Payer: BCN Commercial |
$1,432.62
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cofinity Advantage |
$348.77
|
| Rate for Payer: Cofinity Commercial |
$428.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$448.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.68
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.50
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.68
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$313.89
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$184.35
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.68
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
IP
|
$723.74
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$318.45 |
| Max. Negotiated Rate |
$651.37 |
| Rate for Payer: Aetna American Axle |
$470.43
|
| Rate for Payer: Aetna Commercial |
$615.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.43
|
| Rate for Payer: Cash Price |
$578.99
|
| Rate for Payer: Cofinity Advantage |
$506.62
|
| Rate for Payer: Cofinity Commercial |
$622.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.99
|
| Rate for Payer: Healthscope Commercial |
$651.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$506.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$542.80
|
| Rate for Payer: PHP Commercial |
$615.18
|
| Rate for Payer: Priority Health SBD |
$455.96
|
| Rate for Payer: UMR Bronson Commercial |
$318.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.80
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
OP
|
$723.74
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,432.62 |
| Rate for Payer: Aetna American Axle |
$470.43
|
| Rate for Payer: Aetna Commercial |
$615.18
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.62
|
| Rate for Payer: BCN Commercial |
$1,432.62
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$578.99
|
| Rate for Payer: Cash Price |
$578.99
|
| Rate for Payer: Cofinity Advantage |
$506.62
|
| Rate for Payer: Cofinity Commercial |
$622.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$651.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$506.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.80
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.18
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$542.80
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$615.18
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$455.96
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$267.78
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.80
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
IP
|
$705.71
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$310.51 |
| Max. Negotiated Rate |
$635.14 |
| Rate for Payer: Aetna American Axle |
$458.71
|
| Rate for Payer: Aetna Commercial |
$599.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.71
|
| Rate for Payer: Cash Price |
$564.57
|
| Rate for Payer: Cofinity Advantage |
$494.00
|
| Rate for Payer: Cofinity Commercial |
$606.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.57
|
| Rate for Payer: Healthscope Commercial |
$635.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.28
|
| Rate for Payer: PHP Commercial |
$599.85
|
| Rate for Payer: Priority Health SBD |
$444.60
|
| Rate for Payer: UMR Bronson Commercial |
$310.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.28
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
OP
|
$705.71
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,432.62 |
| Rate for Payer: Aetna American Axle |
$458.71
|
| Rate for Payer: Aetna Commercial |
$599.85
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.62
|
| Rate for Payer: BCN Commercial |
$1,432.62
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$564.57
|
| Rate for Payer: Cash Price |
$564.57
|
| Rate for Payer: Cofinity Advantage |
$494.00
|
| Rate for Payer: Cofinity Commercial |
$606.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$635.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.28
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.85
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.28
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$599.85
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$444.60
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$261.11
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.28
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$505.84
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,432.62 |
| Rate for Payer: Aetna American Axle |
$328.80
|
| Rate for Payer: Aetna Commercial |
$429.96
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.62
|
| Rate for Payer: BCN Commercial |
$1,432.62
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$404.67
|
| Rate for Payer: Cash Price |
$404.67
|
| Rate for Payer: Cofinity Advantage |
$354.09
|
| Rate for Payer: Cofinity Commercial |
$435.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$455.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$354.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.38
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.96
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.38
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$429.96
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$318.68
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$187.16
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.38
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$505.84
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$222.57 |
| Max. Negotiated Rate |
$455.26 |
| Rate for Payer: Aetna American Axle |
$328.80
|
| Rate for Payer: Aetna Commercial |
$429.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.80
|
| Rate for Payer: Cash Price |
$404.67
|
| Rate for Payer: Cofinity Advantage |
$354.09
|
| Rate for Payer: Cofinity Commercial |
$435.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.67
|
| Rate for Payer: Healthscope Commercial |
$455.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$354.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.38
|
| Rate for Payer: PHP Commercial |
$429.96
|
| Rate for Payer: Priority Health SBD |
$318.68
|
| Rate for Payer: UMR Bronson Commercial |
$222.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.38
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
IP
|
$447.71
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.99 |
| Max. Negotiated Rate |
$402.94 |
| Rate for Payer: Aetna American Axle |
$291.01
|
| Rate for Payer: Aetna Commercial |
$380.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.01
|
| Rate for Payer: Cash Price |
$358.17
|
| Rate for Payer: Cofinity Advantage |
$313.40
|
| Rate for Payer: Cofinity Commercial |
$385.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.17
|
| Rate for Payer: Healthscope Commercial |
$402.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.78
|
| Rate for Payer: PHP Commercial |
$380.55
|
| Rate for Payer: Priority Health SBD |
$282.06
|
| Rate for Payer: UMR Bronson Commercial |
$196.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.78
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
OP
|
$447.71
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,432.62 |
| Rate for Payer: Aetna American Axle |
$291.01
|
| Rate for Payer: Aetna Commercial |
$380.55
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.62
|
| Rate for Payer: BCN Commercial |
$1,432.62
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$358.17
|
| Rate for Payer: Cash Price |
$358.17
|
| Rate for Payer: Cofinity Advantage |
$313.40
|
| Rate for Payer: Cofinity Commercial |
$385.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$402.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.78
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.55
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.78
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$380.55
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$282.06
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$165.65
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.78
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
IP
|
$420.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.14 |
| Max. Negotiated Rate |
$378.69 |
| Rate for Payer: Aetna American Axle |
$273.50
|
| Rate for Payer: Aetna Commercial |
$357.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.50
|
| Rate for Payer: Cash Price |
$336.62
|
| Rate for Payer: Cofinity Advantage |
$294.54
|
| Rate for Payer: Cofinity Commercial |
$361.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.62
|
| Rate for Payer: Healthscope Commercial |
$378.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.58
|
| Rate for Payer: PHP Commercial |
$357.65
|
| Rate for Payer: Priority Health SBD |
$265.09
|
| Rate for Payer: UMR Bronson Commercial |
$185.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.58
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
OP
|
$420.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,432.62 |
| Rate for Payer: Aetna American Axle |
$273.50
|
| Rate for Payer: Aetna Commercial |
$357.65
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.62
|
| Rate for Payer: BCN Commercial |
$1,432.62
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$336.62
|
| Rate for Payer: Cash Price |
$336.62
|
| Rate for Payer: Cofinity Advantage |
$294.54
|
| Rate for Payer: Cofinity Commercial |
$361.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$378.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.58
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.65
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.58
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$357.65
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$265.09
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$155.68
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.58
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
OP
|
$216.03
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,432.62 |
| Rate for Payer: Aetna American Axle |
$140.42
|
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.62
|
| Rate for Payer: BCN Commercial |
$1,432.62
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$172.82
|
| Rate for Payer: Cash Price |
$172.82
|
| Rate for Payer: Cofinity Advantage |
$151.22
|
| Rate for Payer: Cofinity Commercial |
$185.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$194.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.02
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.02
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$183.63
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$136.10
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$79.93
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.02
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
IP
|
$216.03
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.05 |
| Max. Negotiated Rate |
$194.43 |
| Rate for Payer: Aetna American Axle |
$140.42
|
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.42
|
| Rate for Payer: Cash Price |
$172.82
|
| Rate for Payer: Cofinity Advantage |
$151.22
|
| Rate for Payer: Cofinity Commercial |
$185.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.82
|
| Rate for Payer: Healthscope Commercial |
$194.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.02
|
| Rate for Payer: PHP Commercial |
$183.63
|
| Rate for Payer: Priority Health SBD |
$136.10
|
| Rate for Payer: UMR Bronson Commercial |
$95.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.02
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
OP
|
$404.73
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$1,432.62 |
| Rate for Payer: Aetna American Axle |
$263.07
|
| Rate for Payer: Aetna Commercial |
$344.02
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.62
|
| Rate for Payer: BCN Commercial |
$1,432.62
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cofinity Advantage |
$283.31
|
| Rate for Payer: Cofinity Commercial |
$348.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$364.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.55
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.02
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.55
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$344.02
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$254.98
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$149.75
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.55
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
IP
|
$404.73
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.08 |
| Max. Negotiated Rate |
$364.26 |
| Rate for Payer: Aetna American Axle |
$263.07
|
| Rate for Payer: Aetna Commercial |
$344.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.07
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cofinity Advantage |
$283.31
|
| Rate for Payer: Cofinity Commercial |
$348.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.78
|
| Rate for Payer: Healthscope Commercial |
$364.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.55
|
| Rate for Payer: PHP Commercial |
$344.02
|
| Rate for Payer: Priority Health SBD |
$254.98
|
| Rate for Payer: UMR Bronson Commercial |
$178.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.55
|
|
