|
GELATIN ABSORBABLE EYE FILM
|
Facility
|
OP
|
$999.82
|
|
|
Service Code
|
NDC 00009029703
|
| Hospital Charge Code |
28028
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.27 |
| Max. Negotiated Rate |
$899.84 |
| Rate for Payer: Aetna Commercial |
$849.85
|
| Rate for Payer: Aetna Medicare |
$259.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$312.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$312.44
|
| Rate for Payer: BCBS Complete |
$185.07
|
| Rate for Payer: BCBS MAPPO |
$249.96
|
| Rate for Payer: BCBS Trust/PPO |
$821.95
|
| Rate for Payer: BCN Commercial |
$821.95
|
| Rate for Payer: BCN Medicare Advantage |
$249.96
|
| Rate for Payer: Cash Price |
$799.86
|
| Rate for Payer: Cofinity Commercial |
$859.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.96
|
| Rate for Payer: Healthscope Commercial |
$899.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.87
|
| Rate for Payer: Mclaren Medicaid |
$176.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$262.45
|
| Rate for Payer: Meridian Medicaid |
$185.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.85
|
| Rate for Payer: Nomi Health Commercial |
$819.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$749.87
|
| Rate for Payer: PACE Senior Care Partners |
$237.46
|
| Rate for Payer: PACE SWMI |
$249.96
|
| Rate for Payer: PHP Commercial |
$849.85
|
| Rate for Payer: PHP Medicare Advantage |
$249.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$869.84
|
| Rate for Payer: Priority Health Medicare |
$252.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$695.87
|
| Rate for Payer: Railroad Medicare Medicare |
$249.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.84
|
| Rate for Payer: UHC Core |
$834.85
|
| Rate for Payer: UHC Exchange |
$249.96
|
| Rate for Payer: UHC Medicaid |
$176.27
|
| Rate for Payer: UHC Medicare Advantage |
$249.96
|
| Rate for Payer: UHCCP Medicaid |
$176.27
|
| Rate for Payer: VA VA |
$249.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.87
|
|
|
GELATIN ABSORBABLE EYE FILM
|
Facility
|
IP
|
$999.82
|
|
|
Service Code
|
NDC 00009029703
|
| Hospital Charge Code |
28028
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$695.87 |
| Max. Negotiated Rate |
$899.84 |
| Rate for Payer: Aetna Commercial |
$849.85
|
| Rate for Payer: BCBS Trust/PPO |
$825.75
|
| Rate for Payer: BCN Commercial |
$825.75
|
| Rate for Payer: Cash Price |
$799.86
|
| Rate for Payer: Cofinity Commercial |
$859.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.86
|
| Rate for Payer: Healthscope Commercial |
$899.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.85
|
| Rate for Payer: Nomi Health Commercial |
$819.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$749.87
|
| Rate for Payer: PHP Commercial |
$849.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$869.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$695.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.84
|
| Rate for Payer: UHC Core |
$834.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.87
|
|
|
GELATIN ABSORBABLE MUCOSAL POWDER
|
Facility
|
IP
|
$316.91
|
|
|
Service Code
|
NDC 00009043304
|
| Hospital Charge Code |
28017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$220.57 |
| Max. Negotiated Rate |
$285.22 |
| Rate for Payer: Aetna Commercial |
$269.37
|
| Rate for Payer: BCBS Trust/PPO |
$261.74
|
| Rate for Payer: BCN Commercial |
$261.74
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Cofinity Commercial |
$272.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.53
|
| Rate for Payer: Healthscope Commercial |
$285.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.37
|
| Rate for Payer: Nomi Health Commercial |
$259.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.68
|
| Rate for Payer: PHP Commercial |
$269.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.88
|
| Rate for Payer: UHC Core |
$264.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.68
|
|
|
GELATIN ABSORBABLE MUCOSAL POWDER
|
Facility
|
OP
|
$316.91
|
|
|
Service Code
|
NDC 00009043304
|
| Hospital Charge Code |
28017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.87 |
| Max. Negotiated Rate |
$285.22 |
| Rate for Payer: Aetna Commercial |
$269.37
|
| Rate for Payer: Aetna Medicare |
$82.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.03
|
| Rate for Payer: BCBS Complete |
$58.66
|
| Rate for Payer: BCBS MAPPO |
$79.23
|
| Rate for Payer: BCBS Trust/PPO |
$260.53
|
| Rate for Payer: BCN Commercial |
$260.53
|
| Rate for Payer: BCN Medicare Advantage |
$79.23
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Cofinity Commercial |
$272.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$285.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.68
|
| Rate for Payer: Mclaren Medicaid |
$55.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.19
|
| Rate for Payer: Meridian Medicaid |
$58.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.37
|
| Rate for Payer: Nomi Health Commercial |
$259.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.68
|
| Rate for Payer: PACE Senior Care Partners |
$75.27
|
| Rate for Payer: PACE SWMI |
$79.23
|
| Rate for Payer: PHP Commercial |
$269.37
|
| Rate for Payer: PHP Medicare Advantage |
$79.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.71
|
| Rate for Payer: Priority Health Medicare |
$80.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.57
|
| Rate for Payer: Railroad Medicare Medicare |
$79.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.88
|
| Rate for Payer: UHC Core |
$264.62
|
| Rate for Payer: UHC Exchange |
$79.23
|
| Rate for Payer: UHC Medicaid |
$55.87
|
| Rate for Payer: UHC Medicare Advantage |
$79.23
|
| Rate for Payer: UHCCP Medicaid |
$55.87
|
| Rate for Payer: VA VA |
$79.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.68
|
|
|
GELATIN POWDER 1G WITH THROMBIN 5000 UNITS IN 6 ML NS
|
Facility
|
OP
|
$277.21
|
|
|
Service Code
|
NDC 00009000301
|
| Hospital Charge Code |
500530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$249.49 |
| Rate for Payer: Aetna Commercial |
$235.63
|
| Rate for Payer: Aetna Medicare |
$72.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.63
|
| Rate for Payer: BCBS Complete |
$51.31
|
| Rate for Payer: BCBS MAPPO |
$69.30
|
| Rate for Payer: BCBS Trust/PPO |
$227.89
|
| Rate for Payer: BCN Commercial |
$227.89
|
| Rate for Payer: BCN Medicare Advantage |
$69.30
|
| Rate for Payer: Cash Price |
$221.77
|
| Rate for Payer: Cofinity Commercial |
$238.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.30
|
| Rate for Payer: Healthscope Commercial |
$249.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.91
|
| Rate for Payer: Mclaren Medicaid |
$48.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.77
|
| Rate for Payer: Meridian Medicaid |
$51.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.63
|
| Rate for Payer: Nomi Health Commercial |
$227.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.91
|
| Rate for Payer: PACE Senior Care Partners |
$65.84
|
| Rate for Payer: PACE SWMI |
$69.30
|
| Rate for Payer: PHP Commercial |
$235.63
|
| Rate for Payer: PHP Medicare Advantage |
$69.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.17
|
| Rate for Payer: Priority Health Medicare |
$70.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.94
|
| Rate for Payer: Railroad Medicare Medicare |
$69.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.94
|
| Rate for Payer: UHC Core |
$231.47
|
| Rate for Payer: UHC Exchange |
$69.30
|
| Rate for Payer: UHC Medicaid |
$48.87
|
| Rate for Payer: UHC Medicare Advantage |
$69.30
|
| Rate for Payer: UHCCP Medicaid |
$48.87
|
| Rate for Payer: VA VA |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.91
|
|
|
GELATIN POWDER 1G WITH THROMBIN 5000 UNITS IN 6 ML NS
|
Facility
|
IP
|
$277.21
|
|
|
Service Code
|
NDC 00009000301
|
| Hospital Charge Code |
500530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.94 |
| Max. Negotiated Rate |
$249.49 |
| Rate for Payer: Aetna Commercial |
$235.63
|
| Rate for Payer: BCBS Trust/PPO |
$228.95
|
| Rate for Payer: BCN Commercial |
$228.95
|
| Rate for Payer: Cash Price |
$221.77
|
| Rate for Payer: Cofinity Commercial |
$238.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.77
|
| Rate for Payer: Healthscope Commercial |
$249.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.63
|
| Rate for Payer: Nomi Health Commercial |
$227.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.91
|
| Rate for Payer: PHP Commercial |
$235.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.94
|
| Rate for Payer: UHC Core |
$231.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.91
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
IP
|
$707.59
|
|
|
Service Code
|
NDC 63713001974
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$492.48 |
| Max. Negotiated Rate |
$636.83 |
| Rate for Payer: Aetna Commercial |
$601.45
|
| Rate for Payer: BCBS Trust/PPO |
$584.40
|
| Rate for Payer: BCN Commercial |
$584.40
|
| Rate for Payer: Cash Price |
$566.07
|
| Rate for Payer: Cofinity Commercial |
$608.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.07
|
| Rate for Payer: Healthscope Commercial |
$636.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.45
|
| Rate for Payer: Nomi Health Commercial |
$580.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.69
|
| Rate for Payer: PHP Commercial |
$601.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$615.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$622.68
|
| Rate for Payer: UHC Core |
$590.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.69
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
OP
|
$707.59
|
|
|
Service Code
|
NDC 63713001974
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$124.75 |
| Max. Negotiated Rate |
$636.83 |
| Rate for Payer: Aetna Commercial |
$601.45
|
| Rate for Payer: Aetna Medicare |
$183.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.12
|
| Rate for Payer: BCBS Complete |
$130.97
|
| Rate for Payer: BCBS MAPPO |
$176.90
|
| Rate for Payer: BCBS Trust/PPO |
$581.71
|
| Rate for Payer: BCN Commercial |
$581.71
|
| Rate for Payer: BCN Medicare Advantage |
$176.90
|
| Rate for Payer: Cash Price |
$566.07
|
| Rate for Payer: Cofinity Commercial |
$608.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.90
|
| Rate for Payer: Healthscope Commercial |
$636.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.69
|
| Rate for Payer: Mclaren Medicaid |
$124.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.74
|
| Rate for Payer: Meridian Medicaid |
$130.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.45
|
| Rate for Payer: Nomi Health Commercial |
$580.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.69
|
| Rate for Payer: PACE Senior Care Partners |
$168.05
|
| Rate for Payer: PACE SWMI |
$176.90
|
| Rate for Payer: PHP Commercial |
$601.45
|
| Rate for Payer: PHP Medicare Advantage |
$176.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$615.60
|
| Rate for Payer: Priority Health Medicare |
$178.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.48
|
| Rate for Payer: Railroad Medicare Medicare |
$176.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$622.68
|
| Rate for Payer: UHC Core |
$590.84
|
| Rate for Payer: UHC Exchange |
$176.90
|
| Rate for Payer: UHC Medicaid |
$124.75
|
| Rate for Payer: UHC Medicare Advantage |
$176.90
|
| Rate for Payer: UHCCP Medicaid |
$124.75
|
| Rate for Payer: VA VA |
$176.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.69
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
OP
|
$971.54
|
|
|
Service Code
|
NDC 00009034201
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.28 |
| Max. Negotiated Rate |
$874.39 |
| Rate for Payer: Aetna Commercial |
$825.81
|
| Rate for Payer: Aetna Medicare |
$252.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$303.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$303.61
|
| Rate for Payer: BCBS Complete |
$179.83
|
| Rate for Payer: BCBS MAPPO |
$242.88
|
| Rate for Payer: BCBS Trust/PPO |
$798.70
|
| Rate for Payer: BCN Commercial |
$798.70
|
| Rate for Payer: BCN Medicare Advantage |
$242.88
|
| Rate for Payer: Cash Price |
$777.23
|
| Rate for Payer: Cofinity Commercial |
$835.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.88
|
| Rate for Payer: Healthscope Commercial |
$874.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.65
|
| Rate for Payer: Mclaren Medicaid |
$171.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.03
|
| Rate for Payer: Meridian Medicaid |
$179.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$267.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.81
|
| Rate for Payer: Nomi Health Commercial |
$796.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.65
|
| Rate for Payer: PACE Senior Care Partners |
$230.74
|
| Rate for Payer: PACE SWMI |
$242.88
|
| Rate for Payer: PHP Commercial |
$825.81
|
| Rate for Payer: PHP Medicare Advantage |
$242.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$845.24
|
| Rate for Payer: Priority Health Medicare |
$245.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$676.19
|
| Rate for Payer: Railroad Medicare Medicare |
$242.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.96
|
| Rate for Payer: UHC Core |
$811.24
|
| Rate for Payer: UHC Exchange |
$242.88
|
| Rate for Payer: UHC Medicaid |
$171.28
|
| Rate for Payer: UHC Medicare Advantage |
$242.88
|
| Rate for Payer: UHCCP Medicaid |
$171.28
|
| Rate for Payer: VA VA |
$242.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.65
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
IP
|
$971.54
|
|
|
Service Code
|
NDC 00009034201
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$676.19 |
| Max. Negotiated Rate |
$874.39 |
| Rate for Payer: Aetna Commercial |
$825.81
|
| Rate for Payer: BCBS Trust/PPO |
$802.39
|
| Rate for Payer: BCN Commercial |
$802.39
|
| Rate for Payer: Cash Price |
$777.23
|
| Rate for Payer: Cofinity Commercial |
$835.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.23
|
| Rate for Payer: Healthscope Commercial |
$874.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.81
|
| Rate for Payer: Nomi Health Commercial |
$796.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.65
|
| Rate for Payer: PHP Commercial |
$825.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$845.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$676.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.96
|
| Rate for Payer: UHC Core |
$811.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.65
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
OP
|
$407.42
|
|
|
Service Code
|
NDC 00009031508
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.83 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Aetna Commercial |
$346.31
|
| Rate for Payer: Aetna Medicare |
$105.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.32
|
| Rate for Payer: BCBS Complete |
$75.41
|
| Rate for Payer: BCBS MAPPO |
$101.86
|
| Rate for Payer: BCBS Trust/PPO |
$334.94
|
| Rate for Payer: BCN Commercial |
$334.94
|
| Rate for Payer: BCN Medicare Advantage |
$101.86
|
| Rate for Payer: Cash Price |
$325.94
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.86
|
| Rate for Payer: Healthscope Commercial |
$366.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.56
|
| Rate for Payer: Mclaren Medicaid |
$71.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.95
|
| Rate for Payer: Meridian Medicaid |
$75.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$112.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.31
|
| Rate for Payer: Nomi Health Commercial |
$334.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.56
|
| Rate for Payer: PACE Senior Care Partners |
$96.76
|
| Rate for Payer: PACE SWMI |
$101.86
|
| Rate for Payer: PHP Commercial |
$346.31
|
| Rate for Payer: PHP Medicare Advantage |
$101.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$354.46
|
| Rate for Payer: Priority Health Medicare |
$102.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.56
|
| Rate for Payer: Railroad Medicare Medicare |
$101.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.53
|
| Rate for Payer: UHC Core |
$340.20
|
| Rate for Payer: UHC Exchange |
$101.86
|
| Rate for Payer: UHC Medicaid |
$71.83
|
| Rate for Payer: UHC Medicare Advantage |
$101.86
|
| Rate for Payer: UHCCP Medicaid |
$71.83
|
| Rate for Payer: VA VA |
$101.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.56
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$407.42
|
|
|
Service Code
|
NDC 00009031508
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$283.56 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Aetna Commercial |
$346.31
|
| Rate for Payer: BCBS Trust/PPO |
$336.49
|
| Rate for Payer: BCN Commercial |
$336.49
|
| Rate for Payer: Cash Price |
$325.94
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.94
|
| Rate for Payer: Healthscope Commercial |
$366.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.31
|
| Rate for Payer: Nomi Health Commercial |
$334.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.56
|
| Rate for Payer: PHP Commercial |
$346.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$354.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.53
|
| Rate for Payer: UHC Core |
$340.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.56
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
OP
|
$289.89
|
|
|
Service Code
|
NDC 63713001972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$260.90 |
| Rate for Payer: Aetna Commercial |
$246.41
|
| Rate for Payer: Aetna Medicare |
$75.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.59
|
| Rate for Payer: BCBS Complete |
$53.66
|
| Rate for Payer: BCBS MAPPO |
$72.47
|
| Rate for Payer: BCBS Trust/PPO |
$238.32
|
| Rate for Payer: BCN Commercial |
$238.32
|
| Rate for Payer: BCN Medicare Advantage |
$72.47
|
| Rate for Payer: Cash Price |
$231.91
|
| Rate for Payer: Cofinity Commercial |
$249.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.47
|
| Rate for Payer: Healthscope Commercial |
$260.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.42
|
| Rate for Payer: Mclaren Medicaid |
$51.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.10
|
| Rate for Payer: Meridian Medicaid |
$53.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.41
|
| Rate for Payer: Nomi Health Commercial |
$237.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.42
|
| Rate for Payer: PACE Senior Care Partners |
$68.85
|
| Rate for Payer: PACE SWMI |
$72.47
|
| Rate for Payer: PHP Commercial |
$246.41
|
| Rate for Payer: PHP Medicare Advantage |
$72.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.20
|
| Rate for Payer: Priority Health Medicare |
$73.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.76
|
| Rate for Payer: Railroad Medicare Medicare |
$72.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.10
|
| Rate for Payer: UHC Core |
$242.06
|
| Rate for Payer: UHC Exchange |
$72.47
|
| Rate for Payer: UHC Medicaid |
$51.11
|
| Rate for Payer: UHC Medicare Advantage |
$72.47
|
| Rate for Payer: UHCCP Medicaid |
$51.11
|
| Rate for Payer: VA VA |
$72.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.42
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$289.89
|
|
|
Service Code
|
NDC 63713001972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$201.76 |
| Max. Negotiated Rate |
$260.90 |
| Rate for Payer: Aetna Commercial |
$246.41
|
| Rate for Payer: BCBS Trust/PPO |
$239.42
|
| Rate for Payer: BCN Commercial |
$239.42
|
| Rate for Payer: Cash Price |
$231.91
|
| Rate for Payer: Cofinity Commercial |
$249.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.91
|
| Rate for Payer: Healthscope Commercial |
$260.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.41
|
| Rate for Payer: Nomi Health Commercial |
$237.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.42
|
| Rate for Payer: PHP Commercial |
$246.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.10
|
| Rate for Payer: UHC Core |
$242.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.42
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
IP
|
$437.91
|
|
|
Service Code
|
NDC 00009032301
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$394.12 |
| Rate for Payer: Aetna Commercial |
$372.22
|
| Rate for Payer: BCBS Trust/PPO |
$361.67
|
| Rate for Payer: BCN Commercial |
$361.67
|
| Rate for Payer: Cash Price |
$350.33
|
| Rate for Payer: Cofinity Commercial |
$376.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.33
|
| Rate for Payer: Healthscope Commercial |
$394.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.22
|
| Rate for Payer: Nomi Health Commercial |
$359.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.43
|
| Rate for Payer: PHP Commercial |
$372.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$380.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$304.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.36
|
| Rate for Payer: UHC Core |
$365.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.43
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
OP
|
$437.91
|
|
|
Service Code
|
NDC 00009032301
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$394.12 |
| Rate for Payer: Aetna Commercial |
$372.22
|
| Rate for Payer: Aetna Medicare |
$113.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.85
|
| Rate for Payer: BCBS Complete |
$81.06
|
| Rate for Payer: BCBS MAPPO |
$109.48
|
| Rate for Payer: BCBS Trust/PPO |
$360.01
|
| Rate for Payer: BCN Commercial |
$360.01
|
| Rate for Payer: BCN Medicare Advantage |
$109.48
|
| Rate for Payer: Cash Price |
$350.33
|
| Rate for Payer: Cofinity Commercial |
$376.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.48
|
| Rate for Payer: Healthscope Commercial |
$394.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.43
|
| Rate for Payer: Mclaren Medicaid |
$77.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.95
|
| Rate for Payer: Meridian Medicaid |
$81.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$120.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.22
|
| Rate for Payer: Nomi Health Commercial |
$359.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.43
|
| Rate for Payer: PACE Senior Care Partners |
$104.00
|
| Rate for Payer: PACE SWMI |
$109.48
|
| Rate for Payer: PHP Commercial |
$372.22
|
| Rate for Payer: PHP Medicare Advantage |
$109.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$380.98
|
| Rate for Payer: Priority Health Medicare |
$110.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$304.79
|
| Rate for Payer: Railroad Medicare Medicare |
$109.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.36
|
| Rate for Payer: UHC Core |
$365.65
|
| Rate for Payer: UHC Exchange |
$109.48
|
| Rate for Payer: UHC Medicaid |
$77.20
|
| Rate for Payer: UHC Medicare Advantage |
$109.48
|
| Rate for Payer: UHCCP Medicaid |
$77.20
|
| Rate for Payer: VA VA |
$109.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.43
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
OP
|
$346.69
|
|
|
Service Code
|
NDC 63713001973
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.12 |
| Max. Negotiated Rate |
$312.02 |
| Rate for Payer: Aetna Commercial |
$294.69
|
| Rate for Payer: Aetna Medicare |
$90.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.34
|
| Rate for Payer: BCBS Complete |
$64.17
|
| Rate for Payer: BCBS MAPPO |
$86.67
|
| Rate for Payer: BCBS Trust/PPO |
$285.01
|
| Rate for Payer: BCN Commercial |
$285.01
|
| Rate for Payer: BCN Medicare Advantage |
$86.67
|
| Rate for Payer: Cash Price |
$277.35
|
| Rate for Payer: Cofinity Commercial |
$298.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.67
|
| Rate for Payer: Healthscope Commercial |
$312.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.02
|
| Rate for Payer: Mclaren Medicaid |
$61.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.01
|
| Rate for Payer: Meridian Medicaid |
$64.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.69
|
| Rate for Payer: Nomi Health Commercial |
$284.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.02
|
| Rate for Payer: PACE Senior Care Partners |
$82.34
|
| Rate for Payer: PACE SWMI |
$86.67
|
| Rate for Payer: PHP Commercial |
$294.69
|
| Rate for Payer: PHP Medicare Advantage |
$86.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.62
|
| Rate for Payer: Priority Health Medicare |
$87.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.30
|
| Rate for Payer: Railroad Medicare Medicare |
$86.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.09
|
| Rate for Payer: UHC Core |
$289.49
|
| Rate for Payer: UHC Exchange |
$86.67
|
| Rate for Payer: UHC Medicaid |
$61.12
|
| Rate for Payer: UHC Medicare Advantage |
$86.67
|
| Rate for Payer: UHCCP Medicaid |
$61.12
|
| Rate for Payer: VA VA |
$86.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.02
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
IP
|
$346.69
|
|
|
Service Code
|
NDC 63713001973
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$241.30 |
| Max. Negotiated Rate |
$312.02 |
| Rate for Payer: Aetna Commercial |
$294.69
|
| Rate for Payer: BCBS Trust/PPO |
$286.33
|
| Rate for Payer: BCN Commercial |
$286.33
|
| Rate for Payer: Cash Price |
$277.35
|
| Rate for Payer: Cofinity Commercial |
$298.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.35
|
| Rate for Payer: Healthscope Commercial |
$312.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.69
|
| Rate for Payer: Nomi Health Commercial |
$284.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.02
|
| Rate for Payer: PHP Commercial |
$294.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.09
|
| Rate for Payer: UHC Core |
$289.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.02
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.32 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: BCBS Trust/PPO |
$193.80
|
| Rate for Payer: BCN Commercial |
$193.80
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.43
|
| Rate for Payer: BCBS MAPPO |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.93
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: BCN Medicare Advantage |
$0.59
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.59
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Mclaren Medicaid |
$0.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.62
|
| Rate for Payer: Meridian Medicaid |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: Nomi Health Commercial |
$1.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: PACE Senior Care Partners |
$0.56
|
| Rate for Payer: PACE SWMI |
$0.59
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: PHP Medicare Advantage |
$0.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.04
|
| Rate for Payer: Priority Health Medicare |
$0.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: Railroad Medicare Medicare |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Medicaid |
$0.41
|
| Rate for Payer: UHC Medicare Advantage |
$0.59
|
| Rate for Payer: UHCCP Medicaid |
$0.41
|
| Rate for Payer: VA VA |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.94
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: Nomi Health Commercial |
$1.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$61.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.33
|
| Rate for Payer: BCBS Complete |
$43.43
|
| Rate for Payer: BCBS MAPPO |
$58.66
|
| Rate for Payer: BCBS Trust/PPO |
$192.91
|
| Rate for Payer: BCN Commercial |
$192.91
|
| Rate for Payer: BCN Medicare Advantage |
$58.66
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.66
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Mclaren Medicaid |
$41.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.60
|
| Rate for Payer: Meridian Medicaid |
$43.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PACE Senior Care Partners |
$55.73
|
| Rate for Payer: PACE SWMI |
$58.66
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: PHP Medicare Advantage |
$58.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Medicare |
$59.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: UHC Exchange |
$58.66
|
| Rate for Payer: UHC Medicaid |
$41.37
|
| Rate for Payer: UHC Medicare Advantage |
$58.66
|
| Rate for Payer: UHCCP Medicaid |
$41.37
|
| Rate for Payer: VA VA |
$58.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$9,255.31
|
|
|
Service Code
|
APR-DRG 8511
|
| Min. Negotiated Rate |
$8,814.58 |
| Max. Negotiated Rate |
$9,255.31 |
| Rate for Payer: BCBS Complete |
$9,255.31
|
| Rate for Payer: Mclaren Medicaid |
$8,814.58
|
| Rate for Payer: Meridian Medicaid |
$9,255.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,814.58
|
| Rate for Payer: UHC Medicaid |
$8,814.58
|
| Rate for Payer: UHCCP Medicaid |
$8,814.58
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$51,110.07
|
|
|
Service Code
|
APR-DRG 8513
|
| Min. Negotiated Rate |
$48,676.26 |
| Max. Negotiated Rate |
$51,110.07 |
| Rate for Payer: BCBS Complete |
$51,110.07
|
| Rate for Payer: Mclaren Medicaid |
$48,676.26
|
| Rate for Payer: Meridian Medicaid |
$51,110.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$48,676.26
|
| Rate for Payer: UHC Medicaid |
$48,676.26
|
| Rate for Payer: UHCCP Medicaid |
$48,676.26
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$13,352.13
|
|
|
Service Code
|
APR-DRG 8512
|
| Min. Negotiated Rate |
$12,716.31 |
| Max. Negotiated Rate |
$13,352.13 |
| Rate for Payer: BCBS Complete |
$13,352.13
|
| Rate for Payer: Mclaren Medicaid |
$12,716.31
|
| Rate for Payer: Meridian Medicaid |
$13,352.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,716.31
|
| Rate for Payer: UHC Medicaid |
$12,716.31
|
| Rate for Payer: UHCCP Medicaid |
$12,716.31
|
|
