|
HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$26.54
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Aetna Commercial |
$22.56
|
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Commercial |
$19.69
|
| Rate for Payer: BCBS Trust/PPO |
$20.51
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCBS Trust/PPO |
$18.82
|
| Rate for Payer: BCBS Trust/PPO |
$12.45
|
| Rate for Payer: BCBS Trust/PPO |
$17.91
|
| Rate for Payer: BCN Commercial |
$17.91
|
| Rate for Payer: BCN Commercial |
$20.51
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: BCN Commercial |
$18.82
|
| Rate for Payer: BCN Commercial |
$12.45
|
| Rate for Payer: Cash Price |
$21.23
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$12.89
|
| Rate for Payer: Cofinity Commercial |
$19.93
|
| Rate for Payer: Cofinity Commercial |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$20.94
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$23.89
|
| Rate for Payer: Healthscope Commercial |
$20.85
|
| Rate for Payer: Healthscope Commercial |
$21.92
|
| Rate for Payer: Healthscope Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.56
|
| Rate for Payer: PHP Commercial |
$13.69
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$20.70
|
| Rate for Payer: PHP Commercial |
$22.56
|
| Rate for Payer: PHP Commercial |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Core |
$22.16
|
| Rate for Payer: UHC Core |
$19.35
|
| Rate for Payer: UHC Core |
$20.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV
|
Facility
|
IP
|
$71.15
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$64.04 |
| Rate for Payer: Aetna Commercial |
$60.48
|
| Rate for Payer: BCBS Trust/PPO |
$54.98
|
| Rate for Payer: BCN Commercial |
$54.98
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.92
|
| Rate for Payer: Healthscope Commercial |
$64.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.48
|
| Rate for Payer: PHP Commercial |
$60.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.61
|
| Rate for Payer: UHC Core |
$59.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.36
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) INFUSION CUSTOM
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
180233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: BCBS Trust/PPO |
$67.80
|
| Rate for Payer: BCN Commercial |
$67.80
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.57
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.20
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN
|
Facility
|
IP
|
$87.21
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.19 |
| Max. Negotiated Rate |
$78.49 |
| Rate for Payer: Aetna Commercial |
$74.13
|
| Rate for Payer: Aetna Commercial |
$60.48
|
| Rate for Payer: BCBS Trust/PPO |
$54.98
|
| Rate for Payer: BCBS Trust/PPO |
$67.40
|
| Rate for Payer: BCN Commercial |
$54.98
|
| Rate for Payer: BCN Commercial |
$67.40
|
| Rate for Payer: Cash Price |
$69.77
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Cofinity Commercial |
$75.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.92
|
| Rate for Payer: Healthscope Commercial |
$64.04
|
| Rate for Payer: Healthscope Commercial |
$78.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.13
|
| Rate for Payer: PHP Commercial |
$74.13
|
| Rate for Payer: PHP Commercial |
$60.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.74
|
| Rate for Payer: UHC Core |
$72.82
|
| Rate for Payer: UHC Core |
$59.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.36
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
HCPCS J1643
|
| Hospital Charge Code |
10181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$10.22
|
| Rate for Payer: BCN Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.64
|
| Rate for Payer: UHC Core |
$11.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.58
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Commercial |
$10.67
|
| Rate for Payer: Aetna Commercial |
$14.56
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$15.44
|
| Rate for Payer: BCBS Trust/PPO |
$9.70
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$15.90
|
| Rate for Payer: BCN Commercial |
$13.24
|
| Rate for Payer: BCN Commercial |
$15.90
|
| Rate for Payer: BCN Commercial |
$14.04
|
| Rate for Payer: BCN Commercial |
$13.04
|
| Rate for Payer: BCN Commercial |
$9.70
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cofinity Commercial |
$10.79
|
| Rate for Payer: Cofinity Commercial |
$14.73
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$15.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$11.30
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$16.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.44
|
| Rate for Payer: PHP Commercial |
$15.44
|
| Rate for Payer: PHP Commercial |
$17.49
|
| Rate for Payer: PHP Commercial |
$10.67
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.11
|
| Rate for Payer: UHC Core |
$14.30
|
| Rate for Payer: UHC Core |
$15.17
|
| Rate for Payer: UHC Core |
$14.09
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: UHC Core |
$10.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.34
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
116331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Aetna Commercial |
$16.44
|
| Rate for Payer: BCBS Trust/PPO |
$14.95
|
| Rate for Payer: BCN Commercial |
$14.95
|
| Rate for Payer: Cash Price |
$15.47
|
| Rate for Payer: Cofinity Commercial |
$16.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.47
|
| Rate for Payer: Healthscope Commercial |
$17.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.44
|
| Rate for Payer: PHP Commercial |
$16.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.02
|
| Rate for Payer: UHC Core |
$16.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.50
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$11.13
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
116327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$10.02 |
| Rate for Payer: Aetna Commercial |
$9.46
|
| Rate for Payer: Aetna Commercial |
$11.05
|
| Rate for Payer: Aetna Commercial |
$8.71
|
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$10.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.92
|
| Rate for Payer: BCN Commercial |
$7.92
|
| Rate for Payer: BCN Commercial |
$8.60
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: BCN Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cash Price |
$8.20
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$11.18
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$9.57
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$10.02
|
| Rate for Payer: Healthscope Commercial |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.05
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: PHP Commercial |
$8.71
|
| Rate for Payer: PHP Commercial |
$9.46
|
| Rate for Payer: PHP Commercial |
$11.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.44
|
| Rate for Payer: UHC Core |
$10.86
|
| Rate for Payer: UHC Core |
$9.29
|
| Rate for Payer: UHC Core |
$8.56
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.59
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
116330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna Commercial |
$14.10
|
| Rate for Payer: BCBS Trust/PPO |
$12.82
|
| Rate for Payer: BCN Commercial |
$12.82
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$14.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$14.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.10
|
| Rate for Payer: PHP Commercial |
$14.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.60
|
| Rate for Payer: UHC Core |
$13.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.44
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$11.25
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
105460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.56
|
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.69
|
| Rate for Payer: BCN Commercial |
$7.73
|
| Rate for Payer: BCN Commercial |
$8.69
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$10.12
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.56
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Commercial |
$9.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.80
|
| Rate for Payer: UHC Core |
$8.35
|
| Rate for Payer: UHC Core |
$9.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.44
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$2,111.52
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
91047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,287.82 |
| Max. Negotiated Rate |
$1,900.37 |
| Rate for Payer: Aetna Commercial |
$1,794.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.78
|
| Rate for Payer: BCN Commercial |
$1,631.78
|
| Rate for Payer: Cash Price |
$1,689.22
|
| Rate for Payer: Cofinity Commercial |
$1,815.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,689.22
|
| Rate for Payer: Healthscope Commercial |
$1,900.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,583.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,794.79
|
| Rate for Payer: PHP Commercial |
$1,794.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,478.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,837.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,287.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,858.14
|
| Rate for Payer: UHC Core |
$1,763.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,583.64
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP
|
Facility
|
IP
|
$153.75
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
118174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna Commercial |
$130.69
|
| Rate for Payer: BCBS Trust/PPO |
$118.82
|
| Rate for Payer: BCN Commercial |
$118.82
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cofinity Commercial |
$132.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.00
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.69
|
| Rate for Payer: PHP Commercial |
$130.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.30
|
| Rate for Payer: UHC Core |
$128.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.31
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP
|
Facility
|
IP
|
$197.64
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
117065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$177.88 |
| Rate for Payer: Aetna Commercial |
$167.99
|
| Rate for Payer: BCBS Trust/PPO |
$152.74
|
| Rate for Payer: BCN Commercial |
$152.74
|
| Rate for Payer: Cash Price |
$158.11
|
| Rate for Payer: Cofinity Commercial |
$169.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.11
|
| Rate for Payer: Healthscope Commercial |
$177.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.99
|
| Rate for Payer: PHP Commercial |
$167.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.92
|
| Rate for Payer: UHC Core |
$165.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.23
|
|
|
HH CATHETER LEG STRAP BARD
|
Facility
|
OP
|
$12.47
|
|
|
Service Code
|
HCPCS A4334
|
| Hospital Charge Code |
27000598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Medicare |
$3.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.90
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS MAPPO |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$9.70
|
| Rate for Payer: BCN Commercial |
$9.70
|
| Rate for Payer: BCN Medicare Advantage |
$3.12
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.60
|
| Rate for Payer: PACE Senior Care Partners |
$2.96
|
| Rate for Payer: PACE SWMI |
$3.12
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: PHP Medicare Advantage |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.85
|
| Rate for Payer: Priority Health Medicare |
$3.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.97
|
| Rate for Payer: UHC Core |
$10.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.12
|
| Rate for Payer: UHC Medicare Advantage |
$3.21
|
| Rate for Payer: VA VA |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
|
|
HH CATHETER LEG STRAP BARD
|
Facility
|
IP
|
$12.47
|
|
|
Service Code
|
HCPCS A4334
|
| Hospital Charge Code |
27000598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.60
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.97
|
| Rate for Payer: UHC Core |
$10.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
|
|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
OP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna Commercial |
$23.09
|
| Rate for Payer: Aetna Medicare |
$7.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.49
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: BCBS MAPPO |
$6.79
|
| Rate for Payer: BCBS Trust/PPO |
$21.12
|
| Rate for Payer: BCN Commercial |
$21.12
|
| Rate for Payer: BCN Medicare Advantage |
$6.79
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$23.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.79
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.09
|
| Rate for Payer: PACE Senior Care Partners |
$6.45
|
| Rate for Payer: PACE SWMI |
$6.79
|
| Rate for Payer: PHP Commercial |
$23.09
|
| Rate for Payer: PHP Medicare Advantage |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.63
|
| Rate for Payer: Priority Health Medicare |
$6.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.56
|
| Rate for Payer: Railroad Medicare Medicare |
$6.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.90
|
| Rate for Payer: UHC Core |
$22.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.79
|
| Rate for Payer: UHC Medicare Advantage |
$6.99
|
| Rate for Payer: VA VA |
$6.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.37
|
|
|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
IP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna Commercial |
$23.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.99
|
| Rate for Payer: BCN Commercial |
$20.99
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$23.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.73
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.09
|
| Rate for Payer: PHP Commercial |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.90
|
| Rate for Payer: UHC Core |
$22.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.37
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
OP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna Commercial |
$8.31
|
| Rate for Payer: Aetna Medicare |
$2.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.06
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS MAPPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$7.60
|
| Rate for Payer: BCN Commercial |
$7.60
|
| Rate for Payer: BCN Medicare Advantage |
$2.44
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$8.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.31
|
| Rate for Payer: PACE Senior Care Partners |
$2.32
|
| Rate for Payer: PACE SWMI |
$2.44
|
| Rate for Payer: PHP Commercial |
$8.31
|
| Rate for Payer: PHP Medicare Advantage |
$2.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.51
|
| Rate for Payer: Priority Health Medicare |
$2.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.96
|
| Rate for Payer: Railroad Medicare Medicare |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.61
|
| Rate for Payer: UHC Core |
$8.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.44
|
| Rate for Payer: UHC Medicare Advantage |
$2.52
|
| Rate for Payer: VA VA |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.34
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
IP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna Commercial |
$8.31
|
| Rate for Payer: BCBS Trust/PPO |
$7.56
|
| Rate for Payer: BCN Commercial |
$7.56
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$8.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.31
|
| Rate for Payer: PHP Commercial |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.61
|
| Rate for Payer: UHC Core |
$8.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.34
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
IP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$19.68 |
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: BCBS Trust/PPO |
$16.90
|
| Rate for Payer: BCN Commercial |
$16.90
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.59
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.25
|
| Rate for Payer: UHC Core |
$18.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
OP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$19.68 |
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.83
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$5.47
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.47
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.47
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.59
|
| Rate for Payer: PACE Senior Care Partners |
$5.19
|
| Rate for Payer: PACE SWMI |
$5.47
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: PHP Medicare Advantage |
$5.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.03
|
| Rate for Payer: Priority Health Medicare |
$5.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.34
|
| Rate for Payer: Railroad Medicare Medicare |
$5.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.25
|
| Rate for Payer: UHC Core |
$18.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.47
|
| Rate for Payer: UHC Medicare Advantage |
$5.63
|
| Rate for Payer: VA VA |
$5.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: BCBS Trust/PPO |
$17.36
|
| Rate for Payer: BCN Commercial |
$17.36
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.10
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
OP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.02
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS MAPPO |
$5.62
|
| Rate for Payer: BCBS Trust/PPO |
$17.47
|
| Rate for Payer: BCN Commercial |
$17.47
|
| Rate for Payer: BCN Medicare Advantage |
$5.62
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.62
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.10
|
| Rate for Payer: PACE Senior Care Partners |
$5.34
|
| Rate for Payer: PACE SWMI |
$5.62
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Medicare Advantage |
$5.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.55
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.62
|
| Rate for Payer: UHC Medicare Advantage |
$5.79
|
| Rate for Payer: VA VA |
$5.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
IP
|
$823.40
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$502.19 |
| Max. Negotiated Rate |
$741.06 |
| Rate for Payer: Aetna Commercial |
$699.89
|
| Rate for Payer: BCBS Trust/PPO |
$636.32
|
| Rate for Payer: BCN Commercial |
$636.32
|
| Rate for Payer: Cash Price |
$658.72
|
| Rate for Payer: Cofinity Commercial |
$708.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.72
|
| Rate for Payer: Healthscope Commercial |
$741.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.89
|
| Rate for Payer: PHP Commercial |
$699.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$502.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$724.59
|
| Rate for Payer: UHC Core |
$687.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.55
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
OP
|
$823.40
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.56 |
| Max. Negotiated Rate |
$741.06 |
| Rate for Payer: Aetna Commercial |
$699.89
|
| Rate for Payer: Aetna Medicare |
$214.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$257.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$257.31
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$205.85
|
| Rate for Payer: BCBS Trust/PPO |
$640.19
|
| Rate for Payer: BCN Commercial |
$640.19
|
| Rate for Payer: BCN Medicare Advantage |
$205.85
|
| Rate for Payer: Cash Price |
$658.72
|
| Rate for Payer: Cash Price |
$658.72
|
| Rate for Payer: Cofinity Commercial |
$708.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.85
|
| Rate for Payer: Healthscope Commercial |
$741.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.55
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$216.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.89
|
| Rate for Payer: PACE Senior Care Partners |
$195.56
|
| Rate for Payer: PACE SWMI |
$205.85
|
| Rate for Payer: PHP Commercial |
$699.89
|
| Rate for Payer: PHP Medicare Advantage |
$205.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.36
|
| Rate for Payer: Priority Health Medicare |
$205.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$502.19
|
| Rate for Payer: Railroad Medicare Medicare |
$205.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$724.59
|
| Rate for Payer: UHC Core |
$687.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.85
|
| Rate for Payer: UHC Medicare Advantage |
$212.03
|
| Rate for Payer: VA VA |
$205.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.55
|
|
