|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
IP
|
$27.70
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: BCBS Trust/PPO |
$22.88
|
| Rate for Payer: BCN Commercial |
$22.88
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.77
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.38
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.77
|
|
|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
OP
|
$27.70
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.66
|
| Rate for Payer: BCBS Complete |
$5.13
|
| Rate for Payer: BCBS MAPPO |
$6.92
|
| Rate for Payer: BCBS Trust/PPO |
$22.77
|
| Rate for Payer: BCN Commercial |
$22.77
|
| Rate for Payer: BCN Medicare Advantage |
$6.92
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.92
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.77
|
| Rate for Payer: Mclaren Medicaid |
$4.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.27
|
| Rate for Payer: Meridian Medicaid |
$5.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.77
|
| Rate for Payer: PACE Senior Care Partners |
$6.58
|
| Rate for Payer: PACE SWMI |
$6.92
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Medicare Advantage |
$6.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.10
|
| Rate for Payer: Priority Health Medicare |
$6.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.38
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: UHC Exchange |
$6.92
|
| Rate for Payer: UHC Medicaid |
$4.88
|
| Rate for Payer: UHC Medicare Advantage |
$6.92
|
| Rate for Payer: UHCCP Medicaid |
$4.88
|
| Rate for Payer: VA VA |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.77
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
IP
|
$9.98
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Aetna Commercial |
$8.48
|
| Rate for Payer: BCBS Trust/PPO |
$8.24
|
| Rate for Payer: BCN Commercial |
$8.24
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Cofinity Commercial |
$8.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.98
|
| Rate for Payer: Healthscope Commercial |
$8.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.48
|
| Rate for Payer: Nomi Health Commercial |
$8.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.49
|
| Rate for Payer: PHP Commercial |
$8.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.78
|
| Rate for Payer: UHC Core |
$8.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.49
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
OP
|
$9.98
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Aetna Commercial |
$8.48
|
| Rate for Payer: Aetna Medicare |
$2.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.12
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: BCBS MAPPO |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.20
|
| Rate for Payer: BCN Commercial |
$8.20
|
| Rate for Payer: BCN Medicare Advantage |
$2.50
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Cofinity Commercial |
$8.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$8.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.49
|
| Rate for Payer: Mclaren Medicaid |
$1.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.62
|
| Rate for Payer: Meridian Medicaid |
$1.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.48
|
| Rate for Payer: Nomi Health Commercial |
$8.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.49
|
| Rate for Payer: PACE Senior Care Partners |
$2.37
|
| Rate for Payer: PACE SWMI |
$2.50
|
| Rate for Payer: PHP Commercial |
$8.48
|
| Rate for Payer: PHP Medicare Advantage |
$2.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.68
|
| Rate for Payer: Priority Health Medicare |
$2.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.95
|
| Rate for Payer: Railroad Medicare Medicare |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.78
|
| Rate for Payer: UHC Core |
$8.33
|
| Rate for Payer: UHC Exchange |
$2.50
|
| Rate for Payer: UHC Medicaid |
$1.76
|
| Rate for Payer: UHC Medicare Advantage |
$2.50
|
| Rate for Payer: UHCCP Medicaid |
$1.76
|
| Rate for Payer: VA VA |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.49
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
OP
|
$22.31
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.97
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$18.34
|
| Rate for Payer: BCN Commercial |
$18.34
|
| Rate for Payer: BCN Medicare Advantage |
$5.58
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.58
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Mclaren Medicaid |
$3.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.86
|
| Rate for Payer: Meridian Medicaid |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Nomi Health Commercial |
$18.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PACE Senior Care Partners |
$5.30
|
| Rate for Payer: PACE SWMI |
$5.58
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Medicare Advantage |
$5.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.41
|
| Rate for Payer: Priority Health Medicare |
$5.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: Railroad Medicare Medicare |
$5.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.63
|
| Rate for Payer: UHC Core |
$18.63
|
| Rate for Payer: UHC Exchange |
$5.58
|
| Rate for Payer: UHC Medicaid |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$5.58
|
| Rate for Payer: UHCCP Medicaid |
$3.93
|
| Rate for Payer: VA VA |
$5.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
IP
|
$22.31
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$18.43
|
| Rate for Payer: BCN Commercial |
$18.43
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Nomi Health Commercial |
$18.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.63
|
| Rate for Payer: UHC Core |
$18.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$5.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.16
|
| Rate for Payer: BCBS Complete |
$4.24
|
| Rate for Payer: BCBS MAPPO |
$5.73
|
| Rate for Payer: BCBS Trust/PPO |
$18.84
|
| Rate for Payer: BCN Commercial |
$18.84
|
| Rate for Payer: BCN Medicare Advantage |
$5.73
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.73
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.02
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: PACE Senior Care Partners |
$5.44
|
| Rate for Payer: PACE SWMI |
$5.73
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: PHP Medicare Advantage |
$5.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.94
|
| Rate for Payer: Priority Health Medicare |
$5.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.95
|
| Rate for Payer: Railroad Medicare Medicare |
$5.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.17
|
| Rate for Payer: UHC Core |
$19.14
|
| Rate for Payer: UHC Exchange |
$5.73
|
| Rate for Payer: UHC Medicaid |
$4.04
|
| Rate for Payer: UHC Medicare Advantage |
$5.73
|
| Rate for Payer: UHCCP Medicaid |
$4.04
|
| Rate for Payer: VA VA |
$5.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: BCBS Trust/PPO |
$18.93
|
| Rate for Payer: BCN Commercial |
$18.93
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.17
|
| Rate for Payer: UHC Core |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
IP
|
$964.48
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$671.28 |
| Max. Negotiated Rate |
$868.03 |
| Rate for Payer: Aetna Commercial |
$819.81
|
| Rate for Payer: BCBS Trust/PPO |
$796.56
|
| Rate for Payer: BCN Commercial |
$796.56
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$829.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$868.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.81
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.36
|
| Rate for Payer: PHP Commercial |
$819.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$839.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.74
|
| Rate for Payer: UHC Core |
$805.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.36
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
OP
|
$964.48
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.04 |
| Max. Negotiated Rate |
$868.03 |
| Rate for Payer: Aetna Commercial |
$819.81
|
| Rate for Payer: Aetna Medicare |
$250.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.40
|
| Rate for Payer: BCBS Complete |
$178.53
|
| Rate for Payer: BCBS MAPPO |
$241.12
|
| Rate for Payer: BCBS Trust/PPO |
$792.90
|
| Rate for Payer: BCN Commercial |
$792.90
|
| Rate for Payer: BCN Medicare Advantage |
$241.12
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$829.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.12
|
| Rate for Payer: Healthscope Commercial |
$868.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.36
|
| Rate for Payer: Mclaren Medicaid |
$170.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.18
|
| Rate for Payer: Meridian Medicaid |
$178.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.81
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.36
|
| Rate for Payer: PACE Senior Care Partners |
$229.06
|
| Rate for Payer: PACE SWMI |
$241.12
|
| Rate for Payer: PHP Commercial |
$819.81
|
| Rate for Payer: PHP Medicare Advantage |
$241.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$839.10
|
| Rate for Payer: Priority Health Medicare |
$243.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.28
|
| Rate for Payer: Railroad Medicare Medicare |
$241.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.74
|
| Rate for Payer: UHC Core |
$805.34
|
| Rate for Payer: UHC Exchange |
$241.12
|
| Rate for Payer: UHC Medicaid |
$170.04
|
| Rate for Payer: UHC Medicare Advantage |
$241.12
|
| Rate for Payer: UHCCP Medicaid |
$170.04
|
| Rate for Payer: VA VA |
$241.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.36
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
IP
|
$839.87
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.55 |
| Max. Negotiated Rate |
$755.88 |
| Rate for Payer: Aetna Commercial |
$713.89
|
| Rate for Payer: BCBS Trust/PPO |
$693.65
|
| Rate for Payer: BCN Commercial |
$693.65
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$722.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$688.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.90
|
| Rate for Payer: PHP Commercial |
$713.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$730.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$584.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.09
|
| Rate for Payer: UHC Core |
$701.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.90
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
OP
|
$839.87
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.07 |
| Max. Negotiated Rate |
$755.88 |
| Rate for Payer: Aetna Commercial |
$713.89
|
| Rate for Payer: Aetna Medicare |
$218.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.46
|
| Rate for Payer: BCBS Complete |
$155.46
|
| Rate for Payer: BCBS MAPPO |
$209.97
|
| Rate for Payer: BCBS Trust/PPO |
$690.46
|
| Rate for Payer: BCN Commercial |
$690.46
|
| Rate for Payer: BCN Medicare Advantage |
$209.97
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$722.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.97
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.90
|
| Rate for Payer: Mclaren Medicaid |
$148.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.47
|
| Rate for Payer: Meridian Medicaid |
$155.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$688.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.90
|
| Rate for Payer: PACE Senior Care Partners |
$199.47
|
| Rate for Payer: PACE SWMI |
$209.97
|
| Rate for Payer: PHP Commercial |
$713.89
|
| Rate for Payer: PHP Medicare Advantage |
$209.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$730.69
|
| Rate for Payer: Priority Health Medicare |
$212.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$584.55
|
| Rate for Payer: Railroad Medicare Medicare |
$209.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.09
|
| Rate for Payer: UHC Core |
$701.29
|
| Rate for Payer: UHC Exchange |
$209.97
|
| Rate for Payer: UHC Medicaid |
$148.07
|
| Rate for Payer: UHC Medicare Advantage |
$209.97
|
| Rate for Payer: UHCCP Medicaid |
$148.07
|
| Rate for Payer: VA VA |
$209.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.90
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$5.25
|
| Rate for Payer: BCN Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.60
|
| Rate for Payer: UHC Core |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Commercial |
$5.23
|
| Rate for Payer: BCN Medicare Advantage |
$1.59
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Mclaren Medicaid |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.67
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PACE Senior Care Partners |
$1.51
|
| Rate for Payer: PACE SWMI |
$1.59
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: PHP Medicare Advantage |
$1.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.53
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.60
|
| Rate for Payer: UHC Core |
$5.31
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UHC Medicaid |
$1.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.59
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: VA VA |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$9,900.52
|
|
|
Service Code
|
APR-DRG 3082
|
| Min. Negotiated Rate |
$9,429.06 |
| Max. Negotiated Rate |
$9,900.52 |
| Rate for Payer: BCBS Complete |
$9,900.52
|
| Rate for Payer: Mclaren Medicaid |
$9,429.06
|
| Rate for Payer: Meridian Medicaid |
$9,900.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,429.06
|
| Rate for Payer: UHC Medicaid |
$9,429.06
|
| Rate for Payer: UHCCP Medicaid |
$9,429.06
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$12,408.25
|
|
|
Service Code
|
APR-DRG 3083
|
| Min. Negotiated Rate |
$11,817.38 |
| Max. Negotiated Rate |
$12,408.25 |
| Rate for Payer: BCBS Complete |
$12,408.25
|
| Rate for Payer: Mclaren Medicaid |
$11,817.38
|
| Rate for Payer: Meridian Medicaid |
$12,408.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,817.38
|
| Rate for Payer: UHC Medicaid |
$11,817.38
|
| Rate for Payer: UHCCP Medicaid |
$11,817.38
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$21,684.59
|
|
|
Service Code
|
APR-DRG 3084
|
| Min. Negotiated Rate |
$20,651.99 |
| Max. Negotiated Rate |
$21,684.59 |
| Rate for Payer: BCBS Complete |
$21,684.59
|
| Rate for Payer: Mclaren Medicaid |
$20,651.99
|
| Rate for Payer: Meridian Medicaid |
$21,684.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,651.99
|
| Rate for Payer: UHC Medicaid |
$20,651.99
|
| Rate for Payer: UHCCP Medicaid |
$20,651.99
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$7,662.01
|
|
|
Service Code
|
APR-DRG 3081
|
| Min. Negotiated Rate |
$7,297.16 |
| Max. Negotiated Rate |
$7,662.01 |
| Rate for Payer: BCBS Complete |
$7,662.01
|
| Rate for Payer: Mclaren Medicaid |
$7,297.16
|
| Rate for Payer: Meridian Medicaid |
$7,662.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,297.16
|
| Rate for Payer: UHC Medicaid |
$7,297.16
|
| Rate for Payer: UHCCP Medicaid |
$7,297.16
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION OR MULTIPLE HIV SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$9,224.81
|
|
|
Service Code
|
APR-DRG 8914
|
| Min. Negotiated Rate |
$8,785.53 |
| Max. Negotiated Rate |
$9,224.81 |
| Rate for Payer: BCBS Complete |
$9,224.81
|
| Rate for Payer: Mclaren Medicaid |
$8,785.53
|
| Rate for Payer: Meridian Medicaid |
$9,224.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,785.53
|
| Rate for Payer: UHC Medicaid |
$8,785.53
|
| Rate for Payer: UHCCP Medicaid |
$8,785.53
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION OR MULTIPLE HIV SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,052.65
|
|
|
Service Code
|
APR-DRG 8911
|
| Min. Negotiated Rate |
$3,859.67 |
| Max. Negotiated Rate |
$4,052.65 |
| Rate for Payer: BCBS Complete |
$4,052.65
|
| Rate for Payer: Mclaren Medicaid |
$3,859.67
|
| Rate for Payer: Meridian Medicaid |
$4,052.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,859.67
|
| Rate for Payer: UHC Medicaid |
$3,859.67
|
| Rate for Payer: UHCCP Medicaid |
$3,859.67
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION OR MULTIPLE HIV SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,265.61
|
|
|
Service Code
|
APR-DRG 8912
|
| Min. Negotiated Rate |
$4,062.49 |
| Max. Negotiated Rate |
$4,265.61 |
| Rate for Payer: BCBS Complete |
$4,265.61
|
| Rate for Payer: Mclaren Medicaid |
$4,062.49
|
| Rate for Payer: Meridian Medicaid |
$4,265.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,062.49
|
| Rate for Payer: UHC Medicaid |
$4,062.49
|
| Rate for Payer: UHCCP Medicaid |
$4,062.49
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION OR MULTIPLE HIV SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$5,610.19
|
|
|
Service Code
|
APR-DRG 8913
|
| Min. Negotiated Rate |
$5,343.04 |
| Max. Negotiated Rate |
$5,610.19 |
| Rate for Payer: BCBS Complete |
$5,610.19
|
| Rate for Payer: Mclaren Medicaid |
$5,343.04
|
| Rate for Payer: Meridian Medicaid |
$5,610.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,343.04
|
| Rate for Payer: UHC Medicaid |
$5,343.04
|
| Rate for Payer: UHCCP Medicaid |
$5,343.04
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$8,631.66
|
|
|
Service Code
|
APR-DRG 8903
|
| Min. Negotiated Rate |
$8,220.63 |
| Max. Negotiated Rate |
$8,631.66 |
| Rate for Payer: BCBS Complete |
$8,631.66
|
| Rate for Payer: Mclaren Medicaid |
$8,220.63
|
| Rate for Payer: Meridian Medicaid |
$8,631.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,220.63
|
| Rate for Payer: UHC Medicaid |
$8,220.63
|
| Rate for Payer: UHCCP Medicaid |
$8,220.63
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$6,690.79
|
|
|
Service Code
|
APR-DRG 8902
|
| Min. Negotiated Rate |
$6,372.18 |
| Max. Negotiated Rate |
$6,690.79 |
| Rate for Payer: BCBS Complete |
$6,690.79
|
| Rate for Payer: Mclaren Medicaid |
$6,372.18
|
| Rate for Payer: Meridian Medicaid |
$6,690.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,372.18
|
| Rate for Payer: UHC Medicaid |
$6,372.18
|
| Rate for Payer: UHCCP Medicaid |
$6,372.18
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$4,641.59
|
|
|
Service Code
|
APR-DRG 8901
|
| Min. Negotiated Rate |
$4,420.56 |
| Max. Negotiated Rate |
$4,641.59 |
| Rate for Payer: BCBS Complete |
$4,641.59
|
| Rate for Payer: Mclaren Medicaid |
$4,420.56
|
| Rate for Payer: Meridian Medicaid |
$4,641.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,420.56
|
| Rate for Payer: UHC Medicaid |
$4,420.56
|
| Rate for Payer: UHCCP Medicaid |
$4,420.56
|
|
