|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$1,697.33
|
|
|
Service Code
|
CPT 32554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$1,697.33 |
| Rate for Payer: Aetna Medicare |
$627.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,697.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Exchange |
$1,152.36
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$323.20
|
| Rate for Payer: VA VA |
$602.98
|
|
|
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINAL SPACE, WITH BIOPSY
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 32606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
THORACOSCOPY; WITH BIOPSY(IES) OF PLEURA
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 32609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
THORACOSCOPY; WITH DIAGNOSTIC BIOPSY(IES) OF LUNG INFILTRATE(S) (EG, WEDGE, INCISIONAL), UNILATERAL
|
Facility
|
OP
|
$28,582.07
|
|
|
Service Code
|
CPT 32607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,442.46 |
| Max. Negotiated Rate |
$28,582.07 |
| Rate for Payer: Aetna Medicare |
$10,560.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,692.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,692.31
|
| Rate for Payer: BCBS Complete |
$5,714.59
|
| Rate for Payer: BCBS MAPPO |
$10,153.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,153.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,153.85
|
| Rate for Payer: Mclaren Medicaid |
$5,442.46
|
| Rate for Payer: Mclaren Medicare |
$10,153.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,661.54
|
| Rate for Payer: Meridian Medicaid |
$5,714.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,676.93
|
| Rate for Payer: PACE Medicare |
$9,646.16
|
| Rate for Payer: PACE SWMI |
$10,153.85
|
| Rate for Payer: PHP Medicare Advantage |
$10,153.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,442.46
|
| Rate for Payer: Priority Health Medicare |
$10,153.85
|
| Rate for Payer: Railroad Medicare Medicare |
$10,153.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,582.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,153.85
|
| Rate for Payer: UHC Exchange |
$19,405.02
|
| Rate for Payer: UHC Medicare Advantage |
$10,153.85
|
| Rate for Payer: UHCCP Medicaid |
$5,442.46
|
| Rate for Payer: VA VA |
$10,153.85
|
|
|
THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR FISTULA);
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 35875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 36831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
THROMBIN 5000UNITS/EPINEPHRINE TOPICAL 30ML/NS 1L
|
Facility
|
IP
|
$218.05
|
|
|
Service Code
|
NDC 09900000200
|
| Hospital Charge Code |
500527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.94 |
| Max. Negotiated Rate |
$196.25 |
| Rate for Payer: Aetna American Axle |
$141.73
|
| Rate for Payer: Aetna Commercial |
$185.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.73
|
| Rate for Payer: Cash Price |
$174.44
|
| Rate for Payer: Cofinity Commercial |
$152.63
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.44
|
| Rate for Payer: Healthscope Commercial |
$196.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.34
|
| Rate for Payer: PHP Commercial |
$185.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.73
|
| Rate for Payer: Priority Health SBD |
$137.37
|
| Rate for Payer: UMR Bronson Commercial |
$95.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.54
|
|
|
THROMBIN 5000UNITS/EPINEPHRINE TOPICAL 30ML/NS 1L
|
Facility
|
OP
|
$218.05
|
|
|
Service Code
|
NDC 09900000200
|
| Hospital Charge Code |
500527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.68 |
| Max. Negotiated Rate |
$196.25 |
| Rate for Payer: Aetna American Axle |
$141.73
|
| Rate for Payer: Aetna Commercial |
$185.34
|
| Rate for Payer: Aetna Medicare |
$109.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.73
|
| Rate for Payer: BCBS Complete |
$87.22
|
| Rate for Payer: Cash Price |
$174.44
|
| Rate for Payer: Cofinity Commercial |
$152.63
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.44
|
| Rate for Payer: Healthscope Commercial |
$196.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.34
|
| Rate for Payer: PHP Commercial |
$185.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.73
|
| Rate for Payer: Priority Health SBD |
$137.37
|
| Rate for Payer: UMR Bronson Commercial |
$80.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.54
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$746.78
|
|
|
Service Code
|
NDC 60793021720
|
| Hospital Charge Code |
108932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$328.58 |
| Max. Negotiated Rate |
$672.10 |
| Rate for Payer: Aetna American Axle |
$485.41
|
| Rate for Payer: Aetna Commercial |
$634.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.41
|
| Rate for Payer: Cash Price |
$597.42
|
| Rate for Payer: Cofinity Commercial |
$522.75
|
| Rate for Payer: Cofinity Commercial |
$642.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$522.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$597.42
|
| Rate for Payer: Healthscope Commercial |
$672.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$522.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$560.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$634.76
|
| Rate for Payer: PHP Commercial |
$634.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.41
|
| Rate for Payer: Priority Health SBD |
$470.47
|
| Rate for Payer: UMR Bronson Commercial |
$328.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$560.09
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$746.78
|
|
|
Service Code
|
NDC 60793021720
|
| Hospital Charge Code |
108932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$276.31 |
| Max. Negotiated Rate |
$672.10 |
| Rate for Payer: Aetna American Axle |
$485.41
|
| Rate for Payer: Aetna Commercial |
$634.76
|
| Rate for Payer: Aetna Medicare |
$373.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.41
|
| Rate for Payer: BCBS Complete |
$298.71
|
| Rate for Payer: Cash Price |
$597.42
|
| Rate for Payer: Cofinity Commercial |
$522.75
|
| Rate for Payer: Cofinity Commercial |
$642.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$522.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$597.42
|
| Rate for Payer: Healthscope Commercial |
$672.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$522.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$560.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$634.76
|
| Rate for Payer: PHP Commercial |
$634.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.41
|
| Rate for Payer: Priority Health SBD |
$470.47
|
| Rate for Payer: UMR Bronson Commercial |
$276.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$560.09
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
IP
|
$854.74
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$376.09 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna American Axle |
$555.58
|
| Rate for Payer: Aetna Commercial |
$726.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.58
|
| Rate for Payer: Cash Price |
$683.79
|
| Rate for Payer: Cofinity Commercial |
$598.32
|
| Rate for Payer: Cofinity Commercial |
$735.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$598.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.79
|
| Rate for Payer: Healthscope Commercial |
$769.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$598.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.53
|
| Rate for Payer: PHP Commercial |
$726.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.58
|
| Rate for Payer: Priority Health SBD |
$538.49
|
| Rate for Payer: UMR Bronson Commercial |
$376.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.05
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
OP
|
$854.74
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$316.25 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna American Axle |
$555.58
|
| Rate for Payer: Aetna Commercial |
$726.53
|
| Rate for Payer: Aetna Medicare |
$427.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.58
|
| Rate for Payer: BCBS Complete |
$341.90
|
| Rate for Payer: Cash Price |
$683.79
|
| Rate for Payer: Cofinity Commercial |
$598.32
|
| Rate for Payer: Cofinity Commercial |
$735.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$598.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.79
|
| Rate for Payer: Healthscope Commercial |
$769.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$598.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.53
|
| Rate for Payer: PHP Commercial |
$726.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.58
|
| Rate for Payer: Priority Health SBD |
$538.49
|
| Rate for Payer: UMR Bronson Commercial |
$316.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.05
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
OP
|
$854.74
|
|
|
Service Code
|
NDC 60793021722
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$316.25 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna American Axle |
$555.58
|
| Rate for Payer: Aetna Commercial |
$726.53
|
| Rate for Payer: Aetna Medicare |
$427.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.58
|
| Rate for Payer: BCBS Complete |
$341.90
|
| Rate for Payer: Cash Price |
$683.79
|
| Rate for Payer: Cofinity Commercial |
$598.32
|
| Rate for Payer: Cofinity Commercial |
$735.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$598.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.79
|
| Rate for Payer: Healthscope Commercial |
$769.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$598.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.53
|
| Rate for Payer: PHP Commercial |
$726.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.58
|
| Rate for Payer: Priority Health SBD |
$538.49
|
| Rate for Payer: UMR Bronson Commercial |
$316.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.05
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
IP
|
$854.74
|
|
|
Service Code
|
NDC 60793021722
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$376.09 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna American Axle |
$555.58
|
| Rate for Payer: Aetna Commercial |
$726.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.58
|
| Rate for Payer: Cash Price |
$683.79
|
| Rate for Payer: Cofinity Commercial |
$598.32
|
| Rate for Payer: Cofinity Commercial |
$735.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$598.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.79
|
| Rate for Payer: Healthscope Commercial |
$769.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$598.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.53
|
| Rate for Payer: PHP Commercial |
$726.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.58
|
| Rate for Payer: Priority Health SBD |
$538.49
|
| Rate for Payer: UMR Bronson Commercial |
$376.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.05
|
|
|
THROMBIN (BOVINE) 5,000 UNIT NASAL SPRAY SYRINGE
|
Facility
|
OP
|
$212.12
|
|
|
Service Code
|
NDC 60793020505
|
| Hospital Charge Code |
161618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$190.91 |
| Rate for Payer: Aetna American Axle |
$137.88
|
| Rate for Payer: Aetna Commercial |
$180.30
|
| Rate for Payer: Aetna Medicare |
$106.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.88
|
| Rate for Payer: BCBS Complete |
$84.85
|
| Rate for Payer: Cash Price |
$169.70
|
| Rate for Payer: Cofinity Commercial |
$148.48
|
| Rate for Payer: Cofinity Commercial |
$182.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.70
|
| Rate for Payer: Healthscope Commercial |
$190.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.30
|
| Rate for Payer: PHP Commercial |
$180.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.88
|
| Rate for Payer: Priority Health SBD |
$133.64
|
| Rate for Payer: UMR Bronson Commercial |
$78.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.09
|
|
|
THROMBIN (BOVINE) 5,000 UNIT NASAL SPRAY SYRINGE
|
Facility
|
IP
|
$212.12
|
|
|
Service Code
|
NDC 60793020505
|
| Hospital Charge Code |
161618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.33 |
| Max. Negotiated Rate |
$190.91 |
| Rate for Payer: Aetna American Axle |
$137.88
|
| Rate for Payer: Aetna Commercial |
$180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.88
|
| Rate for Payer: Cash Price |
$169.70
|
| Rate for Payer: Cofinity Commercial |
$148.48
|
| Rate for Payer: Cofinity Commercial |
$182.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.70
|
| Rate for Payer: Healthscope Commercial |
$190.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.30
|
| Rate for Payer: PHP Commercial |
$180.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.88
|
| Rate for Payer: Priority Health SBD |
$133.64
|
| Rate for Payer: UMR Bronson Commercial |
$93.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.09
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$189.37
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.07 |
| Max. Negotiated Rate |
$170.43 |
| Rate for Payer: Aetna American Axle |
$123.09
|
| Rate for Payer: Aetna Commercial |
$160.96
|
| Rate for Payer: Aetna Medicare |
$94.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.09
|
| Rate for Payer: BCBS Complete |
$75.75
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cofinity Commercial |
$132.56
|
| Rate for Payer: Cofinity Commercial |
$162.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.50
|
| Rate for Payer: Healthscope Commercial |
$170.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.96
|
| Rate for Payer: PHP Commercial |
$160.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.09
|
| Rate for Payer: Priority Health SBD |
$119.30
|
| Rate for Payer: UMR Bronson Commercial |
$70.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.03
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$189.37
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.32 |
| Max. Negotiated Rate |
$170.43 |
| Rate for Payer: Aetna American Axle |
$123.09
|
| Rate for Payer: Aetna Commercial |
$160.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.09
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cofinity Commercial |
$132.56
|
| Rate for Payer: Cofinity Commercial |
$162.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.50
|
| Rate for Payer: Healthscope Commercial |
$170.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.96
|
| Rate for Payer: PHP Commercial |
$160.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.09
|
| Rate for Payer: Priority Health SBD |
$119.30
|
| Rate for Payer: UMR Bronson Commercial |
$83.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.03
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
IP
|
$202.04
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$181.84 |
| Rate for Payer: Aetna American Axle |
$131.33
|
| Rate for Payer: Aetna Commercial |
$171.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.33
|
| Rate for Payer: Cash Price |
$161.63
|
| Rate for Payer: Cofinity Commercial |
$141.43
|
| Rate for Payer: Cofinity Commercial |
$173.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.63
|
| Rate for Payer: Healthscope Commercial |
$181.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.73
|
| Rate for Payer: PHP Commercial |
$171.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.33
|
| Rate for Payer: Priority Health SBD |
$127.29
|
| Rate for Payer: UMR Bronson Commercial |
$88.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.53
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
OP
|
$202.04
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$181.84 |
| Rate for Payer: Aetna American Axle |
$131.33
|
| Rate for Payer: Aetna Commercial |
$171.73
|
| Rate for Payer: Aetna Medicare |
$101.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.33
|
| Rate for Payer: BCBS Complete |
$80.82
|
| Rate for Payer: Cash Price |
$161.63
|
| Rate for Payer: Cofinity Commercial |
$141.43
|
| Rate for Payer: Cofinity Commercial |
$173.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.63
|
| Rate for Payer: Healthscope Commercial |
$181.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.73
|
| Rate for Payer: PHP Commercial |
$171.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.33
|
| Rate for Payer: Priority Health SBD |
$127.29
|
| Rate for Payer: UMR Bronson Commercial |
$74.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.53
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$254.27
|
|
|
Service Code
|
NDC 00338032401
|
| Hospital Charge Code |
89570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$228.84 |
| Rate for Payer: Aetna American Axle |
$165.28
|
| Rate for Payer: Aetna Commercial |
$216.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.28
|
| Rate for Payer: Cash Price |
$203.42
|
| Rate for Payer: Cofinity Commercial |
$177.99
|
| Rate for Payer: Cofinity Commercial |
$218.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.42
|
| Rate for Payer: Healthscope Commercial |
$228.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.13
|
| Rate for Payer: PHP Commercial |
$216.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.28
|
| Rate for Payer: Priority Health SBD |
$160.19
|
| Rate for Payer: UMR Bronson Commercial |
$111.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.70
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$254.27
|
|
|
Service Code
|
NDC 00338032401
|
| Hospital Charge Code |
89570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$228.84 |
| Rate for Payer: Aetna American Axle |
$165.28
|
| Rate for Payer: Aetna Commercial |
$216.13
|
| Rate for Payer: Aetna Medicare |
$127.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.28
|
| Rate for Payer: BCBS Complete |
$101.71
|
| Rate for Payer: Cash Price |
$203.42
|
| Rate for Payer: Cofinity Commercial |
$177.99
|
| Rate for Payer: Cofinity Commercial |
$218.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.42
|
| Rate for Payer: Healthscope Commercial |
$228.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.13
|
| Rate for Payer: PHP Commercial |
$216.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.28
|
| Rate for Payer: Priority Health SBD |
$160.19
|
| Rate for Payer: UMR Bronson Commercial |
$94.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.70
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$254.27
|
|
|
Service Code
|
NDC 00338032201
|
| Hospital Charge Code |
89570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$228.84 |
| Rate for Payer: Aetna American Axle |
$165.28
|
| Rate for Payer: Aetna Commercial |
$216.13
|
| Rate for Payer: Aetna Medicare |
$127.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.28
|
| Rate for Payer: BCBS Complete |
$101.71
|
| Rate for Payer: Cash Price |
$203.42
|
| Rate for Payer: Cofinity Commercial |
$177.99
|
| Rate for Payer: Cofinity Commercial |
$218.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.42
|
| Rate for Payer: Healthscope Commercial |
$228.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.13
|
| Rate for Payer: PHP Commercial |
$216.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.28
|
| Rate for Payer: Priority Health SBD |
$160.19
|
| Rate for Payer: UMR Bronson Commercial |
$94.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.70
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$254.27
|
|
|
Service Code
|
NDC 00338032201
|
| Hospital Charge Code |
89570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$228.84 |
| Rate for Payer: Aetna American Axle |
$165.28
|
| Rate for Payer: Aetna Commercial |
$216.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.28
|
| Rate for Payer: Cash Price |
$203.42
|
| Rate for Payer: Cofinity Commercial |
$177.99
|
| Rate for Payer: Cofinity Commercial |
$218.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.42
|
| Rate for Payer: Healthscope Commercial |
$228.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.13
|
| Rate for Payer: PHP Commercial |
$216.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.28
|
| Rate for Payer: Priority Health SBD |
$160.19
|
| Rate for Payer: UMR Bronson Commercial |
$111.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.70
|
|
|
THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION
|
Facility
|
OP
|
$910.59
|
|
|
Service Code
|
CPT 37195
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$910.59 |
| Rate for Payer: Aetna Medicare |
$336.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Exchange |
$618.22
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$173.39
|
| Rate for Payer: VA VA |
$323.49
|
|
