|
GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.73
|
|
|
Service Code
|
HCPCS J1570
|
| Hospital Charge Code |
10101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.88 |
| Max. Negotiated Rate |
$179.76 |
| Rate for Payer: Aetna American Axle |
$129.82
|
| Rate for Payer: Aetna American Axle |
$110.40
|
| Rate for Payer: Aetna American Axle |
$154.51
|
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna Commercial |
$144.37
|
| Rate for Payer: Aetna Commercial |
$169.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.40
|
| Rate for Payer: Cash Price |
$135.88
|
| Rate for Payer: Cash Price |
$159.78
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cofinity Commercial |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$118.90
|
| Rate for Payer: Cofinity Commercial |
$146.07
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Cofinity Commercial |
$204.43
|
| Rate for Payer: Cofinity Commercial |
$139.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.78
|
| Rate for Payer: Healthscope Commercial |
$213.94
|
| Rate for Payer: Healthscope Commercial |
$179.76
|
| Rate for Payer: Healthscope Commercial |
$152.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.37
|
| Rate for Payer: PHP Commercial |
$169.77
|
| Rate for Payer: PHP Commercial |
$144.37
|
| Rate for Payer: PHP Commercial |
$202.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.40
|
| Rate for Payer: Priority Health SBD |
$149.76
|
| Rate for Payer: Priority Health SBD |
$125.83
|
| Rate for Payer: Priority Health SBD |
$107.01
|
| Rate for Payer: UMR Bronson Commercial |
$104.59
|
| Rate for Payer: UMR Bronson Commercial |
$87.88
|
| Rate for Payer: UMR Bronson Commercial |
$74.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.80
|
|
|
GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.42
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$452.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH CC
|
Facility
|
IP
|
$19,975.04
|
|
|
Service Code
|
MS-DRG 378
|
| Min. Negotiated Rate |
$7,688.86 |
| Max. Negotiated Rate |
$19,975.04 |
| Rate for Payer: Aetna Medicare |
$8,417.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,116.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,116.92
|
| Rate for Payer: BCBS MAPPO |
$8,093.54
|
| Rate for Payer: BCBS Trust/PPO |
$19,975.04
|
| Rate for Payer: BCN Medicare Advantage |
$8,093.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,093.54
|
| Rate for Payer: Mclaren Medicare |
$8,093.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,498.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,307.57
|
| Rate for Payer: PACE Medicare |
$7,688.86
|
| Rate for Payer: PACE SWMI |
$8,093.54
|
| Rate for Payer: PHP Medicare Advantage |
$8,093.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,117.45
|
| Rate for Payer: Priority Health Medicare |
$8,093.54
|
| Rate for Payer: Priority Health Narrow Network |
$11,293.96
|
| Rate for Payer: Railroad Medicare Medicare |
$8,093.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,006.89
|
| Rate for Payer: UHC Core |
$12,305.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,093.54
|
| Rate for Payer: UHC Exchange |
$9,782.91
|
| Rate for Payer: UHC Medicare Advantage |
$8,336.35
|
| Rate for Payer: VA VA |
$8,093.54
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$30,478.96
|
|
|
Service Code
|
MS-DRG 377
|
| Min. Negotiated Rate |
$13,593.05 |
| Max. Negotiated Rate |
$30,478.96 |
| Rate for Payer: Aetna Medicare |
$14,880.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,885.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,885.59
|
| Rate for Payer: BCBS MAPPO |
$14,308.47
|
| Rate for Payer: BCBS Trust/PPO |
$30,478.96
|
| Rate for Payer: BCN Medicare Advantage |
$14,308.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,308.47
|
| Rate for Payer: Mclaren Medicare |
$14,308.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,023.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,454.74
|
| Rate for Payer: PACE Medicare |
$13,593.05
|
| Rate for Payer: PACE SWMI |
$14,308.47
|
| Rate for Payer: PHP Medicare Advantage |
$14,308.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,690.66
|
| Rate for Payer: Priority Health Medicare |
$14,308.47
|
| Rate for Payer: Priority Health Narrow Network |
$20,552.53
|
| Rate for Payer: Railroad Medicare Medicare |
$14,308.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,309.24
|
| Rate for Payer: UHC Core |
$22,393.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,308.47
|
| Rate for Payer: UHC Exchange |
$17,802.74
|
| Rate for Payer: UHC Medicare Advantage |
$14,737.72
|
| Rate for Payer: VA VA |
$14,308.47
|
|
|
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$14,728.11
|
|
|
Service Code
|
MS-DRG 379
|
| Min. Negotiated Rate |
$5,122.22 |
| Max. Negotiated Rate |
$14,728.11 |
| Rate for Payer: Aetna Medicare |
$5,607.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,739.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,739.76
|
| Rate for Payer: BCBS MAPPO |
$5,391.81
|
| Rate for Payer: BCBS Trust/PPO |
$14,728.11
|
| Rate for Payer: BCN Medicare Advantage |
$5,391.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,391.81
|
| Rate for Payer: Mclaren Medicare |
$5,391.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,661.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,200.58
|
| Rate for Payer: PACE Medicare |
$5,122.22
|
| Rate for Payer: PACE SWMI |
$5,391.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,391.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,086.37
|
| Rate for Payer: Priority Health Medicare |
$5,391.81
|
| Rate for Payer: Priority Health Narrow Network |
$7,269.10
|
| Rate for Payer: Railroad Medicare Medicare |
$5,391.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,658.83
|
| Rate for Payer: UHC Core |
$7,920.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,391.81
|
| Rate for Payer: UHC Exchange |
$6,296.54
|
| Rate for Payer: UHC Medicare Advantage |
$5,553.56
|
| Rate for Payer: VA VA |
$5,391.81
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH CC
|
Facility
|
IP
|
$13,162.57
|
|
|
Service Code
|
MS-DRG 389
|
| Min. Negotiated Rate |
$6,316.96 |
| Max. Negotiated Rate |
$13,162.57 |
| Rate for Payer: Aetna Medicare |
$6,915.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,311.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,311.79
|
| Rate for Payer: BCBS MAPPO |
$6,649.43
|
| Rate for Payer: BCBS Trust/PPO |
$13,162.57
|
| Rate for Payer: BCN Medicare Advantage |
$6,649.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,649.43
|
| Rate for Payer: Mclaren Medicare |
$6,649.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,981.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,646.84
|
| Rate for Payer: PACE Medicare |
$6,316.96
|
| Rate for Payer: PACE SWMI |
$6,649.43
|
| Rate for Payer: PHP Medicare Advantage |
$6,649.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,428.28
|
| Rate for Payer: Priority Health Medicare |
$6,649.43
|
| Rate for Payer: Priority Health Narrow Network |
$9,142.62
|
| Rate for Payer: Railroad Medicare Medicare |
$6,649.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,148.29
|
| Rate for Payer: UHC Core |
$9,961.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,649.43
|
| Rate for Payer: UHC Exchange |
$7,919.40
|
| Rate for Payer: UHC Medicare Advantage |
$6,848.91
|
| Rate for Payer: VA VA |
$6,649.43
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH MCC
|
Facility
|
IP
|
$23,724.29
|
|
|
Service Code
|
MS-DRG 388
|
| Min. Negotiated Rate |
$11,127.42 |
| Max. Negotiated Rate |
$23,724.29 |
| Rate for Payer: Aetna Medicare |
$12,181.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,641.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,641.34
|
| Rate for Payer: BCBS MAPPO |
$11,713.07
|
| Rate for Payer: BCBS Trust/PPO |
$23,724.29
|
| Rate for Payer: BCN Medicare Advantage |
$11,713.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,713.07
|
| Rate for Payer: Mclaren Medicare |
$11,713.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,298.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,470.03
|
| Rate for Payer: PACE Medicare |
$11,127.42
|
| Rate for Payer: PACE SWMI |
$11,713.07
|
| Rate for Payer: PHP Medicare Advantage |
$11,713.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,857.61
|
| Rate for Payer: Priority Health Medicare |
$11,713.07
|
| Rate for Payer: Priority Health Narrow Network |
$16,686.09
|
| Rate for Payer: Railroad Medicare Medicare |
$11,713.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,171.69
|
| Rate for Payer: UHC Core |
$18,180.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,713.07
|
| Rate for Payer: UHC Exchange |
$14,453.60
|
| Rate for Payer: UHC Medicare Advantage |
$12,064.46
|
| Rate for Payer: VA VA |
$11,713.07
|
|
|
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$10,267.71
|
|
|
Service Code
|
MS-DRG 390
|
| Min. Negotiated Rate |
$4,579.03 |
| Max. Negotiated Rate |
$10,267.71 |
| Rate for Payer: Aetna Medicare |
$5,012.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,025.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,025.04
|
| Rate for Payer: BCBS MAPPO |
$4,820.03
|
| Rate for Payer: BCBS Trust/PPO |
$10,267.71
|
| Rate for Payer: BCN Medicare Advantage |
$4,820.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,820.03
|
| Rate for Payer: Mclaren Medicare |
$4,820.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,061.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,543.03
|
| Rate for Payer: PACE Medicare |
$4,579.03
|
| Rate for Payer: PACE SWMI |
$4,820.03
|
| Rate for Payer: PHP Medicare Advantage |
$4,820.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,021.61
|
| Rate for Payer: Priority Health Medicare |
$4,820.03
|
| Rate for Payer: Priority Health Narrow Network |
$6,417.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4,820.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,526.99
|
| Rate for Payer: UHC Core |
$6,991.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,820.03
|
| Rate for Payer: UHC Exchange |
$5,558.70
|
| Rate for Payer: UHC Medicare Advantage |
$4,964.63
|
| Rate for Payer: VA VA |
$4,820.03
|
|
|
GASTROINTESTINAL TRACT IMAGING, INTRALUMINAL (EG, CAPSULE ENDOSCOPY), ESOPHAGUS THROUGH ILEUM, WITH INTERPRETATION AND REPORT
|
Facility
|
OP
|
$3,190.35
|
|
|
Service Code
|
CPT 91110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$3,190.35 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,190.35
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$788.81
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$717.10
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
GASTROSTOMY, OPEN; WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$693.85 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$763.24
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$693.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
GELATIN ABSORBABLE EYE FILM
|
Facility
|
IP
|
$812.43
|
|
|
Service Code
|
NDC 9029703
|
| Hospital Charge Code |
28028
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.47 |
| Max. Negotiated Rate |
$731.19 |
| Rate for Payer: Aetna American Axle |
$528.08
|
| Rate for Payer: Aetna Commercial |
$690.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.08
|
| Rate for Payer: Cash Price |
$649.94
|
| Rate for Payer: Cofinity Commercial |
$568.70
|
| Rate for Payer: Cofinity Commercial |
$698.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.94
|
| Rate for Payer: Healthscope Commercial |
$731.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$568.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$609.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$690.57
|
| Rate for Payer: PHP Commercial |
$690.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.70
|
| Rate for Payer: Priority Health SBD |
$511.83
|
| Rate for Payer: UMR Bronson Commercial |
$357.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$609.32
|
|
|
GELATIN ABSORBABLE IMPLANT FILM
|
Facility
|
IP
|
$7,006.40
|
|
|
Service Code
|
NDC 0009-0283-01
|
| Hospital Charge Code |
109149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,082.82 |
| Max. Negotiated Rate |
$6,305.76 |
| Rate for Payer: Aetna American Axle |
$4,554.16
|
| Rate for Payer: Aetna Commercial |
$5,955.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,554.16
|
| Rate for Payer: Cash Price |
$5,605.12
|
| Rate for Payer: Cofinity Commercial |
$4,904.48
|
| Rate for Payer: Cofinity Commercial |
$6,025.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,605.12
|
| Rate for Payer: Healthscope Commercial |
$6,305.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,904.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,254.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,955.44
|
| Rate for Payer: PHP Commercial |
$5,955.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,904.48
|
| Rate for Payer: Priority Health SBD |
$4,414.03
|
| Rate for Payer: UMR Bronson Commercial |
$3,082.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,254.80
|
|
|
GELATIN ABSORBABLE MUCOSAL POWDER
|
Facility
|
IP
|
$190.19
|
|
|
Service Code
|
NDC 0009-0433-04
|
| Hospital Charge Code |
28017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.68 |
| Max. Negotiated Rate |
$171.17 |
| Rate for Payer: Aetna American Axle |
$123.62
|
| Rate for Payer: Aetna Commercial |
$161.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.62
|
| Rate for Payer: Cash Price |
$152.15
|
| Rate for Payer: Cofinity Commercial |
$133.13
|
| Rate for Payer: Cofinity Commercial |
$163.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.15
|
| Rate for Payer: Healthscope Commercial |
$171.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.66
|
| Rate for Payer: PHP Commercial |
$161.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.13
|
| Rate for Payer: Priority Health SBD |
$119.82
|
| Rate for Payer: UMR Bronson Commercial |
$83.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.64
|
|
|
GELATIN POWDER 1G WITH THROMBIN 5000 UNITS IN 6 ML NS
|
Facility
|
IP
|
$277.21
|
|
|
Service Code
|
NDC 0009-0003-01
|
| Hospital Charge Code |
500530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.97 |
| Max. Negotiated Rate |
$249.49 |
| Rate for Payer: Aetna American Axle |
$180.19
|
| Rate for Payer: Aetna Commercial |
$235.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.19
|
| Rate for Payer: Cash Price |
$221.77
|
| Rate for Payer: Cofinity Commercial |
$194.05
|
| Rate for Payer: Cofinity Commercial |
$238.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.77
|
| Rate for Payer: Healthscope Commercial |
$249.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.63
|
| Rate for Payer: PHP Commercial |
$235.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.05
|
| Rate for Payer: Priority Health SBD |
$174.64
|
| Rate for Payer: UMR Bronson Commercial |
$121.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.91
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
IP
|
$422.18
|
|
|
Service Code
|
NDC 0009-0342-01
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna American Axle |
$274.42
|
| Rate for Payer: Aetna Commercial |
$358.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.42
|
| Rate for Payer: Cash Price |
$337.74
|
| Rate for Payer: Cofinity Commercial |
$295.53
|
| Rate for Payer: Cofinity Commercial |
$363.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.74
|
| Rate for Payer: Healthscope Commercial |
$379.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.85
|
| Rate for Payer: PHP Commercial |
$358.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.53
|
| Rate for Payer: Priority Health SBD |
$265.97
|
| Rate for Payer: UMR Bronson Commercial |
$185.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.64
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
IP
|
$659.90
|
|
|
Service Code
|
NDC 6371301974
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$290.36 |
| Max. Negotiated Rate |
$593.91 |
| Rate for Payer: Aetna American Axle |
$428.94
|
| Rate for Payer: Aetna Commercial |
$560.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.94
|
| Rate for Payer: Cash Price |
$527.92
|
| Rate for Payer: Cofinity Commercial |
$461.93
|
| Rate for Payer: Cofinity Commercial |
$567.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.92
|
| Rate for Payer: Healthscope Commercial |
$593.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$461.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$560.92
|
| Rate for Payer: PHP Commercial |
$560.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.93
|
| Rate for Payer: Priority Health SBD |
$415.74
|
| Rate for Payer: UMR Bronson Commercial |
$290.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.92
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$184.84
|
|
|
Service Code
|
NDC 0009-0315-08
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$81.33 |
| Max. Negotiated Rate |
$166.36 |
| Rate for Payer: Aetna American Axle |
$120.15
|
| Rate for Payer: Aetna Commercial |
$157.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.15
|
| Rate for Payer: Cash Price |
$147.87
|
| Rate for Payer: Cofinity Commercial |
$129.39
|
| Rate for Payer: Cofinity Commercial |
$158.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.87
|
| Rate for Payer: Healthscope Commercial |
$166.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.11
|
| Rate for Payer: PHP Commercial |
$157.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.39
|
| Rate for Payer: Priority Health SBD |
$116.45
|
| Rate for Payer: UMR Bronson Commercial |
$81.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.63
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$270.31
|
|
|
Service Code
|
NDC 6371301972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.94 |
| Max. Negotiated Rate |
$243.28 |
| Rate for Payer: Aetna American Axle |
$175.70
|
| Rate for Payer: Aetna Commercial |
$229.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.70
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: Cofinity Commercial |
$189.22
|
| Rate for Payer: Cofinity Commercial |
$232.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.25
|
| Rate for Payer: Healthscope Commercial |
$243.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: PHP Commercial |
$229.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.22
|
| Rate for Payer: Priority Health SBD |
$170.30
|
| Rate for Payer: UMR Bronson Commercial |
$118.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.73
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
IP
|
$196.37
|
|
|
Service Code
|
NDC 0009-0323-01
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$176.73 |
| Rate for Payer: Aetna American Axle |
$127.64
|
| Rate for Payer: Aetna Commercial |
$166.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.64
|
| Rate for Payer: Cash Price |
$157.10
|
| Rate for Payer: Cofinity Commercial |
$137.46
|
| Rate for Payer: Cofinity Commercial |
$168.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.10
|
| Rate for Payer: Healthscope Commercial |
$176.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.91
|
| Rate for Payer: PHP Commercial |
$166.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.46
|
| Rate for Payer: Priority Health SBD |
$123.71
|
| Rate for Payer: UMR Bronson Commercial |
$86.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.28
|
|
|
GELATIN SPONGE,ABSORBABLE TOPICAL SYRINGE
|
Facility
|
IP
|
$1,586.66
|
|
|
Service Code
|
NDC 0009-1040-06
|
| Hospital Charge Code |
189527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$698.13 |
| Max. Negotiated Rate |
$1,427.99 |
| Rate for Payer: Aetna American Axle |
$1,031.33
|
| Rate for Payer: Aetna Commercial |
$1,348.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.33
|
| Rate for Payer: Cash Price |
$1,269.33
|
| Rate for Payer: Cofinity Commercial |
$1,110.66
|
| Rate for Payer: Cofinity Commercial |
$1,364.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,269.33
|
| Rate for Payer: Healthscope Commercial |
$1,427.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,110.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,190.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.66
|
| Rate for Payer: PHP Commercial |
$1,348.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.66
|
| Rate for Payer: Priority Health SBD |
$999.60
|
| Rate for Payer: UMR Bronson Commercial |
$698.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,190.00
|
|
|
GELATIN SPONGE,ABSORBABLE TOPICAL SYRINGE
|
Facility
|
IP
|
$264.45
|
|
|
Service Code
|
NDC 0009-1040-01
|
| Hospital Charge Code |
189527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.36 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Aetna American Axle |
$171.89
|
| Rate for Payer: Aetna Commercial |
$224.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.89
|
| Rate for Payer: Cash Price |
$211.56
|
| Rate for Payer: Cofinity Commercial |
$185.12
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.56
|
| Rate for Payer: Healthscope Commercial |
$238.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.78
|
| Rate for Payer: PHP Commercial |
$224.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.12
|
| Rate for Payer: Priority Health SBD |
$166.60
|
| Rate for Payer: UMR Bronson Commercial |
$116.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.34
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$248.01
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.12 |
| Max. Negotiated Rate |
$223.21 |
| Rate for Payer: Aetna American Axle |
$161.21
|
| Rate for Payer: Aetna Commercial |
$210.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.21
|
| Rate for Payer: Cash Price |
$198.41
|
| Rate for Payer: Cofinity Commercial |
$213.29
|
| Rate for Payer: Cofinity Commercial |
$173.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.41
|
| Rate for Payer: Healthscope Commercial |
$223.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.81
|
| Rate for Payer: PHP Commercial |
$210.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.61
|
| Rate for Payer: Priority Health SBD |
$156.25
|
| Rate for Payer: UMR Bronson Commercial |
$109.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.01
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$236.15
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$212.54 |
| Rate for Payer: Aetna American Axle |
$153.50
|
| Rate for Payer: Aetna American Axle |
$161.21
|
| Rate for Payer: Aetna Commercial |
$210.81
|
| Rate for Payer: Aetna Commercial |
$200.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.21
|
| Rate for Payer: BCBS Complete |
$99.20
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: BCBS Trust/PPO |
$11.77
|
| Rate for Payer: BCBS Trust/PPO |
$11.77
|
| Rate for Payer: Cash Price |
$198.41
|
| Rate for Payer: Cash Price |
$188.92
|
| Rate for Payer: Cash Price |
$188.92
|
| Rate for Payer: Cash Price |
$198.41
|
| Rate for Payer: Cofinity Commercial |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$165.30
|
| Rate for Payer: Cofinity Commercial |
$173.61
|
| Rate for Payer: Cofinity Commercial |
$213.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.41
|
| Rate for Payer: Healthscope Commercial |
$223.21
|
| Rate for Payer: Healthscope Commercial |
$212.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.81
|
| Rate for Payer: PHP Commercial |
$210.81
|
| Rate for Payer: PHP Commercial |
$200.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.61
|
| Rate for Payer: Priority Health SBD |
$156.25
|
| Rate for Payer: Priority Health SBD |
$148.77
|
| Rate for Payer: UMR Bronson Commercial |
$87.38
|
| Rate for Payer: UMR Bronson Commercial |
$91.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.01
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$191.88
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
17122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.43 |
| Max. Negotiated Rate |
$172.69 |
| Rate for Payer: Aetna American Axle |
$124.72
|
| Rate for Payer: Aetna American Axle |
$446.32
|
| Rate for Payer: Aetna Commercial |
$163.10
|
| Rate for Payer: Aetna Commercial |
$583.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.72
|
| Rate for Payer: Cash Price |
$549.32
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cofinity Commercial |
$590.52
|
| Rate for Payer: Cofinity Commercial |
$165.02
|
| Rate for Payer: Cofinity Commercial |
$134.32
|
| Rate for Payer: Cofinity Commercial |
$480.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.32
|
| Rate for Payer: Healthscope Commercial |
$617.98
|
| Rate for Payer: Healthscope Commercial |
$172.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$583.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.10
|
| Rate for Payer: PHP Commercial |
$583.65
|
| Rate for Payer: PHP Commercial |
$163.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.32
|
| Rate for Payer: Priority Health SBD |
$120.88
|
| Rate for Payer: Priority Health SBD |
$432.59
|
| Rate for Payer: UMR Bronson Commercial |
$302.13
|
| Rate for Payer: UMR Bronson Commercial |
$84.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.91
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$270.12
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155792
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$243.11 |
| Rate for Payer: Aetna American Axle |
$175.58
|
| Rate for Payer: Aetna American Axle |
$167.17
|
| Rate for Payer: Aetna Commercial |
$218.60
|
| Rate for Payer: Aetna Commercial |
$229.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.17
|
| Rate for Payer: BCBS Complete |
$102.87
|
| Rate for Payer: BCBS Complete |
$108.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.77
|
| Rate for Payer: BCBS Trust/PPO |
$11.77
|
| Rate for Payer: Cash Price |
$216.10
|
| Rate for Payer: Cash Price |
$205.74
|
| Rate for Payer: Cash Price |
$205.74
|
| Rate for Payer: Cash Price |
$216.10
|
| Rate for Payer: Cofinity Commercial |
$221.17
|
| Rate for Payer: Cofinity Commercial |
$189.08
|
| Rate for Payer: Cofinity Commercial |
$232.30
|
| Rate for Payer: Cofinity Commercial |
$180.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.74
|
| Rate for Payer: Healthscope Commercial |
$243.11
|
| Rate for Payer: Healthscope Commercial |
$231.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.60
|
| Rate for Payer: PHP Commercial |
$229.60
|
| Rate for Payer: PHP Commercial |
$218.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.08
|
| Rate for Payer: Priority Health SBD |
$170.18
|
| Rate for Payer: Priority Health SBD |
$162.02
|
| Rate for Payer: UMR Bronson Commercial |
$95.16
|
| Rate for Payer: UMR Bronson Commercial |
$99.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.59
|
|
