|
GAMUNEX-C 5 GRAM/50 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$2,272.15
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$2,044.93 |
| Rate for Payer: Aetna American Axle |
$1,476.90
|
| Rate for Payer: Aetna Commercial |
$1,931.33
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,476.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$159.13
|
| Rate for Payer: BCN Commercial |
$159.13
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$1,817.72
|
| Rate for Payer: Cash Price |
$1,817.72
|
| Rate for Payer: Cofinity Advantage |
$1,590.51
|
| Rate for Payer: Cofinity Commercial |
$1,954.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,817.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$2,044.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,590.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,704.11
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,931.33
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,704.11
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$1,931.33
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$1,431.45
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$840.70
|
| Rate for Payer: VA VA |
$49.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,704.11
|
|
|
GAMUNEX-C 5 GRAM/50 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$2,272.15
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$999.75 |
| Max. Negotiated Rate |
$2,044.93 |
| Rate for Payer: Aetna American Axle |
$1,476.90
|
| Rate for Payer: Aetna Commercial |
$1,931.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,476.90
|
| Rate for Payer: Cash Price |
$1,817.72
|
| Rate for Payer: Cofinity Advantage |
$1,590.51
|
| Rate for Payer: Cofinity Commercial |
$1,954.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,817.72
|
| Rate for Payer: Healthscope Commercial |
$2,044.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,590.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,704.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,931.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,704.11
|
| Rate for Payer: PHP Commercial |
$1,931.33
|
| Rate for Payer: Priority Health SBD |
$1,431.45
|
| Rate for Payer: UMR Bronson Commercial |
$999.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,704.11
|
|
|
GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$206.93
|
|
|
Service Code
|
HCPCS J1570
|
| Hospital Charge Code |
10101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$67.26
|
| Rate for Payer: Aetna American Axle |
$129.85
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.85
|
| Rate for Payer: Cash Price |
$159.82
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cofinity Advantage |
$139.84
|
| Rate for Payer: Cofinity Advantage |
$72.43
|
| Rate for Payer: Cofinity Advantage |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$171.80
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Healthscope Commercial |
$179.79
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.20
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: Priority Health SBD |
$65.19
|
| Rate for Payer: Priority Health SBD |
$125.86
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UMR Bronson Commercial |
$87.90
|
| Rate for Payer: UMR Bronson Commercial |
$45.53
|
| Rate for Payer: UMR Bronson Commercial |
$91.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
|
|
GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.77
|
|
|
Service Code
|
HCPCS J1570
|
| Hospital Charge Code |
10101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.31 |
| Max. Negotiated Rate |
$179.79 |
| Rate for Payer: Aetna American Axle |
$129.85
|
| Rate for Payer: Aetna American Axle |
$67.26
|
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Medicare |
$99.89
|
| Rate for Payer: Aetna Medicare |
$51.73
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: BCBS Complete |
$41.39
|
| Rate for Payer: BCBS Complete |
$79.91
|
| Rate for Payer: BCBS Complete |
$82.77
|
| Rate for Payer: BCBS Trust/PPO |
$108.69
|
| Rate for Payer: BCBS Trust/PPO |
$108.69
|
| Rate for Payer: BCBS Trust/PPO |
$108.69
|
| Rate for Payer: BCN Commercial |
$108.69
|
| Rate for Payer: BCN Commercial |
$108.69
|
| Rate for Payer: BCN Commercial |
$108.69
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$159.82
|
| Rate for Payer: Cash Price |
$159.82
|
| Rate for Payer: Cofinity Advantage |
$144.85
|
| Rate for Payer: Cofinity Advantage |
$139.84
|
| Rate for Payer: Cofinity Advantage |
$72.43
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$171.80
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.82
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$179.79
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.20
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: Priority Health SBD |
$65.19
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: Priority Health SBD |
$125.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.31
|
| Rate for Payer: UHC Core |
$55.31
|
| Rate for Payer: UHC Core |
$55.31
|
| Rate for Payer: UHC Core |
$55.31
|
| Rate for Payer: UHC Exchange |
$55.31
|
| Rate for Payer: UHC Exchange |
$55.31
|
| Rate for Payer: UHC Exchange |
$55.31
|
| Rate for Payer: UMR Bronson Commercial |
$76.56
|
| Rate for Payer: UMR Bronson Commercial |
$38.28
|
| Rate for Payer: UMR Bronson Commercial |
$73.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
|
|
GANCICLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$148.68
|
|
|
Service Code
|
NDC 25021018510
|
| Hospital Charge Code |
186410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$133.81 |
| Rate for Payer: Aetna American Axle |
$96.64
|
| Rate for Payer: Aetna Commercial |
$126.38
|
| Rate for Payer: Aetna Medicare |
$74.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.64
|
| Rate for Payer: BCBS Complete |
$59.47
|
| Rate for Payer: Cash Price |
$118.94
|
| Rate for Payer: Cofinity Advantage |
$104.08
|
| Rate for Payer: Cofinity Commercial |
$127.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.94
|
| Rate for Payer: Healthscope Commercial |
$133.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.51
|
| Rate for Payer: PHP Commercial |
$126.38
|
| Rate for Payer: Priority Health SBD |
$93.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.64
|
| Rate for Payer: UHC Core |
$77.46
|
| Rate for Payer: UHC Exchange |
$58.43
|
| Rate for Payer: UMR Bronson Commercial |
$55.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.51
|
|
|
GANCICLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$148.68
|
|
|
Service Code
|
NDC 25021018510
|
| Hospital Charge Code |
186410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.42 |
| Max. Negotiated Rate |
$133.81 |
| Rate for Payer: Aetna American Axle |
$96.64
|
| Rate for Payer: Aetna Commercial |
$126.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.64
|
| Rate for Payer: Cash Price |
$118.94
|
| Rate for Payer: Cofinity Advantage |
$104.08
|
| Rate for Payer: Cofinity Commercial |
$127.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.94
|
| Rate for Payer: Healthscope Commercial |
$133.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.51
|
| Rate for Payer: PHP Commercial |
$126.38
|
| Rate for Payer: Priority Health SBD |
$93.67
|
| Rate for Payer: UMR Bronson Commercial |
$65.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.51
|
|
|
GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 27687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH CC
|
Facility
|
IP
|
$21,820.80
|
|
|
Service Code
|
MSDRG 378
|
| Min. Negotiated Rate |
$8,354.54 |
| Max. Negotiated Rate |
$21,820.80 |
| Rate for Payer: Aetna Medicare |
$9,146.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,992.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,992.81
|
| Rate for Payer: BCBS MAPPO |
$8,794.25
|
| Rate for Payer: BCBS Trust/PPO |
$21,820.80
|
| Rate for Payer: BCN Commercial |
$21,820.80
|
| Rate for Payer: BCN Medicare Advantage |
$8,794.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,794.25
|
| Rate for Payer: Mclaren Medicare |
$8,794.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,233.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,113.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,673.67
|
| Rate for Payer: Nomi Health Commercial |
$12,651.03
|
| Rate for Payer: PACE Medicare |
$8,354.54
|
| Rate for Payer: PACE SWMI |
$8,794.25
|
| Rate for Payer: PHP Medicare Advantage |
$8,794.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,810.98
|
| Rate for Payer: Priority Health Medicare |
$8,794.25
|
| Rate for Payer: Priority Health Tiered Network |
$12,648.78
|
| Rate for Payer: Railroad Medicare Medicare |
$8,794.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,985.41
|
| Rate for Payer: UHC Core |
$13,373.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,794.25
|
| Rate for Payer: UHC Exchange |
$10,922.06
|
| Rate for Payer: VA VA |
$8,794.25
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$33,295.32
|
|
|
Service Code
|
MSDRG 377
|
| Min. Negotiated Rate |
$15,085.98 |
| Max. Negotiated Rate |
$33,295.32 |
| Rate for Payer: Aetna Medicare |
$16,515.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,849.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,849.97
|
| Rate for Payer: BCBS MAPPO |
$15,879.98
|
| Rate for Payer: BCBS Trust/PPO |
$33,295.32
|
| Rate for Payer: BCN Commercial |
$33,295.32
|
| Rate for Payer: BCN Medicare Advantage |
$15,879.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,879.98
|
| Rate for Payer: Mclaren Medicare |
$15,879.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,673.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,261.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,467.98
|
| Rate for Payer: Nomi Health Commercial |
$23,581.20
|
| Rate for Payer: PACE Medicare |
$15,085.98
|
| Rate for Payer: PACE SWMI |
$15,879.98
|
| Rate for Payer: PHP Medicare Advantage |
$15,879.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,471.27
|
| Rate for Payer: Priority Health Medicare |
$15,879.98
|
| Rate for Payer: Priority Health Tiered Network |
$23,577.01
|
| Rate for Payer: Railroad Medicare Medicare |
$15,879.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,796.40
|
| Rate for Payer: UHC Core |
$24,928.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,879.98
|
| Rate for Payer: UHC Exchange |
$20,358.44
|
| Rate for Payer: VA VA |
$15,879.98
|
|
|
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$16,089.03
|
|
|
Service Code
|
MSDRG 379
|
| Min. Negotiated Rate |
$5,571.58 |
| Max. Negotiated Rate |
$16,089.03 |
| Rate for Payer: Aetna Medicare |
$6,099.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,331.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,331.02
|
| Rate for Payer: BCBS MAPPO |
$5,864.82
|
| Rate for Payer: BCBS Trust/PPO |
$16,089.03
|
| Rate for Payer: BCN Commercial |
$16,089.03
|
| Rate for Payer: BCN Medicare Advantage |
$5,864.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,864.82
|
| Rate for Payer: Mclaren Medicare |
$5,864.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,158.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,744.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,451.30
|
| Rate for Payer: Nomi Health Commercial |
$8,132.16
|
| Rate for Payer: PACE Medicare |
$5,571.58
|
| Rate for Payer: PACE SWMI |
$5,864.82
|
| Rate for Payer: PHP Medicare Advantage |
$5,864.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,163.40
|
| Rate for Payer: Priority Health Medicare |
$5,864.82
|
| Rate for Payer: Priority Health Tiered Network |
$8,130.72
|
| Rate for Payer: Railroad Medicare Medicare |
$5,864.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,275.52
|
| Rate for Payer: UHC Core |
$8,596.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,864.82
|
| Rate for Payer: UHC Exchange |
$7,020.76
|
| Rate for Payer: VA VA |
$5,864.82
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH CC
|
Facility
|
IP
|
$14,354.13
|
|
|
Service Code
|
MSDRG 389
|
| Min. Negotiated Rate |
$6,837.93 |
| Max. Negotiated Rate |
$14,354.13 |
| Rate for Payer: Aetna Medicare |
$7,485.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,997.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,997.27
|
| Rate for Payer: BCBS MAPPO |
$7,197.82
|
| Rate for Payer: BCBS Trust/PPO |
$14,354.13
|
| Rate for Payer: BCN Commercial |
$14,354.13
|
| Rate for Payer: BCN Medicare Advantage |
$7,197.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,197.82
|
| Rate for Payer: Mclaren Medicare |
$7,197.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,557.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,277.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,917.60
|
| Rate for Payer: Nomi Health Commercial |
$10,188.42
|
| Rate for Payer: PACE Medicare |
$6,837.93
|
| Rate for Payer: PACE SWMI |
$7,197.82
|
| Rate for Payer: PHP Medicare Advantage |
$7,197.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,733.27
|
| Rate for Payer: Priority Health Medicare |
$7,197.82
|
| Rate for Payer: Priority Health Tiered Network |
$10,186.61
|
| Rate for Payer: Railroad Medicare Medicare |
$7,197.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,873.74
|
| Rate for Payer: UHC Core |
$10,770.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,197.82
|
| Rate for Payer: UHC Exchange |
$8,796.00
|
| Rate for Payer: VA VA |
$7,197.82
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH MCC
|
Facility
|
IP
|
$25,916.49
|
|
|
Service Code
|
MSDRG 388
|
| Min. Negotiated Rate |
$12,295.85 |
| Max. Negotiated Rate |
$25,916.49 |
| Rate for Payer: Aetna Medicare |
$13,460.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,178.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,178.75
|
| Rate for Payer: BCBS MAPPO |
$12,943.00
|
| Rate for Payer: BCBS Trust/PPO |
$25,916.49
|
| Rate for Payer: BCN Commercial |
$25,916.49
|
| Rate for Payer: BCN Medicare Advantage |
$12,943.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,943.00
|
| Rate for Payer: Mclaren Medicare |
$12,943.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,590.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,884.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,237.30
|
| Rate for Payer: Nomi Health Commercial |
$19,050.72
|
| Rate for Payer: PACE Medicare |
$12,295.85
|
| Rate for Payer: PACE SWMI |
$12,943.00
|
| Rate for Payer: PHP Medicare Advantage |
$12,943.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,809.18
|
| Rate for Payer: Priority Health Medicare |
$12,943.00
|
| Rate for Payer: Priority Health Tiered Network |
$19,047.34
|
| Rate for Payer: Railroad Medicare Medicare |
$12,943.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,071.84
|
| Rate for Payer: UHC Core |
$20,139.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,943.00
|
| Rate for Payer: UHC Exchange |
$16,447.12
|
| Rate for Payer: VA VA |
$12,943.00
|
|
|
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$11,216.48
|
|
|
Service Code
|
MSDRG 390
|
| Min. Negotiated Rate |
$4,885.18 |
| Max. Negotiated Rate |
$11,216.48 |
| Rate for Payer: Aetna Medicare |
$5,347.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,427.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,427.86
|
| Rate for Payer: BCBS MAPPO |
$5,142.29
|
| Rate for Payer: BCBS Trust/PPO |
$11,216.48
|
| Rate for Payer: BCN Commercial |
$11,216.48
|
| Rate for Payer: BCN Medicare Advantage |
$5,142.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,142.29
|
| Rate for Payer: Mclaren Medicare |
$5,142.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,399.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,913.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,656.52
|
| Rate for Payer: Nomi Health Commercial |
$7,017.60
|
| Rate for Payer: PACE Medicare |
$4,885.18
|
| Rate for Payer: PACE SWMI |
$5,142.29
|
| Rate for Payer: PHP Medicare Advantage |
$5,142.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,770.44
|
| Rate for Payer: Priority Health Medicare |
$5,142.29
|
| Rate for Payer: Priority Health Tiered Network |
$7,016.35
|
| Rate for Payer: Railroad Medicare Medicare |
$5,142.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,867.20
|
| Rate for Payer: UHC Core |
$7,418.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,142.29
|
| Rate for Payer: UHC Exchange |
$6,058.53
|
| Rate for Payer: VA VA |
$5,142.29
|
|
|
GASTROINTESTINAL TRACT IMAGING, INTRALUMINAL (EG, CAPSULE ENDOSCOPY), ESOPHAGUS THROUGH ILEUM, WITH INTERPRETATION AND REPORT
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 91110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,269.42
|
| Rate for Payer: BCN Commercial |
$1,269.42
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$16,706.36
|
|
|
Service Code
|
APR-DRG 2464
|
| Min. Negotiated Rate |
$15,910.82 |
| Max. Negotiated Rate |
$16,706.36 |
| Rate for Payer: BCBS Complete |
$16,706.36
|
| Rate for Payer: Mclaren Medicaid |
$15,910.82
|
| Rate for Payer: Meridian Medicaid |
$16,706.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,910.82
|
| Rate for Payer: UHC Medicaid |
$15,910.82
|
| Rate for Payer: UHCCP Medicaid |
$15,910.82
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$8,822.01
|
|
|
Service Code
|
APR-DRG 2463
|
| Min. Negotiated Rate |
$8,401.91 |
| Max. Negotiated Rate |
$8,822.01 |
| Rate for Payer: BCBS Complete |
$8,822.01
|
| Rate for Payer: Mclaren Medicaid |
$8,401.91
|
| Rate for Payer: Meridian Medicaid |
$8,822.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,401.91
|
| Rate for Payer: UHC Medicaid |
$8,401.91
|
| Rate for Payer: UHCCP Medicaid |
$8,401.91
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$6,041.75
|
|
|
Service Code
|
APR-DRG 2462
|
| Min. Negotiated Rate |
$5,754.05 |
| Max. Negotiated Rate |
$6,041.75 |
| Rate for Payer: BCBS Complete |
$6,041.75
|
| Rate for Payer: Mclaren Medicaid |
$5,754.05
|
| Rate for Payer: Meridian Medicaid |
$6,041.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,754.05
|
| Rate for Payer: UHC Medicaid |
$5,754.05
|
| Rate for Payer: UHCCP Medicaid |
$5,754.05
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$4,480.01
|
|
|
Service Code
|
APR-DRG 2461
|
| Min. Negotiated Rate |
$4,266.68 |
| Max. Negotiated Rate |
$4,480.01 |
| Rate for Payer: BCBS Complete |
$4,480.01
|
| Rate for Payer: Mclaren Medicaid |
$4,266.68
|
| Rate for Payer: Meridian Medicaid |
$4,480.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,266.68
|
| Rate for Payer: UHC Medicaid |
$4,266.68
|
| Rate for Payer: UHCCP Medicaid |
$4,266.68
|
|
|
GELATIN ABSORBABLE EYE FILM
|
Facility
|
OP
|
$999.82
|
|
|
Service Code
|
NDC 00009029703
|
| Hospital Charge Code |
28028
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$369.93 |
| Max. Negotiated Rate |
$899.84 |
| Rate for Payer: Aetna American Axle |
$649.88
|
| Rate for Payer: Aetna Commercial |
$849.85
|
| Rate for Payer: Aetna Medicare |
$499.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.88
|
| Rate for Payer: BCBS Complete |
$399.93
|
| Rate for Payer: Cash Price |
$799.86
|
| Rate for Payer: Cofinity Advantage |
$699.87
|
| Rate for Payer: Cofinity Commercial |
$859.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.86
|
| Rate for Payer: Healthscope Commercial |
$899.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$699.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$749.87
|
| Rate for Payer: PHP Commercial |
$849.85
|
| Rate for Payer: Priority Health SBD |
$629.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$649.88
|
| Rate for Payer: UHC Core |
$520.91
|
| Rate for Payer: UHC Exchange |
$392.93
|
| Rate for Payer: UMR Bronson Commercial |
$369.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.87
|
|
|
GELATIN ABSORBABLE EYE FILM
|
Facility
|
IP
|
$999.82
|
|
|
Service Code
|
NDC 00009029703
|
| Hospital Charge Code |
28028
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$439.92 |
| Max. Negotiated Rate |
$899.84 |
| Rate for Payer: Aetna American Axle |
$649.88
|
| Rate for Payer: Aetna Commercial |
$849.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.88
|
| Rate for Payer: Cash Price |
$799.86
|
| Rate for Payer: Cofinity Advantage |
$699.87
|
| Rate for Payer: Cofinity Commercial |
$859.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.86
|
| Rate for Payer: Healthscope Commercial |
$899.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$699.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$749.87
|
| Rate for Payer: PHP Commercial |
$849.85
|
| Rate for Payer: Priority Health SBD |
$629.89
|
| Rate for Payer: UMR Bronson Commercial |
$439.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.87
|
|
|
GELATIN ABSORBABLE IMPLANT FILM
|
Facility
|
OP
|
$7,006.40
|
|
|
Service Code
|
NDC 00009028301
|
| Hospital Charge Code |
109149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,592.37 |
| 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 Medicare |
$3,503.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,554.16
|
| Rate for Payer: BCBS Complete |
$2,802.56
|
| Rate for Payer: Cash Price |
$5,605.12
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$5,605.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,955.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,254.80
|
| Rate for Payer: PHP Commercial |
$5,955.44
|
| Rate for Payer: Priority Health SBD |
$4,414.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,554.16
|
| Rate for Payer: UHC Core |
$3,650.33
|
| Rate for Payer: UHC Exchange |
$2,753.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,592.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,254.80
|
|
|
GELATIN ABSORBABLE IMPLANT FILM
|
Facility
|
IP
|
$7,006.40
|
|
|
Service Code
|
NDC 00009028301
|
| 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 Advantage |
$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 Commercial |
$5,955.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,254.80
|
| Rate for Payer: PHP Commercial |
$5,955.44
|
| 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
|
$316.91
|
|
|
Service Code
|
NDC 00009043304
|
| Hospital Charge Code |
28017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$139.44 |
| Max. Negotiated Rate |
$285.22 |
| Rate for Payer: Aetna American Axle |
$205.99
|
| Rate for Payer: Aetna Commercial |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.99
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Cofinity Advantage |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$272.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.53
|
| Rate for Payer: Healthscope Commercial |
$285.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$221.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.68
|
| Rate for Payer: PHP Commercial |
$269.37
|
| Rate for Payer: Priority Health SBD |
$199.65
|
| Rate for Payer: UMR Bronson Commercial |
$139.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.68
|
|
|
GELATIN ABSORBABLE MUCOSAL POWDER
|
Facility
|
OP
|
$316.91
|
|
|
Service Code
|
NDC 00009043304
|
| Hospital Charge Code |
28017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$285.22 |
| Rate for Payer: Aetna American Axle |
$205.99
|
| Rate for Payer: Aetna Commercial |
$269.37
|
| Rate for Payer: Aetna Medicare |
$158.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.99
|
| Rate for Payer: BCBS Complete |
$126.76
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Cofinity Advantage |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$272.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.53
|
| Rate for Payer: Healthscope Commercial |
$285.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$221.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.68
|
| Rate for Payer: PHP Commercial |
$269.37
|
| Rate for Payer: Priority Health SBD |
$199.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.99
|
| Rate for Payer: UHC Core |
$165.11
|
| Rate for Payer: UHC Exchange |
$124.55
|
| Rate for Payer: UMR Bronson Commercial |
$117.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.68
|
|
|
GELATIN POWDER 1G WITH THROMBIN 5000 UNITS IN 6 ML NS
|
Facility
|
OP
|
$277.21
|
|
|
Service Code
|
NDC 00009000301
|
| Hospital Charge Code |
500530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$249.49 |
| Rate for Payer: Aetna American Axle |
$180.19
|
| Rate for Payer: Aetna Commercial |
$235.63
|
| Rate for Payer: Aetna Medicare |
$138.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.19
|
| Rate for Payer: BCBS Complete |
$110.88
|
| Rate for Payer: Cash Price |
$221.77
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$221.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.91
|
| Rate for Payer: PHP Commercial |
$235.63
|
| Rate for Payer: Priority Health SBD |
$174.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.19
|
| Rate for Payer: UHC Core |
$144.43
|
| Rate for Payer: UHC Exchange |
$108.94
|
| Rate for Payer: UMR Bronson Commercial |
$102.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.91
|
|
