|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
IP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$19.01
|
| Rate for Payer: Cofinity Commercial |
$23.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.73
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.09
|
| Rate for Payer: PHP Commercial |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health SBD |
$17.11
|
| Rate for Payer: UMR Bronson Commercial |
$11.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.37
|
|
|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
OP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$31.53 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: BCBS Trust/PPO |
$31.53
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$23.36
|
| Rate for Payer: Cofinity Commercial |
$19.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.73
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.09
|
| Rate for Payer: PHP Commercial |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health SBD |
$17.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Exchange |
$10.20
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.37
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
IP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna American Axle |
$6.36
|
| Rate for Payer: Aetna Commercial |
$8.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.36
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$6.85
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$8.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.31
|
| Rate for Payer: PHP Commercial |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.85
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.34
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
OP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Aetna American Axle |
$6.36
|
| Rate for Payer: Aetna Commercial |
$8.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.36
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS Trust/PPO |
$40.95
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$6.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$8.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.31
|
| Rate for Payer: PHP Commercial |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.85
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UMR Bronson Commercial |
$3.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.34
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
OP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$40.95
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.59
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
IP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$19.68 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.59
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.10
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.73
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: UMR Bronson Commercial |
$9.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
OP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$57.09 |
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Trust/PPO |
$57.09
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.10
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.73
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: UMR Bronson Commercial |
$8.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
OP
|
$823.40
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$741.06 |
| Rate for Payer: Aetna American Axle |
$535.21
|
| Rate for Payer: Aetna Commercial |
$699.89
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$385.05
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$658.72
|
| Rate for Payer: Cash Price |
$658.72
|
| Rate for Payer: Cofinity Commercial |
$708.12
|
| Rate for Payer: Cofinity Commercial |
$576.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$741.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$576.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.55
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.89
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$699.89
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.44
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$20.35
|
| Rate for Payer: Priority Health SBD |
$518.74
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$20.63
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$304.66
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.55
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
IP
|
$823.40
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.30 |
| Max. Negotiated Rate |
$741.06 |
| Rate for Payer: Aetna American Axle |
$535.21
|
| Rate for Payer: Aetna Commercial |
$699.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.21
|
| Rate for Payer: Cash Price |
$658.72
|
| Rate for Payer: Cofinity Commercial |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$708.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.72
|
| Rate for Payer: Healthscope Commercial |
$741.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$576.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.89
|
| Rate for Payer: PHP Commercial |
$699.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.38
|
| Rate for Payer: Priority Health SBD |
$518.74
|
| Rate for Payer: UMR Bronson Commercial |
$362.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.55
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
IP
|
$686.17
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.91 |
| Max. Negotiated Rate |
$617.55 |
| Rate for Payer: Aetna American Axle |
$446.01
|
| Rate for Payer: Aetna Commercial |
$583.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.01
|
| Rate for Payer: Cash Price |
$548.94
|
| Rate for Payer: Cofinity Commercial |
$480.32
|
| Rate for Payer: Cofinity Commercial |
$590.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.94
|
| Rate for Payer: Healthscope Commercial |
$617.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$583.24
|
| Rate for Payer: PHP Commercial |
$583.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.32
|
| Rate for Payer: Priority Health SBD |
$432.29
|
| Rate for Payer: UMR Bronson Commercial |
$301.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.63
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
OP
|
$686.17
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$617.55 |
| Rate for Payer: Aetna American Axle |
$446.01
|
| Rate for Payer: Aetna Commercial |
$583.24
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$386.45
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$548.94
|
| Rate for Payer: Cash Price |
$548.94
|
| Rate for Payer: Cofinity Commercial |
$480.32
|
| Rate for Payer: Cofinity Commercial |
$590.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$617.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.63
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$583.24
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$583.24
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.59
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$22.07
|
| Rate for Payer: Priority Health SBD |
$432.29
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$24.23
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$253.88
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.63
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna American Axle |
$4.06
|
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.30
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.37
|
| Rate for Payer: Priority Health SBD |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.68
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna American Axle |
$4.06
|
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.30
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.37
|
| Rate for Payer: Priority Health SBD |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.66
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UMR Bronson Commercial |
$2.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.68
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC
|
Facility
|
IP
|
$45,769.96
|
|
|
Service Code
|
MS-DRG 481
|
| Min. Negotiated Rate |
$15,676.52 |
| Max. Negotiated Rate |
$45,769.96 |
| Rate for Payer: Aetna Medicare |
$17,161.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,627.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,627.00
|
| Rate for Payer: BCBS MAPPO |
$16,501.60
|
| Rate for Payer: BCBS Trust/PPO |
$45,769.96
|
| Rate for Payer: BCN Medicare Advantage |
$16,501.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,501.60
|
| Rate for Payer: Mclaren Medicare |
$16,501.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,326.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,976.84
|
| Rate for Payer: PACE Medicare |
$15,676.52
|
| Rate for Payer: PACE SWMI |
$16,501.60
|
| Rate for Payer: PHP Medicare Advantage |
$16,501.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,774.65
|
| Rate for Payer: Priority Health Medicare |
$16,501.60
|
| Rate for Payer: Priority Health Narrow Network |
$23,819.72
|
| Rate for Payer: Railroad Medicare Medicare |
$16,501.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,650.52
|
| Rate for Payer: UHC Core |
$25,952.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,501.60
|
| Rate for Payer: UHC Exchange |
$20,632.81
|
| Rate for Payer: UHC Medicare Advantage |
$16,996.65
|
| Rate for Payer: VA VA |
$16,501.60
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC
|
Facility
|
IP
|
$69,207.78
|
|
|
Service Code
|
MS-DRG 480
|
| Min. Negotiated Rate |
$22,074.85 |
| Max. Negotiated Rate |
$69,207.78 |
| Rate for Payer: Aetna Medicare |
$24,166.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,045.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,045.85
|
| Rate for Payer: BCBS MAPPO |
$23,236.68
|
| Rate for Payer: BCBS Trust/PPO |
$69,207.78
|
| Rate for Payer: BCN Medicare Advantage |
$23,236.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,236.68
|
| Rate for Payer: Mclaren Medicare |
$23,236.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,398.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,722.18
|
| Rate for Payer: PACE Medicare |
$22,074.85
|
| Rate for Payer: PACE SWMI |
$23,236.68
|
| Rate for Payer: PHP Medicare Advantage |
$23,236.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42,316.48
|
| Rate for Payer: Priority Health Medicare |
$23,236.68
|
| Rate for Payer: Priority Health Narrow Network |
$33,853.18
|
| Rate for Payer: Railroad Medicare Medicare |
$23,236.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,982.52
|
| Rate for Payer: UHC Core |
$36,884.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,236.68
|
| Rate for Payer: UHC Exchange |
$29,323.86
|
| Rate for Payer: UHC Medicare Advantage |
$23,933.78
|
| Rate for Payer: VA VA |
$23,236.68
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC
|
Facility
|
IP
|
$32,054.55
|
|
|
Service Code
|
MS-DRG 482
|
| Min. Negotiated Rate |
$12,115.00 |
| Max. Negotiated Rate |
$32,054.55 |
| Rate for Payer: Aetna Medicare |
$13,262.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,940.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,940.79
|
| Rate for Payer: BCBS MAPPO |
$12,752.63
|
| Rate for Payer: BCBS Trust/PPO |
$32,054.55
|
| Rate for Payer: BCN Medicare Advantage |
$12,752.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,752.63
|
| Rate for Payer: Mclaren Medicare |
$12,752.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,390.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,665.52
|
| Rate for Payer: PACE Medicare |
$12,115.00
|
| Rate for Payer: PACE SWMI |
$12,752.63
|
| Rate for Payer: PHP Medicare Advantage |
$12,752.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,793.41
|
| Rate for Payer: Priority Health Medicare |
$12,752.63
|
| Rate for Payer: Priority Health Narrow Network |
$18,234.73
|
| Rate for Payer: Railroad Medicare Medicare |
$12,752.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,229.45
|
| Rate for Payer: UHC Core |
$19,867.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,752.63
|
| Rate for Payer: UHC Exchange |
$15,795.05
|
| Rate for Payer: UHC Medicare Advantage |
$13,135.21
|
| Rate for Payer: VA VA |
$12,752.63
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC
|
Facility
|
IP
|
$81,543.61
|
|
|
Service Code
|
MS-DRG 521
|
| Min. Negotiated Rate |
$22,406.48 |
| Max. Negotiated Rate |
$81,543.61 |
| Rate for Payer: Aetna Medicare |
$24,529.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,482.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,482.21
|
| Rate for Payer: BCBS MAPPO |
$23,585.77
|
| Rate for Payer: BCBS Trust/PPO |
$81,543.61
|
| Rate for Payer: BCN Medicare Advantage |
$23,585.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,585.77
|
| Rate for Payer: Mclaren Medicare |
$23,585.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,765.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,123.64
|
| Rate for Payer: PACE Medicare |
$22,406.48
|
| Rate for Payer: PACE SWMI |
$23,585.77
|
| Rate for Payer: PHP Medicare Advantage |
$23,585.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42,966.53
|
| Rate for Payer: Priority Health Medicare |
$23,585.77
|
| Rate for Payer: Priority Health Narrow Network |
$34,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$23,585.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,673.53
|
| Rate for Payer: UHC Core |
$37,451.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,585.77
|
| Rate for Payer: UHC Exchange |
$29,774.32
|
| Rate for Payer: UHC Medicare Advantage |
$24,293.34
|
| Rate for Payer: VA VA |
$23,585.77
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC
|
Facility
|
IP
|
$45,420.67
|
|
|
Service Code
|
MS-DRG 522
|
| Min. Negotiated Rate |
$15,949.59 |
| Max. Negotiated Rate |
$45,420.67 |
| Rate for Payer: Aetna Medicare |
$17,460.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,986.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,986.30
|
| Rate for Payer: BCBS MAPPO |
$16,789.04
|
| Rate for Payer: BCBS Trust/PPO |
$45,420.67
|
| Rate for Payer: BCN Medicare Advantage |
$16,789.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,789.04
|
| Rate for Payer: Mclaren Medicare |
$16,789.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,628.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,307.40
|
| Rate for Payer: PACE Medicare |
$15,949.59
|
| Rate for Payer: PACE SWMI |
$16,789.04
|
| Rate for Payer: PHP Medicare Advantage |
$16,789.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,309.90
|
| Rate for Payer: Priority Health Medicare |
$16,789.04
|
| Rate for Payer: Priority Health Narrow Network |
$24,247.92
|
| Rate for Payer: Railroad Medicare Medicare |
$16,789.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,219.50
|
| Rate for Payer: UHC Core |
$26,419.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,789.04
|
| Rate for Payer: UHC Exchange |
$21,003.72
|
| Rate for Payer: UHC Medicare Advantage |
$17,292.71
|
| Rate for Payer: VA VA |
$16,789.04
|
|
|
HISTRELIN 50 MG (65 MCG/DAY) IMPLANT KIT
|
Facility
|
IP
|
$212,794.44
|
|
|
Service Code
|
HCPCS J9226
|
| Hospital Charge Code |
172291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93,629.55 |
| Max. Negotiated Rate |
$191,515.00 |
| Rate for Payer: Aetna American Axle |
$138,316.39
|
| Rate for Payer: Aetna Commercial |
$180,875.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138,316.39
|
| Rate for Payer: Cash Price |
$170,235.55
|
| Rate for Payer: Cofinity Commercial |
$148,956.11
|
| Rate for Payer: Cofinity Commercial |
$183,003.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170,235.55
|
| Rate for Payer: Healthscope Commercial |
$191,515.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148,956.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159,595.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180,875.27
|
| Rate for Payer: PHP Commercial |
$180,875.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148,956.11
|
| Rate for Payer: Priority Health SBD |
$134,060.50
|
| Rate for Payer: UMR Bronson Commercial |
$93,629.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159,595.83
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$141,493.86
|
|
|
Service Code
|
MS-DRG 969
|
| Min. Negotiated Rate |
$50,799.21 |
| Max. Negotiated Rate |
$141,493.86 |
| Rate for Payer: Aetna Medicare |
$55,611.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66,841.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66,841.06
|
| Rate for Payer: BCBS MAPPO |
$53,472.85
|
| Rate for Payer: BCBS Trust/PPO |
$141,493.86
|
| Rate for Payer: BCN Medicare Advantage |
$53,472.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,472.85
|
| Rate for Payer: Mclaren Medicare |
$53,472.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56,146.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,493.78
|
| Rate for Payer: PACE Medicare |
$50,799.21
|
| Rate for Payer: PACE SWMI |
$53,472.85
|
| Rate for Payer: PHP Medicare Advantage |
$53,472.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98,621.26
|
| Rate for Payer: Priority Health Medicare |
$53,472.85
|
| Rate for Payer: Priority Health Narrow Network |
$78,897.01
|
| Rate for Payer: Railroad Medicare Medicare |
$53,472.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104,834.64
|
| Rate for Payer: UHC Core |
$85,962.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$53,472.85
|
| Rate for Payer: UHC Exchange |
$68,341.13
|
| Rate for Payer: UHC Medicare Advantage |
$55,077.04
|
| Rate for Payer: VA VA |
$53,472.85
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$45,812.68
|
|
|
Service Code
|
MS-DRG 970
|
| Min. Negotiated Rate |
$20,835.44 |
| Max. Negotiated Rate |
$45,812.68 |
| Rate for Payer: Aetna Medicare |
$22,809.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,415.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,415.05
|
| Rate for Payer: BCBS MAPPO |
$21,932.04
|
| Rate for Payer: BCBS Trust/PPO |
$45,812.68
|
| Rate for Payer: BCN Medicare Advantage |
$21,932.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,932.04
|
| Rate for Payer: Mclaren Medicare |
$21,932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,028.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,221.85
|
| Rate for Payer: PACE Medicare |
$20,835.44
|
| Rate for Payer: PACE SWMI |
$21,932.04
|
| Rate for Payer: PHP Medicare Advantage |
$21,932.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,502.95
|
| Rate for Payer: Priority Health Medicare |
$21,932.04
|
| Rate for Payer: Priority Health Narrow Network |
$27,602.36
|
| Rate for Payer: Railroad Medicare Medicare |
$21,932.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,676.72
|
| Rate for Payer: UHC Core |
$30,074.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,932.04
|
| Rate for Payer: UHC Exchange |
$23,909.35
|
| Rate for Payer: UHC Medicare Advantage |
$22,590.00
|
| Rate for Payer: VA VA |
$21,932.04
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
|
IP
|
$20,795.78
|
|
|
Service Code
|
MS-DRG 975
|
| Min. Negotiated Rate |
$10,467.09 |
| Max. Negotiated Rate |
$20,795.78 |
| Rate for Payer: Aetna Medicare |
$11,458.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,772.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,772.49
|
| Rate for Payer: BCBS MAPPO |
$11,017.99
|
| Rate for Payer: BCBS Trust/PPO |
$14,310.97
|
| Rate for Payer: BCN Medicare Advantage |
$11,017.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,017.99
|
| Rate for Payer: Mclaren Medicare |
$11,017.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,568.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,670.69
|
| Rate for Payer: PACE Medicare |
$10,467.09
|
| Rate for Payer: PACE SWMI |
$11,017.99
|
| Rate for Payer: PHP Medicare Advantage |
$11,017.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,563.25
|
| Rate for Payer: Priority Health Medicare |
$11,017.99
|
| Rate for Payer: Priority Health Narrow Network |
$15,650.60
|
| Rate for Payer: Railroad Medicare Medicare |
$11,017.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,795.78
|
| Rate for Payer: UHC Core |
$17,052.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,017.99
|
| Rate for Payer: UHC Exchange |
$13,556.66
|
| Rate for Payer: UHC Medicare Advantage |
$11,348.53
|
| Rate for Payer: VA VA |
$11,017.99
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
|
IP
|
$54,507.31
|
|
|
Service Code
|
MS-DRG 974
|
| Min. Negotiated Rate |
$21,837.65 |
| Max. Negotiated Rate |
$54,507.31 |
| Rate for Payer: Aetna Medicare |
$23,906.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,733.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,733.75
|
| Rate for Payer: BCBS MAPPO |
$22,987.00
|
| Rate for Payer: BCBS Trust/PPO |
$54,507.31
|
| Rate for Payer: BCN Medicare Advantage |
$22,987.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,987.00
|
| Rate for Payer: Mclaren Medicare |
$22,987.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,136.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,435.05
|
| Rate for Payer: PACE Medicare |
$21,837.65
|
| Rate for Payer: PACE SWMI |
$22,987.00
|
| Rate for Payer: PHP Medicare Advantage |
$22,987.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,851.54
|
| Rate for Payer: Priority Health Medicare |
$22,987.00
|
| Rate for Payer: Priority Health Narrow Network |
$33,481.23
|
| Rate for Payer: Railroad Medicare Medicare |
$22,987.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,488.29
|
| Rate for Payer: UHC Core |
$36,479.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,987.00
|
| Rate for Payer: UHC Exchange |
$29,001.68
|
| Rate for Payer: UHC Medicare Advantage |
$23,676.61
|
| Rate for Payer: VA VA |
$22,987.00
|
|
|
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
|
IP
|
$13,896.34
|
|
|
Service Code
|
MS-DRG 976
|
| Min. Negotiated Rate |
$6,674.96 |
| Max. Negotiated Rate |
$13,896.34 |
| Rate for Payer: Aetna Medicare |
$7,307.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,782.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,782.84
|
| Rate for Payer: BCBS MAPPO |
$7,026.27
|
| Rate for Payer: BCBS Trust/PPO |
$13,896.34
|
| Rate for Payer: BCN Medicare Advantage |
$7,026.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,026.27
|
| Rate for Payer: Mclaren Medicare |
$7,026.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,377.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,080.21
|
| Rate for Payer: PACE Medicare |
$6,674.96
|
| Rate for Payer: PACE SWMI |
$7,026.27
|
| Rate for Payer: PHP Medicare Advantage |
$7,026.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,129.99
|
| Rate for Payer: Priority Health Medicare |
$7,026.27
|
| Rate for Payer: Priority Health Narrow Network |
$9,703.99
|
| Rate for Payer: Railroad Medicare Medicare |
$7,026.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,894.21
|
| Rate for Payer: UHC Core |
$10,573.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,026.27
|
| Rate for Payer: UHC Exchange |
$8,405.66
|
| Rate for Payer: UHC Medicare Advantage |
$7,237.06
|
| Rate for Payer: VA VA |
$7,026.27
|
|
