|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$9,936.41
|
|
|
Service Code
|
APR-DRG 8903
|
| Min. Negotiated Rate |
$9,463.25 |
| Max. Negotiated Rate |
$9,936.41 |
| Rate for Payer: BCBS Complete |
$9,936.41
|
| Rate for Payer: Mclaren Medicaid |
$9,463.25
|
| Rate for Payer: Meridian Medicaid |
$9,936.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,463.25
|
| Rate for Payer: UHC Medicaid |
$9,463.25
|
| Rate for Payer: UHCCP Medicaid |
$9,463.25
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$16,259.03
|
|
|
Service Code
|
APR-DRG 8904
|
| Min. Negotiated Rate |
$15,484.79 |
| Max. Negotiated Rate |
$16,259.03 |
| Rate for Payer: BCBS Complete |
$16,259.03
|
| Rate for Payer: Mclaren Medicaid |
$15,484.79
|
| Rate for Payer: Meridian Medicaid |
$16,259.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,484.79
|
| Rate for Payer: UHC Medicaid |
$15,484.79
|
| Rate for Payer: UHCCP Medicaid |
$15,484.79
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$5,343.20
|
|
|
Service Code
|
APR-DRG 8901
|
| Min. Negotiated Rate |
$5,088.77 |
| Max. Negotiated Rate |
$5,343.20 |
| Rate for Payer: BCBS Complete |
$5,343.20
|
| Rate for Payer: Mclaren Medicaid |
$5,088.77
|
| Rate for Payer: Meridian Medicaid |
$5,343.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,088.77
|
| Rate for Payer: UHC Medicaid |
$5,088.77
|
| Rate for Payer: UHCCP Medicaid |
$5,088.77
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$7,702.16
|
|
|
Service Code
|
APR-DRG 8902
|
| Min. Negotiated Rate |
$7,335.39 |
| Max. Negotiated Rate |
$7,702.16 |
| Rate for Payer: BCBS Complete |
$7,702.16
|
| Rate for Payer: Mclaren Medicaid |
$7,335.39
|
| Rate for Payer: Meridian Medicaid |
$7,702.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,335.39
|
| Rate for Payer: UHC Medicaid |
$7,335.39
|
| Rate for Payer: UHCCP Medicaid |
$7,335.39
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,406.77
|
|
|
Service Code
|
APR-DRG 8941
|
| Min. Negotiated Rate |
$4,196.92 |
| Max. Negotiated Rate |
$4,406.77 |
| Rate for Payer: BCBS Complete |
$4,406.77
|
| Rate for Payer: Mclaren Medicaid |
$4,196.92
|
| Rate for Payer: Meridian Medicaid |
$4,406.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,196.92
|
| Rate for Payer: UHC Medicaid |
$4,196.92
|
| Rate for Payer: UHCCP Medicaid |
$4,196.92
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,707.01
|
|
|
Service Code
|
APR-DRG 8942
|
| Min. Negotiated Rate |
$4,482.86 |
| Max. Negotiated Rate |
$4,707.01 |
| Rate for Payer: BCBS Complete |
$4,707.01
|
| Rate for Payer: Mclaren Medicaid |
$4,482.86
|
| Rate for Payer: Meridian Medicaid |
$4,707.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,482.86
|
| Rate for Payer: UHC Medicaid |
$4,482.86
|
| Rate for Payer: UHCCP Medicaid |
$4,482.86
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$8,161.60
|
|
|
Service Code
|
APR-DRG 8944
|
| Min. Negotiated Rate |
$7,772.95 |
| Max. Negotiated Rate |
$8,161.60 |
| Rate for Payer: BCBS Complete |
$8,161.60
|
| Rate for Payer: Mclaren Medicaid |
$7,772.95
|
| Rate for Payer: Meridian Medicaid |
$8,161.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,772.95
|
| Rate for Payer: UHC Medicaid |
$7,772.95
|
| Rate for Payer: UHCCP Medicaid |
$7,772.95
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$5,218.51
|
|
|
Service Code
|
APR-DRG 8943
|
| Min. Negotiated Rate |
$4,970.01 |
| Max. Negotiated Rate |
$5,218.51 |
| Rate for Payer: BCBS Complete |
$5,218.51
|
| Rate for Payer: Mclaren Medicaid |
$4,970.01
|
| Rate for Payer: Meridian Medicaid |
$5,218.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,970.01
|
| Rate for Payer: UHC Medicaid |
$4,970.01
|
| Rate for Payer: UHCCP Medicaid |
$4,970.01
|
|
|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$23,245.51
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$10,872.99 |
| Max. Negotiated Rate |
$23,245.51 |
| Rate for Payer: Aetna Medicare |
$11,903.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,306.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,306.56
|
| Rate for Payer: BCBS MAPPO |
$11,445.25
|
| Rate for Payer: BCBS Trust/PPO |
$23,245.51
|
| Rate for Payer: BCN Commercial |
$23,245.51
|
| Rate for Payer: BCN Medicare Advantage |
$11,445.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,445.25
|
| Rate for Payer: Mclaren Medicare |
$11,445.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,017.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,162.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,589.77
|
| Rate for Payer: Nomi Health Commercial |
$16,352.04
|
| Rate for Payer: PACE Medicare |
$10,872.99
|
| Rate for Payer: PACE SWMI |
$11,445.25
|
| Rate for Payer: PHP Medicare Advantage |
$11,445.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,921.70
|
| Rate for Payer: Priority Health Medicare |
$11,445.25
|
| Rate for Payer: Priority Health Tiered Network |
$16,737.36
|
| Rate for Payer: Railroad Medicare Medicare |
$11,445.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,661.88
|
| Rate for Payer: UHC Core |
$17,286.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,445.25
|
| Rate for Payer: UHC Exchange |
$14,117.26
|
| Rate for Payer: VA VA |
$11,445.25
|
|
|
HONEY 80 % TOPICAL GEL
|
Facility
|
OP
|
$56.21
|
|
|
Service Code
|
NDC 09958003471
|
| Hospital Charge Code |
164073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: Aetna American Axle |
$36.54
|
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Aetna Medicare |
$28.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.54
|
| Rate for Payer: BCBS Complete |
$22.48
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cofinity Advantage |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.97
|
| Rate for Payer: Healthscope Commercial |
$50.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.16
|
| Rate for Payer: PHP Commercial |
$47.78
|
| Rate for Payer: Priority Health SBD |
$35.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.54
|
| Rate for Payer: UHC Core |
$29.29
|
| Rate for Payer: UHC Exchange |
$22.09
|
| Rate for Payer: UMR Bronson Commercial |
$20.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.16
|
|
|
HONEY 80 % TOPICAL GEL
|
Facility
|
IP
|
$56.21
|
|
|
Service Code
|
NDC 09958003471
|
| Hospital Charge Code |
164073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: Aetna American Axle |
$36.54
|
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.54
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cofinity Advantage |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.97
|
| Rate for Payer: Healthscope Commercial |
$50.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.16
|
| Rate for Payer: PHP Commercial |
$47.78
|
| Rate for Payer: Priority Health SBD |
$35.41
|
| Rate for Payer: UMR Bronson Commercial |
$24.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.16
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$1,136.20
|
|
|
Service Code
|
APR-DRG 8643
|
| Min. Negotiated Rate |
$1,082.09 |
| Max. Negotiated Rate |
$1,136.20 |
| Rate for Payer: BCBS Complete |
$1,136.20
|
| Rate for Payer: Mclaren Medicaid |
$1,082.09
|
| Rate for Payer: Meridian Medicaid |
$1,136.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,082.09
|
| Rate for Payer: UHC Medicaid |
$1,082.09
|
| Rate for Payer: UHCCP Medicaid |
$1,082.09
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$993.94
|
|
|
Service Code
|
APR-DRG 8641
|
| Min. Negotiated Rate |
$946.61 |
| Max. Negotiated Rate |
$993.94 |
| Rate for Payer: BCBS Complete |
$993.94
|
| Rate for Payer: Mclaren Medicaid |
$946.61
|
| Rate for Payer: Meridian Medicaid |
$993.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$946.61
|
| Rate for Payer: UHC Medicaid |
$946.61
|
| Rate for Payer: UHCCP Medicaid |
$946.61
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$1,023.60
|
|
|
Service Code
|
APR-DRG 8642
|
| Min. Negotiated Rate |
$974.86 |
| Max. Negotiated Rate |
$1,023.60 |
| Rate for Payer: BCBS Complete |
$1,023.60
|
| Rate for Payer: Mclaren Medicaid |
$974.86
|
| Rate for Payer: Meridian Medicaid |
$1,023.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$974.86
|
| Rate for Payer: UHC Medicaid |
$974.86
|
| Rate for Payer: UHCCP Medicaid |
$974.86
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$1,193.10
|
|
|
Service Code
|
APR-DRG 8644
|
| Min. Negotiated Rate |
$1,136.28 |
| Max. Negotiated Rate |
$1,193.10 |
| Rate for Payer: BCBS Complete |
$1,193.10
|
| Rate for Payer: Mclaren Medicaid |
$1,136.28
|
| Rate for Payer: Meridian Medicaid |
$1,193.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,136.28
|
| Rate for Payer: UHC Medicaid |
$1,136.28
|
| Rate for Payer: UHCCP Medicaid |
$1,136.28
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT (PF) 0.5 ML IM SUSPENSION
|
Facility
|
OP
|
$699.36
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
173369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$258.76 |
| Max. Negotiated Rate |
$1,047.36 |
| Rate for Payer: Aetna American Axle |
$454.58
|
| Rate for Payer: Aetna Commercial |
$594.46
|
| Rate for Payer: Aetna Medicare |
$349.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.58
|
| Rate for Payer: BCBS Complete |
$279.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,047.36
|
| Rate for Payer: BCN Commercial |
$1,047.36
|
| Rate for Payer: Cash Price |
$559.49
|
| Rate for Payer: Cash Price |
$559.49
|
| Rate for Payer: Cofinity Advantage |
$489.55
|
| Rate for Payer: Cofinity Commercial |
$601.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.49
|
| Rate for Payer: Healthscope Commercial |
$629.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$559.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.52
|
| Rate for Payer: PHP Commercial |
$594.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$375.02
|
| Rate for Payer: Priority Health SBD |
$440.60
|
| Rate for Payer: Priority Health Tiered Network |
$300.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.35
|
| Rate for Payer: UHC Core |
$651.35
|
| Rate for Payer: UHC Exchange |
$651.35
|
| Rate for Payer: UMR Bronson Commercial |
$258.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.52
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT (PF) 0.5 ML IM SUSPENSION
|
Facility
|
IP
|
$699.36
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
173369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$307.72 |
| Max. Negotiated Rate |
$629.42 |
| Rate for Payer: Aetna American Axle |
$454.58
|
| Rate for Payer: Aetna Commercial |
$594.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.58
|
| Rate for Payer: Cash Price |
$559.49
|
| Rate for Payer: Cofinity Advantage |
$489.55
|
| Rate for Payer: Cofinity Commercial |
$601.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.49
|
| Rate for Payer: Healthscope Commercial |
$629.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.52
|
| Rate for Payer: PHP Commercial |
$594.46
|
| Rate for Payer: Priority Health SBD |
$440.60
|
| Rate for Payer: UMR Bronson Commercial |
$307.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.52
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$969.77
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
173370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$300.02 |
| Max. Negotiated Rate |
$1,047.36 |
| Rate for Payer: Aetna American Axle |
$630.35
|
| Rate for Payer: Aetna Commercial |
$824.30
|
| Rate for Payer: Aetna Medicare |
$484.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.35
|
| Rate for Payer: BCBS Complete |
$387.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,047.36
|
| Rate for Payer: BCN Commercial |
$1,047.36
|
| Rate for Payer: Cash Price |
$775.82
|
| Rate for Payer: Cash Price |
$775.82
|
| Rate for Payer: Cofinity Advantage |
$678.84
|
| Rate for Payer: Cofinity Commercial |
$834.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.82
|
| Rate for Payer: Healthscope Commercial |
$872.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$678.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$727.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$775.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$824.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.33
|
| Rate for Payer: PHP Commercial |
$824.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$375.02
|
| Rate for Payer: Priority Health SBD |
$610.96
|
| Rate for Payer: Priority Health Tiered Network |
$300.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.35
|
| Rate for Payer: UHC Core |
$651.35
|
| Rate for Payer: UHC Exchange |
$651.35
|
| Rate for Payer: UMR Bronson Commercial |
$358.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$727.33
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$969.77
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
173370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$426.70 |
| Max. Negotiated Rate |
$872.79 |
| Rate for Payer: Aetna American Axle |
$630.35
|
| Rate for Payer: Aetna Commercial |
$824.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.35
|
| Rate for Payer: Cash Price |
$775.82
|
| Rate for Payer: Cofinity Advantage |
$678.84
|
| Rate for Payer: Cofinity Commercial |
$834.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.82
|
| Rate for Payer: Healthscope Commercial |
$872.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$678.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$727.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$824.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.33
|
| Rate for Payer: PHP Commercial |
$824.30
|
| Rate for Payer: Priority Health SBD |
$610.96
|
| Rate for Payer: UMR Bronson Commercial |
$426.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$727.33
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 1,000 UNIT IV SOLUTION
|
Facility
|
IP
|
$5.82
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Aetna American Axle |
$3.78
|
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cofinity Advantage |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$5.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.37
|
| Rate for Payer: PHP Commercial |
$4.95
|
| Rate for Payer: Priority Health SBD |
$3.67
|
| Rate for Payer: UMR Bronson Commercial |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.37
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 1,000 UNIT IV SOLUTION
|
Facility
|
OP
|
$5.82
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna American Axle |
$3.78
|
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: Aetna Medicare |
$1.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.15
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS MAPPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$10.18
|
| Rate for Payer: BCN Commercial |
$10.18
|
| Rate for Payer: BCN Medicare Advantage |
$1.72
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cofinity Advantage |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.72
|
| Rate for Payer: Healthscope Commercial |
$5.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.37
|
| Rate for Payer: Mclaren Medicaid |
$1.72
|
| Rate for Payer: Mclaren Medicare |
$1.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.81
|
| Rate for Payer: Meridian Medicaid |
$1.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Nomi Health Commercial |
$5.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.37
|
| Rate for Payer: PACE Medicare |
$1.63
|
| Rate for Payer: PACE SWMI |
$1.72
|
| Rate for Payer: PHP Commercial |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$1.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.87
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health SBD |
$3.67
|
| Rate for Payer: Priority Health Tiered Network |
$3.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.82
|
| Rate for Payer: UHC Core |
$2.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.72
|
| Rate for Payer: UHC Exchange |
$2.82
|
| Rate for Payer: UHC Medicaid |
$0.90
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.15
|
| Rate for Payer: VA VA |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.37
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION
|
Facility
|
IP
|
$5.82
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Aetna American Axle |
$3.78
|
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cofinity Advantage |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$5.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.37
|
| Rate for Payer: PHP Commercial |
$4.95
|
| Rate for Payer: Priority Health SBD |
$3.67
|
| Rate for Payer: UMR Bronson Commercial |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.37
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION
|
Facility
|
OP
|
$5.82
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna American Axle |
$3.78
|
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: Aetna Medicare |
$1.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.15
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS MAPPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$10.18
|
| Rate for Payer: BCN Commercial |
$10.18
|
| Rate for Payer: BCN Medicare Advantage |
$1.72
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cofinity Advantage |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.72
|
| Rate for Payer: Healthscope Commercial |
$5.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.37
|
| Rate for Payer: Mclaren Medicaid |
$1.72
|
| Rate for Payer: Mclaren Medicare |
$1.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.81
|
| Rate for Payer: Meridian Medicaid |
$1.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Nomi Health Commercial |
$5.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.37
|
| Rate for Payer: PACE Medicare |
$1.63
|
| Rate for Payer: PACE SWMI |
$1.72
|
| Rate for Payer: PHP Commercial |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$1.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.87
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health SBD |
$3.67
|
| Rate for Payer: Priority Health Tiered Network |
$3.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.82
|
| Rate for Payer: UHC Core |
$2.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.72
|
| Rate for Payer: UHC Exchange |
$2.82
|
| Rate for Payer: UHC Medicaid |
$0.90
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.15
|
| Rate for Payer: VA VA |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.37
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$212.46
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.48 |
| Max. Negotiated Rate |
$191.21 |
| Rate for Payer: Aetna American Axle |
$138.10
|
| Rate for Payer: Aetna Commercial |
$180.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.10
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cofinity Advantage |
$148.72
|
| Rate for Payer: Cofinity Commercial |
$182.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.97
|
| Rate for Payer: Healthscope Commercial |
$191.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.34
|
| Rate for Payer: PHP Commercial |
$180.59
|
| Rate for Payer: Priority Health SBD |
$133.85
|
| Rate for Payer: UMR Bronson Commercial |
$93.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.34
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$212.46
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$191.21 |
| Rate for Payer: Aetna American Axle |
$138.10
|
| Rate for Payer: Aetna Commercial |
$180.59
|
| Rate for Payer: Aetna Medicare |
$106.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.10
|
| Rate for Payer: BCBS Complete |
$84.98
|
| Rate for Payer: BCBS Trust/PPO |
$1.15
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cofinity Advantage |
$148.72
|
| Rate for Payer: Cofinity Commercial |
$182.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.97
|
| Rate for Payer: Healthscope Commercial |
$191.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.34
|
| Rate for Payer: PHP Commercial |
$180.59
|
| Rate for Payer: Priority Health SBD |
$133.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$78.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.34
|
|
