|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE (CUSTOM NO PRIOR AUTH CREATED)
|
Facility
|
IP
|
$11.13
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
300951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$10.02 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna American Axle |
$7.15
|
| Rate for Payer: Aetna American Axle |
$6.83
|
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$9.46
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Cofinity Commercial |
$9.45
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$7.79
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Cofinity Commercial |
$9.57
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$10.02
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.46
|
| Rate for Payer: PHP Commercial |
$9.46
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: PHP Commercial |
$8.93
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.83
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: Priority Health SBD |
$6.93
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: UMR Bronson Commercial |
$4.84
|
| Rate for Payer: UMR Bronson Commercial |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.35
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE (CUSTOM NO PRIOR AUTH CREATED)
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
300951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna American Axle |
$7.15
|
| Rate for Payer: Aetna American Axle |
$8.45
|
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna American Axle |
$6.83
|
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Commercial |
$9.46
|
| Rate for Payer: Aetna Commercial |
$11.05
|
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Aetna Medicare |
$5.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.45
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Cofinity Commercial |
$9.10
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Cofinity Commercial |
$9.57
|
| Rate for Payer: Cofinity Commercial |
$7.79
|
| Rate for Payer: Cofinity Commercial |
$11.18
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Cofinity Commercial |
$9.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$10.02
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Healthscope Commercial |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: PHP Commercial |
$11.05
|
| Rate for Payer: PHP Commercial |
$9.46
|
| Rate for Payer: PHP Commercial |
$8.93
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health SBD |
$6.93
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: Priority Health SBD |
$8.19
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$5.00
|
| Rate for Payer: UMR Bronson Commercial |
$4.81
|
| Rate for Payer: UMR Bronson Commercial |
$4.07
|
| Rate for Payer: UMR Bronson Commercial |
$3.88
|
| Rate for Payer: UMR Bronson Commercial |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.35
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$12.83
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
105460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Aetna American Axle |
$8.34
|
| Rate for Payer: Aetna American Axle |
$6.50
|
| Rate for Payer: Aetna American Axle |
$6.99
|
| Rate for Payer: Aetna American Axle |
$10.58
|
| Rate for Payer: Aetna American Axle |
$7.31
|
| Rate for Payer: Aetna Commercial |
$10.91
|
| Rate for Payer: Aetna Commercial |
$9.14
|
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna Commercial |
$9.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.99
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Cofinity Commercial |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$10.12
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: PHP Commercial |
$9.56
|
| Rate for Payer: PHP Commercial |
$10.91
|
| Rate for Payer: PHP Commercial |
$9.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health SBD |
$10.26
|
| Rate for Payer: Priority Health SBD |
$7.09
|
| Rate for Payer: Priority Health SBD |
$6.77
|
| Rate for Payer: Priority Health SBD |
$6.30
|
| Rate for Payer: Priority Health SBD |
$8.08
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: UMR Bronson Commercial |
$4.73
|
| Rate for Payer: UMR Bronson Commercial |
$5.65
|
| Rate for Payer: UMR Bronson Commercial |
$7.16
|
| Rate for Payer: UMR Bronson Commercial |
$4.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$12.83
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
105460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Aetna American Axle |
$8.34
|
| Rate for Payer: Aetna American Axle |
$6.99
|
| Rate for Payer: Aetna American Axle |
$6.50
|
| Rate for Payer: Aetna American Axle |
$9.43
|
| Rate for Payer: Aetna American Axle |
$7.31
|
| Rate for Payer: Aetna American Axle |
$10.58
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna Commercial |
$10.91
|
| Rate for Payer: Aetna Commercial |
$9.14
|
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna Commercial |
$12.32
|
| Rate for Payer: Aetna Commercial |
$9.56
|
| Rate for Payer: Aetna Medicare |
$5.62
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Aetna Medicare |
$8.14
|
| Rate for Payer: Aetna Medicare |
$6.42
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: BCBS Complete |
$6.51
|
| Rate for Payer: BCBS Complete |
$5.13
|
| Rate for Payer: BCBS Complete |
$4.30
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS Complete |
$5.80
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Cofinity Commercial |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$10.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Healthscope Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$10.12
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Healthscope Commercial |
$13.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.56
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Commercial |
$10.91
|
| Rate for Payer: PHP Commercial |
$9.56
|
| Rate for Payer: PHP Commercial |
$9.14
|
| Rate for Payer: PHP Commercial |
$12.32
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.31
|
| Rate for Payer: Priority Health SBD |
$6.77
|
| Rate for Payer: Priority Health SBD |
$9.13
|
| Rate for Payer: Priority Health SBD |
$7.09
|
| Rate for Payer: Priority Health SBD |
$8.08
|
| Rate for Payer: Priority Health SBD |
$6.30
|
| Rate for Payer: Priority Health SBD |
$10.26
|
| Rate for Payer: UMR Bronson Commercial |
$6.02
|
| Rate for Payer: UMR Bronson Commercial |
$3.70
|
| Rate for Payer: UMR Bronson Commercial |
$3.98
|
| Rate for Payer: UMR Bronson Commercial |
$4.16
|
| Rate for Payer: UMR Bronson Commercial |
$4.75
|
| Rate for Payer: UMR Bronson Commercial |
$5.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.06
|
|
|
HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
118364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna American Axle |
$62.20
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.20
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: Priority Health SBD |
$60.29
|
| Rate for Payer: UMR Bronson Commercial |
$28.07
|
| Rate for Payer: UMR Bronson Commercial |
$42.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
118364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna American Axle |
$62.20
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Medicare |
$31.90
|
| Rate for Payer: Aetna Medicare |
$47.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: BCBS Complete |
$38.28
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.20
|
| Rate for Payer: Priority Health SBD |
$60.29
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$23.61
|
| Rate for Payer: UMR Bronson Commercial |
$35.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$99.78
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
160075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.90 |
| Max. Negotiated Rate |
$89.80 |
| Rate for Payer: Aetna American Axle |
$64.86
|
| Rate for Payer: Aetna Commercial |
$84.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.86
|
| Rate for Payer: Cash Price |
$79.82
|
| Rate for Payer: Cofinity Commercial |
$69.85
|
| Rate for Payer: Cofinity Commercial |
$85.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.82
|
| Rate for Payer: Healthscope Commercial |
$89.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.81
|
| Rate for Payer: PHP Commercial |
$84.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.86
|
| Rate for Payer: Priority Health SBD |
$62.86
|
| Rate for Payer: UMR Bronson Commercial |
$43.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.83
|
|
|
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$99.78
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
160075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$89.80 |
| Rate for Payer: Aetna American Axle |
$64.86
|
| Rate for Payer: Aetna Commercial |
$84.81
|
| Rate for Payer: Aetna Medicare |
$49.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.86
|
| Rate for Payer: BCBS Complete |
$39.91
|
| Rate for Payer: Cash Price |
$79.82
|
| Rate for Payer: Cofinity Commercial |
$69.85
|
| Rate for Payer: Cofinity Commercial |
$85.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.82
|
| Rate for Payer: Healthscope Commercial |
$89.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.81
|
| Rate for Payer: PHP Commercial |
$84.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.86
|
| Rate for Payer: Priority Health SBD |
$62.86
|
| Rate for Payer: UMR Bronson Commercial |
$36.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.83
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$2,174.88
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
91047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.93 |
| Max. Negotiated Rate |
$1,957.39 |
| Rate for Payer: Aetna American Axle |
$1,413.67
|
| Rate for Payer: Aetna Commercial |
$1,848.65
|
| Rate for Payer: Aetna Medicare |
$139.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.74
|
| Rate for Payer: BCBS Complete |
$75.52
|
| Rate for Payer: BCBS MAPPO |
$134.19
|
| Rate for Payer: BCN Medicare Advantage |
$134.19
|
| Rate for Payer: Cash Price |
$1,739.90
|
| Rate for Payer: Cash Price |
$1,739.90
|
| Rate for Payer: Cofinity Commercial |
$1,522.42
|
| Rate for Payer: Cofinity Commercial |
$1,870.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,522.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,739.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.19
|
| Rate for Payer: Healthscope Commercial |
$1,957.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,522.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.16
|
| Rate for Payer: Mclaren Medicaid |
$71.93
|
| Rate for Payer: Mclaren Medicare |
$134.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.90
|
| Rate for Payer: Meridian Medicaid |
$75.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,848.65
|
| Rate for Payer: PACE Medicare |
$127.48
|
| Rate for Payer: PACE SWMI |
$134.19
|
| Rate for Payer: PHP Commercial |
$1,848.65
|
| Rate for Payer: PHP Medicare Advantage |
$134.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,413.67
|
| Rate for Payer: Priority Health Medicare |
$134.19
|
| Rate for Payer: Priority Health SBD |
$1,370.17
|
| Rate for Payer: Railroad Medicare Medicare |
$134.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.19
|
| Rate for Payer: UHC Exchange |
$256.45
|
| Rate for Payer: UHC Medicare Advantage |
$134.19
|
| Rate for Payer: UHCCP Medicaid |
$71.93
|
| Rate for Payer: UMR Bronson Commercial |
$804.71
|
| Rate for Payer: VA VA |
$134.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.16
|
|
|
HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$495.66
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
116868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.09 |
| Max. Negotiated Rate |
$446.09 |
| Rate for Payer: Aetna American Axle |
$322.18
|
| Rate for Payer: Aetna Commercial |
$421.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.18
|
| Rate for Payer: Cash Price |
$396.53
|
| Rate for Payer: Cofinity Commercial |
$346.96
|
| Rate for Payer: Cofinity Commercial |
$426.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.53
|
| Rate for Payer: Healthscope Commercial |
$446.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.31
|
| Rate for Payer: PHP Commercial |
$421.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.18
|
| Rate for Payer: Priority Health SBD |
$312.27
|
| Rate for Payer: UMR Bronson Commercial |
$218.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.75
|
|
|
HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$495.66
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
116868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.93 |
| Max. Negotiated Rate |
$446.09 |
| Rate for Payer: Aetna American Axle |
$322.18
|
| Rate for Payer: Aetna Commercial |
$421.31
|
| Rate for Payer: Aetna Medicare |
$139.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.74
|
| Rate for Payer: BCBS Complete |
$75.52
|
| Rate for Payer: BCBS MAPPO |
$134.19
|
| Rate for Payer: BCN Medicare Advantage |
$134.19
|
| Rate for Payer: Cash Price |
$396.53
|
| Rate for Payer: Cash Price |
$396.53
|
| Rate for Payer: Cofinity Commercial |
$426.27
|
| Rate for Payer: Cofinity Commercial |
$346.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.19
|
| Rate for Payer: Healthscope Commercial |
$446.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.75
|
| Rate for Payer: Mclaren Medicaid |
$71.93
|
| Rate for Payer: Mclaren Medicare |
$134.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.90
|
| Rate for Payer: Meridian Medicaid |
$75.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.31
|
| Rate for Payer: PACE Medicare |
$127.48
|
| Rate for Payer: PACE SWMI |
$134.19
|
| Rate for Payer: PHP Commercial |
$421.31
|
| Rate for Payer: PHP Medicare Advantage |
$134.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.18
|
| Rate for Payer: Priority Health Medicare |
$134.19
|
| Rate for Payer: Priority Health SBD |
$312.27
|
| Rate for Payer: Railroad Medicare Medicare |
$134.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.19
|
| Rate for Payer: UHC Exchange |
$256.45
|
| Rate for Payer: UHC Medicare Advantage |
$134.19
|
| Rate for Payer: UHCCP Medicaid |
$71.93
|
| Rate for Payer: UMR Bronson Commercial |
$183.39
|
| Rate for Payer: VA VA |
$134.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.75
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE
|
Facility
|
OP
|
$117.75
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
117061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.57 |
| Max. Negotiated Rate |
$105.97 |
| Rate for Payer: Aetna American Axle |
$76.54
|
| Rate for Payer: Aetna Commercial |
$100.09
|
| Rate for Payer: Aetna Medicare |
$58.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.54
|
| Rate for Payer: BCBS Complete |
$47.10
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cofinity Commercial |
$101.27
|
| Rate for Payer: Cofinity Commercial |
$82.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.20
|
| Rate for Payer: Healthscope Commercial |
$105.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.09
|
| Rate for Payer: PHP Commercial |
$100.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.54
|
| Rate for Payer: Priority Health SBD |
$74.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.31
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$117.75
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
117061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$105.97 |
| Rate for Payer: Aetna American Axle |
$76.54
|
| Rate for Payer: Aetna Commercial |
$100.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.54
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cofinity Commercial |
$101.27
|
| Rate for Payer: Cofinity Commercial |
$82.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.20
|
| Rate for Payer: Healthscope Commercial |
$105.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.09
|
| Rate for Payer: PHP Commercial |
$100.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.54
|
| Rate for Payer: Priority Health SBD |
$74.18
|
| Rate for Payer: UMR Bronson Commercial |
$51.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.31
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP
|
Facility
|
IP
|
$158.26
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
118174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$142.43 |
| Rate for Payer: Aetna American Axle |
$102.87
|
| Rate for Payer: Aetna American Axle |
$120.65
|
| Rate for Payer: Aetna Commercial |
$134.52
|
| Rate for Payer: Aetna Commercial |
$157.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.65
|
| Rate for Payer: Cash Price |
$126.61
|
| Rate for Payer: Cash Price |
$148.49
|
| Rate for Payer: Cofinity Commercial |
$159.62
|
| Rate for Payer: Cofinity Commercial |
$129.93
|
| Rate for Payer: Cofinity Commercial |
$110.78
|
| Rate for Payer: Cofinity Commercial |
$136.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.49
|
| Rate for Payer: Healthscope Commercial |
$142.43
|
| Rate for Payer: Healthscope Commercial |
$167.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.52
|
| Rate for Payer: PHP Commercial |
$157.77
|
| Rate for Payer: PHP Commercial |
$134.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.65
|
| Rate for Payer: Priority Health SBD |
$99.70
|
| Rate for Payer: Priority Health SBD |
$116.93
|
| Rate for Payer: UMR Bronson Commercial |
$69.63
|
| Rate for Payer: UMR Bronson Commercial |
$81.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.21
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP
|
Facility
|
OP
|
$158.26
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
118174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.56 |
| Max. Negotiated Rate |
$142.43 |
| Rate for Payer: Aetna American Axle |
$102.87
|
| Rate for Payer: Aetna American Axle |
$120.65
|
| Rate for Payer: Aetna Commercial |
$134.52
|
| Rate for Payer: Aetna Commercial |
$157.77
|
| Rate for Payer: Aetna Medicare |
$79.13
|
| Rate for Payer: Aetna Medicare |
$92.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.65
|
| Rate for Payer: BCBS Complete |
$74.24
|
| Rate for Payer: BCBS Complete |
$63.30
|
| Rate for Payer: Cash Price |
$126.61
|
| Rate for Payer: Cash Price |
$148.49
|
| Rate for Payer: Cofinity Commercial |
$136.10
|
| Rate for Payer: Cofinity Commercial |
$110.78
|
| Rate for Payer: Cofinity Commercial |
$129.93
|
| Rate for Payer: Cofinity Commercial |
$159.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.49
|
| Rate for Payer: Healthscope Commercial |
$167.05
|
| Rate for Payer: Healthscope Commercial |
$142.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.77
|
| Rate for Payer: PHP Commercial |
$157.77
|
| Rate for Payer: PHP Commercial |
$134.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.65
|
| Rate for Payer: Priority Health SBD |
$116.93
|
| Rate for Payer: Priority Health SBD |
$99.70
|
| Rate for Payer: UMR Bronson Commercial |
$58.56
|
| Rate for Payer: UMR Bronson Commercial |
$68.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.69
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE
|
Facility
|
OP
|
$333.15
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
34550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.27 |
| Max. Negotiated Rate |
$299.83 |
| Rate for Payer: Aetna American Axle |
$216.55
|
| Rate for Payer: Aetna Commercial |
$283.18
|
| Rate for Payer: Aetna Medicare |
$166.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.55
|
| Rate for Payer: BCBS Complete |
$133.26
|
| Rate for Payer: Cash Price |
$266.52
|
| Rate for Payer: Cofinity Commercial |
$233.21
|
| Rate for Payer: Cofinity Commercial |
$286.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.52
|
| Rate for Payer: Healthscope Commercial |
$299.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.18
|
| Rate for Payer: PHP Commercial |
$283.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.55
|
| Rate for Payer: Priority Health SBD |
$209.88
|
| Rate for Payer: UMR Bronson Commercial |
$123.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.86
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$333.15
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
34550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.59 |
| Max. Negotiated Rate |
$299.83 |
| Rate for Payer: Aetna American Axle |
$216.55
|
| Rate for Payer: Aetna Commercial |
$283.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.55
|
| Rate for Payer: Cash Price |
$266.52
|
| Rate for Payer: Cofinity Commercial |
$233.21
|
| Rate for Payer: Cofinity Commercial |
$286.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.52
|
| Rate for Payer: Healthscope Commercial |
$299.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.18
|
| Rate for Payer: PHP Commercial |
$283.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.55
|
| Rate for Payer: Priority Health SBD |
$209.88
|
| Rate for Payer: UMR Bronson Commercial |
$146.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.86
|
|
|
HH CATHETER LEG STRAP BARD
|
Facility
|
OP
|
$12.47
|
|
|
Service Code
|
HCPCS A4334
|
| Hospital Charge Code |
27000598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna American Axle |
$8.11
|
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Cofinity Commercial |
$8.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.60
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: UMR Bronson Commercial |
$4.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
|
|
HH CATHETER LEG STRAP BARD
|
Facility
|
IP
|
$12.47
|
|
|
Service Code
|
HCPCS A4334
|
| Hospital Charge Code |
27000598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna American Axle |
$8.11
|
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Cofinity Commercial |
$8.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.60
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: UMR Bronson Commercial |
$5.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
|
|
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: Cofinity Medicare Advantage |
$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 Commercial |
$23.09
|
| Rate for Payer: PHP Commercial |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| 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 |
$24.44 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.09
|
| Rate for Payer: Aetna Medicare |
$13.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$19.01
|
| Rate for Payer: Cofinity Commercial |
$23.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$23.09
|
| Rate for Payer: PHP Commercial |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: Priority Health SBD |
$17.11
|
| 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: Cofinity Medicare Advantage |
$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 |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.31
|
| Rate for Payer: PHP Commercial |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.36
|
| 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 |
$7.33
|
|
|
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 |
$8.80 |
| Rate for Payer: Aetna American Axle |
$6.36
|
| Rate for Payer: Aetna Commercial |
$8.31
|
| Rate for Payer: Aetna Medicare |
$4.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.36
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$6.85
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.31
|
| Rate for Payer: PHP Commercial |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.36
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$3.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
|
|
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: Cofinity Medicare Advantage |
$15.31
|
| 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 Commercial |
$18.59
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| 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 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 |
$19.68 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.31
|
| 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 Commercial |
$18.59
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
