|
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 |
$20.22 |
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.73
|
| 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 Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| 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 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: Cofinity Medicare Advantage |
$15.73
|
| 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 Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| 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 HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
OP
|
$839.87
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna American Axle |
$545.92
|
| Rate for Payer: Aetna Commercial |
$713.89
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$722.29
|
| Rate for Payer: Cofinity Commercial |
$587.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$587.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.90
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$713.89
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.92
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$529.12
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: UMR Bronson Commercial |
$310.75
|
| Rate for Payer: VA VA |
$389.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.90
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
IP
|
$839.87
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.54 |
| Max. Negotiated Rate |
$755.88 |
| Rate for Payer: Aetna American Axle |
$545.92
|
| Rate for Payer: Aetna Commercial |
$713.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.92
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$587.91
|
| Rate for Payer: Cofinity Commercial |
$722.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$587.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: PHP Commercial |
$713.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.92
|
| Rate for Payer: Priority Health SBD |
$529.12
|
| Rate for Payer: UMR Bronson Commercial |
$369.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.90
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
OP
|
$699.89
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna American Axle |
$454.93
|
| Rate for Payer: Aetna Commercial |
$594.91
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cofinity Commercial |
$601.91
|
| Rate for Payer: Cofinity Commercial |
$489.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$629.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.92
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.91
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$594.91
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.93
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$440.93
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: UMR Bronson Commercial |
$258.96
|
| Rate for Payer: VA VA |
$389.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.92
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
IP
|
$699.89
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.95 |
| Max. Negotiated Rate |
$629.90 |
| Rate for Payer: Aetna American Axle |
$454.93
|
| Rate for Payer: Aetna Commercial |
$594.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.93
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cofinity Commercial |
$489.92
|
| Rate for Payer: Cofinity Commercial |
$601.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.91
|
| Rate for Payer: Healthscope Commercial |
$629.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.91
|
| Rate for Payer: PHP Commercial |
$594.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.93
|
| Rate for Payer: Priority Health SBD |
$440.93
|
| Rate for Payer: UMR Bronson Commercial |
$307.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.92
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.13
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.13
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HISTRELIN 50 MG (65 MCG/DAY) IMPLANT KIT
|
Facility
|
IP
|
$218,965.50
|
|
|
Service Code
|
HCPCS J9226
|
| Hospital Charge Code |
172291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96,344.82 |
| Max. Negotiated Rate |
$197,068.95 |
| Rate for Payer: Aetna American Axle |
$142,327.58
|
| Rate for Payer: Aetna Commercial |
$186,120.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142,327.58
|
| Rate for Payer: Cash Price |
$175,172.40
|
| Rate for Payer: Cofinity Commercial |
$153,275.85
|
| Rate for Payer: Cofinity Commercial |
$188,310.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$153,275.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175,172.40
|
| Rate for Payer: Healthscope Commercial |
$197,068.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153,275.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164,224.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186,120.67
|
| Rate for Payer: PHP Commercial |
$186,120.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142,327.58
|
| Rate for Payer: Priority Health SBD |
$137,948.27
|
| Rate for Payer: UMR Bronson Commercial |
$96,344.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164,224.12
|
|
|
HISTRELIN 50 MG (65 MCG/DAY) IMPLANT KIT
|
Facility
|
OP
|
$218,965.50
|
|
|
Service Code
|
HCPCS J9226
|
| Hospital Charge Code |
172291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24,131.07 |
| Max. Negotiated Rate |
$197,068.95 |
| Rate for Payer: Aetna American Axle |
$142,327.58
|
| Rate for Payer: Aetna Commercial |
$186,120.67
|
| Rate for Payer: Aetna Medicare |
$46,821.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142,327.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,275.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,275.81
|
| Rate for Payer: BCBS Complete |
$25,337.62
|
| Rate for Payer: BCBS MAPPO |
$45,020.65
|
| Rate for Payer: BCN Medicare Advantage |
$45,020.65
|
| Rate for Payer: Cash Price |
$175,172.40
|
| Rate for Payer: Cash Price |
$175,172.40
|
| Rate for Payer: Cofinity Commercial |
$153,275.85
|
| Rate for Payer: Cofinity Commercial |
$188,310.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$153,275.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175,172.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,020.65
|
| Rate for Payer: Healthscope Commercial |
$197,068.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153,275.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164,224.12
|
| Rate for Payer: Mclaren Medicaid |
$24,131.07
|
| Rate for Payer: Mclaren Medicare |
$45,020.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47,271.68
|
| Rate for Payer: Meridian Medicaid |
$25,337.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,773.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186,120.67
|
| Rate for Payer: PACE Medicare |
$42,769.62
|
| Rate for Payer: PACE SWMI |
$45,020.65
|
| Rate for Payer: PHP Commercial |
$186,120.67
|
| Rate for Payer: PHP Medicare Advantage |
$45,020.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,131.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142,327.58
|
| Rate for Payer: Priority Health Medicare |
$45,020.65
|
| Rate for Payer: Priority Health SBD |
$137,948.27
|
| Rate for Payer: Railroad Medicare Medicare |
$45,020.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126,728.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$45,020.65
|
| Rate for Payer: UHC Exchange |
$86,038.96
|
| Rate for Payer: UHC Medicare Advantage |
$45,020.65
|
| Rate for Payer: UHCCP Medicaid |
$24,131.07
|
| Rate for Payer: UMR Bronson Commercial |
$81,017.24
|
| Rate for Payer: VA VA |
$45,020.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164,224.12
|
|
|
HONEY 80 % TOPICAL GEL
|
Facility
|
OP
|
$47.90
|
|
|
Service Code
|
NDC 09958003471
|
| Hospital Charge Code |
164073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$43.11 |
| Rate for Payer: Aetna American Axle |
$31.14
|
| Rate for Payer: Aetna Commercial |
$40.72
|
| Rate for Payer: Aetna Medicare |
$23.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.14
|
| Rate for Payer: BCBS Complete |
$19.16
|
| Rate for Payer: Cash Price |
$38.32
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Cofinity Commercial |
$41.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.32
|
| Rate for Payer: Healthscope Commercial |
$43.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.72
|
| Rate for Payer: PHP Commercial |
$40.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.14
|
| Rate for Payer: Priority Health SBD |
$30.18
|
| Rate for Payer: UMR Bronson Commercial |
$17.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.92
|
|
|
HONEY 80 % TOPICAL GEL
|
Facility
|
IP
|
$47.90
|
|
|
Service Code
|
NDC 09958003471
|
| Hospital Charge Code |
164073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$43.11 |
| Rate for Payer: Aetna American Axle |
$31.14
|
| Rate for Payer: Aetna Commercial |
$40.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.14
|
| Rate for Payer: Cash Price |
$38.32
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Cofinity Commercial |
$41.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.32
|
| Rate for Payer: Healthscope Commercial |
$43.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.72
|
| Rate for Payer: PHP Commercial |
$40.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.14
|
| Rate for Payer: Priority Health SBD |
$30.18
|
| Rate for Payer: UMR Bronson Commercial |
$21.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.92
|
|
|
HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT
|
Facility
|
OP
|
$353.78
|
|
|
Service Code
|
CPT G0463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$353.78 |
| Rate for Payer: Aetna Medicare |
$130.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$240.19
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 Commercial |
$489.55
|
| Rate for Payer: Cofinity Commercial |
$601.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.55
|
| 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: PHP Commercial |
$594.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.58
|
| 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 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 |
$629.42 |
| 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: Cash Price |
$559.49
|
| Rate for Payer: Cofinity Commercial |
$489.55
|
| Rate for Payer: Cofinity Commercial |
$601.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.55
|
| 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: PHP Commercial |
$594.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.58
|
| Rate for Payer: Priority Health SBD |
$440.60
|
| 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 INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,015.75
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
173370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$446.93 |
| Max. Negotiated Rate |
$914.17 |
| Rate for Payer: Aetna American Axle |
$660.24
|
| Rate for Payer: Aetna Commercial |
$863.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.24
|
| Rate for Payer: Cash Price |
$812.60
|
| Rate for Payer: Cofinity Commercial |
$711.02
|
| Rate for Payer: Cofinity Commercial |
$873.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$711.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$812.60
|
| Rate for Payer: Healthscope Commercial |
$914.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$761.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.39
|
| Rate for Payer: PHP Commercial |
$863.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.24
|
| Rate for Payer: Priority Health SBD |
$639.92
|
| Rate for Payer: UMR Bronson Commercial |
$446.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$761.81
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,015.75
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
173370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$375.83 |
| Max. Negotiated Rate |
$914.17 |
| Rate for Payer: Aetna American Axle |
$660.24
|
| Rate for Payer: Aetna Commercial |
$863.39
|
| Rate for Payer: Aetna Medicare |
$507.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.24
|
| Rate for Payer: BCBS Complete |
$406.30
|
| Rate for Payer: Cash Price |
$812.60
|
| Rate for Payer: Cofinity Commercial |
$711.02
|
| Rate for Payer: Cofinity Commercial |
$873.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$711.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$812.60
|
| Rate for Payer: Healthscope Commercial |
$914.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$761.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.39
|
| Rate for Payer: PHP Commercial |
$863.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.24
|
| Rate for Payer: Priority Health SBD |
$639.92
|
| Rate for Payer: UMR Bronson Commercial |
$375.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$761.81
|
|
|
HUMAN PROTHROMBIN CMPLX CONCENTRATE (PCC)-LANS 1,000 UNIT IV SOLUTION
|
Facility
|
OP
|
$6,970.60
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$6,273.54 |
| Rate for Payer: Aetna American Axle |
$4,530.89
|
| Rate for Payer: Aetna Commercial |
$5,925.01
|
| Rate for Payer: Aetna Medicare |
$1.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,530.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.94
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.55
|
| Rate for Payer: BCN Medicare Advantage |
$1.55
|
| Rate for Payer: Cash Price |
$5,576.48
|
| Rate for Payer: Cash Price |
$5,576.48
|
| Rate for Payer: Cofinity Commercial |
$5,994.72
|
| Rate for Payer: Cofinity Commercial |
$4,879.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,879.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,576.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$6,273.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,879.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,227.95
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.63
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,925.01
|
| Rate for Payer: PACE Medicare |
$1.47
|
| Rate for Payer: PACE SWMI |
$1.55
|
| Rate for Payer: PHP Commercial |
$5,925.01
|
| Rate for Payer: PHP Medicare Advantage |
$1.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,530.89
|
| Rate for Payer: Priority Health Medicare |
$1.55
|
| Rate for Payer: Priority Health SBD |
$4,391.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.55
|
| Rate for Payer: UHC Exchange |
$2.96
|
| Rate for Payer: UHC Medicare Advantage |
$1.55
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$2,579.12
|
| Rate for Payer: VA VA |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,227.95
|
|
|
HUMAN PROTHROMBIN CMPLX CONCENTRATE (PCC)-LANS 1,000 UNIT IV SOLUTION
|
Facility
|
IP
|
$6,970.60
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,067.06 |
| Max. Negotiated Rate |
$6,273.54 |
| Rate for Payer: Aetna American Axle |
$4,530.89
|
| Rate for Payer: Aetna Commercial |
$5,925.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,530.89
|
| Rate for Payer: Cash Price |
$5,576.48
|
| Rate for Payer: Cofinity Commercial |
$4,879.42
|
| Rate for Payer: Cofinity Commercial |
$5,994.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,879.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,576.48
|
| Rate for Payer: Healthscope Commercial |
$6,273.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,879.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,227.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,925.01
|
| Rate for Payer: PHP Commercial |
$5,925.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,530.89
|
| Rate for Payer: Priority Health SBD |
$4,391.48
|
| Rate for Payer: UMR Bronson Commercial |
$3,067.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,227.95
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION
|
Facility
|
IP
|
$3,753.41
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,651.50 |
| Max. Negotiated Rate |
$3,378.07 |
| Rate for Payer: Aetna American Axle |
$2,439.72
|
| Rate for Payer: Aetna Commercial |
$3,190.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,439.72
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cofinity Commercial |
$2,627.39
|
| Rate for Payer: Cofinity Commercial |
$3,227.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,627.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.73
|
| Rate for Payer: Healthscope Commercial |
$3,378.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,627.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,815.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.40
|
| Rate for Payer: PHP Commercial |
$3,190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.72
|
| Rate for Payer: Priority Health SBD |
$2,364.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,651.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,815.06
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION
|
Facility
|
OP
|
$3,753.41
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3,378.07 |
| Rate for Payer: Aetna American Axle |
$2,439.72
|
| Rate for Payer: Aetna Commercial |
$3,190.40
|
| Rate for Payer: Aetna Medicare |
$1.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,439.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.94
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.55
|
| Rate for Payer: BCN Medicare Advantage |
$1.55
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cofinity Commercial |
$3,227.93
|
| Rate for Payer: Cofinity Commercial |
$2,627.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,627.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$3,378.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,627.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,815.06
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.63
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.40
|
| Rate for Payer: PACE Medicare |
$1.47
|
| Rate for Payer: PACE SWMI |
$1.55
|
| Rate for Payer: PHP Commercial |
$3,190.40
|
| Rate for Payer: PHP Medicare Advantage |
$1.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.72
|
| Rate for Payer: Priority Health Medicare |
$1.55
|
| Rate for Payer: Priority Health SBD |
$2,364.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.55
|
| Rate for Payer: UHC Exchange |
$2.96
|
| Rate for Payer: UHC Medicare Advantage |
$1.55
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,388.76
|
| Rate for Payer: VA VA |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,815.06
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
171259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: PHP Commercial |
$4.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health SBD |
$3.11
|
| Rate for Payer: UMR Bronson Commercial |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.70
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
171259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.67
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$2.14
|
| Rate for Payer: BCN Medicare Advantage |
$2.14
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$4.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Mclaren Medicaid |
$1.15
|
| Rate for Payer: Mclaren Medicare |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: PACE Medicare |
$2.03
|
| Rate for Payer: PACE SWMI |
$2.14
|
| Rate for Payer: PHP Commercial |
$4.19
|
| Rate for Payer: PHP Medicare Advantage |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health Medicare |
$2.14
|
| Rate for Payer: Priority Health SBD |
$3.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.14
|
| Rate for Payer: UHC Exchange |
$4.09
|
| Rate for Payer: UHC Medicare Advantage |
$2.14
|
| Rate for Payer: UHCCP Medicaid |
$1.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: VA VA |
$2.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.70
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
170850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: PHP Commercial |
$4.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health SBD |
$3.11
|
| Rate for Payer: UMR Bronson Commercial |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.70
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
170850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.67
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$2.14
|
| Rate for Payer: BCN Medicare Advantage |
$2.14
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$4.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Mclaren Medicaid |
$1.15
|
| Rate for Payer: Mclaren Medicare |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: PACE Medicare |
$2.03
|
| Rate for Payer: PACE SWMI |
$2.14
|
| Rate for Payer: PHP Commercial |
$4.19
|
| Rate for Payer: PHP Medicare Advantage |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health Medicare |
$2.14
|
| Rate for Payer: Priority Health SBD |
$3.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.14
|
| Rate for Payer: UHC Exchange |
$4.09
|
| Rate for Payer: UHC Medicare Advantage |
$2.14
|
| Rate for Payer: UHCCP Medicaid |
$1.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: VA VA |
$2.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.70
|
|
