|
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 |
$17.76 |
| 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: BCBS Trust/PPO |
$17.76
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: Cash Price |
$9.98
|
| 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: UHC All Payor (Choice/PPO) |
$8.05
|
| Rate for Payer: UHC Exchange |
$6.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
|
|
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 |
$26.99 |
| 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: BCBS Trust/PPO |
$26.99
|
| Rate for Payer: BCN Commercial |
$26.99
|
| Rate for Payer: Cash Price |
$21.73
|
| 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: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Exchange |
$10.20
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.37
|
|
|
HH DRSG MEPILEX 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 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 |
$35.06 |
| 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: BCBS Trust/PPO |
$35.06
|
| Rate for Payer: BCN Commercial |
$35.06
|
| Rate for Payer: Cash Price |
$7.82
|
| 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 |
$7.34
|
| 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: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UMR Bronson Commercial |
$3.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.34
|
|
|
HH DRSG MEPILEX BORDER 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 |
$7.34
|
| 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 |
$7.34
|
|
|
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 |
$35.06 |
| 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: BCBS Trust/PPO |
$35.06
|
| Rate for Payer: BCN Commercial |
$35.06
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: 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: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
|
HH DRSG MEPILEX BORDER 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 |
$47.64 |
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$11.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Trust/PPO |
$47.64
|
| Rate for Payer: BCN Commercial |
$47.64
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: 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 |
$20.50 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna American Axle |
$545.92
|
| Rate for Payer: Aetna Commercial |
$713.89
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$421.55
|
| Rate for Payer: BCN Commercial |
$421.55
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$671.90
|
| 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 |
$391.45
|
| 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 |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$713.89
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$529.12
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$20.50
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: UMR Bronson Commercial |
$310.75
|
| Rate for Payer: VA VA |
$391.45
|
| 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
|
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 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 |
$24.19 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna American Axle |
$454.93
|
| Rate for Payer: Aetna Commercial |
$594.91
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$436.07
|
| Rate for Payer: BCN Commercial |
$436.07
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$559.91
|
| 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 |
$391.45
|
| 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 |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.91
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$594.91
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$440.93
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$24.19
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: UMR Bronson Commercial |
$258.96
|
| Rate for Payer: VA VA |
$391.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.92
|
|
|
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
|
|
|
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 |
$16.88 |
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UMR Bronson Commercial |
$2.35
|
| 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: BCBS Trust/PPO |
$16.88
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: Cash Price |
$5.09
|
| 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: UHC All Payor (Choice/PPO) |
$7.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
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 |
$24,260.32 |
| Max. Negotiated Rate |
$197,068.95 |
| Rate for Payer: Aetna American Axle |
$142,327.58
|
| Rate for Payer: Aetna Commercial |
$186,120.68
|
| Rate for Payer: Aetna Medicare |
$47,072.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142,327.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,577.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,577.25
|
| Rate for Payer: BCBS Complete |
$25,473.34
|
| Rate for Payer: BCBS MAPPO |
$45,261.80
|
| Rate for Payer: BCBS Trust/PPO |
$122,279.24
|
| Rate for Payer: BCN Commercial |
$122,279.24
|
| Rate for Payer: BCN Medicare Advantage |
$45,261.80
|
| Rate for Payer: Cash Price |
$175,172.40
|
| Rate for Payer: Cash Price |
$175,172.40
|
| Rate for Payer: Cofinity Commercial |
$188,310.33
|
| Rate for Payer: Cofinity Commercial |
$153,275.85
|
| 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 |
$45,261.80
|
| 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 |
$24,260.32
|
| Rate for Payer: Mclaren Medicare |
$45,261.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47,524.89
|
| Rate for Payer: Meridian Medicaid |
$25,473.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52,051.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186,120.68
|
| Rate for Payer: Nomi Health Commercial |
$135,785.40
|
| Rate for Payer: PACE Medicare |
$42,998.71
|
| Rate for Payer: PACE SWMI |
$45,261.80
|
| Rate for Payer: PHP Commercial |
$186,120.68
|
| Rate for Payer: PHP Medicare Advantage |
$45,261.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,260.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142,327.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130,518.73
|
| Rate for Payer: Priority Health Medicare |
$45,261.80
|
| Rate for Payer: Priority Health Narrow Network |
$104,414.98
|
| Rate for Payer: Priority Health SBD |
$137,948.26
|
| Rate for Payer: Railroad Medicare Medicare |
$45,261.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127,407.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$45,261.80
|
| Rate for Payer: UHC Exchange |
$86,499.83
|
| Rate for Payer: UHC Medicare Advantage |
$45,261.80
|
| Rate for Payer: UHCCP Medicaid |
$24,260.32
|
| Rate for Payer: UMR Bronson Commercial |
$81,017.24
|
| Rate for Payer: VA VA |
$45,261.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164,224.12
|
|
|
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 |
$186,120.68
|
| 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 |
$186,120.68
|
| Rate for Payer: PHP Commercial |
$186,120.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142,327.58
|
| Rate for Payer: Priority Health SBD |
$137,948.26
|
| Rate for Payer: UMR Bronson Commercial |
$96,344.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164,224.12
|
|
|
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
|
|
|
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
|
|
|
HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT
|
Facility
|
OP
|
$396.84
|
|
|
Service Code
|
CPT G0463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$396.84 |
| Rate for Payer: Aetna Medicare |
$131.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.82
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: BCBS MAPPO |
$126.26
|
| Rate for Payer: BCBS Trust/PPO |
$333.31
|
| Rate for Payer: BCN Commercial |
$333.31
|
| Rate for Payer: BCN Medicare Advantage |
$126.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.26
|
| Rate for Payer: Mclaren Medicaid |
$67.68
|
| Rate for Payer: Mclaren Medicare |
$126.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.57
|
| Rate for Payer: Meridian Medicaid |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.20
|
| Rate for Payer: Nomi Health Commercial |
$378.78
|
| Rate for Payer: PACE Medicare |
$119.95
|
| Rate for Payer: PACE SWMI |
$126.26
|
| Rate for Payer: PHP Medicare Advantage |
$126.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.84
|
| Rate for Payer: Priority Health Medicare |
$126.26
|
| Rate for Payer: Priority Health Narrow Network |
$317.47
|
| Rate for Payer: Railroad Medicare Medicare |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.26
|
| Rate for Payer: UHC Exchange |
$241.30
|
| Rate for Payer: UHC Medicare Advantage |
$126.26
|
| Rate for Payer: UHCCP Medicaid |
$67.68
|
| Rate for Payer: VA VA |
$126.26
|
|
|
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 |
$800.69 |
| Rate for Payer: Aetna American Axle |
$454.58
|
| Rate for Payer: Aetna Commercial |
$594.46
|
| Rate for Payer: Aetna Medicare |
$349.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.58
|
| Rate for Payer: BCBS Complete |
$279.74
|
| Rate for Payer: BCBS Trust/PPO |
$800.69
|
| Rate for Payer: BCN Commercial |
$800.69
|
| Rate for Payer: Cash Price |
$559.49
|
| 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 HMO/PPO/Tiered Network |
$350.53
|
| Rate for Payer: Priority Health Narrow Network |
$280.42
|
| 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
|
OP
|
$1,015.75
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
173370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$280.42 |
| Max. Negotiated Rate |
$914.18 |
| 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: BCBS Trust/PPO |
$800.69
|
| Rate for Payer: BCN Commercial |
$800.69
|
| Rate for Payer: Cash Price |
$812.60
|
| 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 |
$914.18
|
| 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 HMO/PPO/Tiered Network |
$350.53
|
| Rate for Payer: Priority Health Narrow Network |
$280.42
|
| 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 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 |
$914.18 |
| 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 |
$914.18
|
| 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 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
|
|
