|
IMPACT PEPTIDE/VITAL 1.5 BOLUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
150765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.22
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$59.20
|
|
|
Service Code
|
NDC 70074062720
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$53.28 |
| Rate for Payer: Aetna American Axle |
$38.48
|
| Rate for Payer: Aetna Commercial |
$50.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.48
|
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Cofinity Commercial |
$41.44
|
| Rate for Payer: Cofinity Commercial |
$50.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.36
|
| Rate for Payer: Healthscope Commercial |
$53.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.32
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.48
|
| Rate for Payer: Priority Health SBD |
$37.30
|
| Rate for Payer: UMR Bronson Commercial |
$26.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.40
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$59.20
|
|
|
Service Code
|
NDC 70074062720
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$53.28 |
| Rate for Payer: Aetna American Axle |
$38.48
|
| Rate for Payer: Aetna Commercial |
$50.32
|
| Rate for Payer: Aetna Medicare |
$29.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.48
|
| Rate for Payer: BCBS Complete |
$23.68
|
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Cofinity Commercial |
$41.44
|
| Rate for Payer: Cofinity Commercial |
$50.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.36
|
| Rate for Payer: Healthscope Commercial |
$53.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.32
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.48
|
| Rate for Payer: Priority Health SBD |
$37.30
|
| Rate for Payer: UMR Bronson Commercial |
$21.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.40
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.22
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
168957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.22
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.22
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.22
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.22
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna American Axle |
$43.29
|
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.29
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Commercial |
$46.62
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.29
|
| Rate for Payer: Priority Health SBD |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900097399
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna American Axle |
$10.22
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.22
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.80
|
|
|
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING
|
Facility
|
OP
|
$48,521.05
|
|
|
Service Code
|
CPT 62362
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,239.15 |
| Max. Negotiated Rate |
$48,521.05 |
| Rate for Payer: Aetna Medicare |
$17,926.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,546.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,546.53
|
| Rate for Payer: BCBS Complete |
$9,701.11
|
| Rate for Payer: BCBS MAPPO |
$17,237.22
|
| Rate for Payer: BCN Medicare Advantage |
$17,237.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,237.22
|
| Rate for Payer: Mclaren Medicaid |
$9,239.15
|
| Rate for Payer: Mclaren Medicare |
$17,237.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,099.08
|
| Rate for Payer: Meridian Medicaid |
$9,701.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,822.80
|
| Rate for Payer: PACE Medicare |
$16,375.36
|
| Rate for Payer: PACE SWMI |
$17,237.22
|
| Rate for Payer: PHP Medicare Advantage |
$17,237.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,239.15
|
| Rate for Payer: Priority Health Medicare |
$17,237.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17,237.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48,521.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,237.22
|
| Rate for Payer: UHC Exchange |
$32,942.05
|
| Rate for Payer: UHC Medicare Advantage |
$17,237.22
|
| Rate for Payer: UHCCP Medicaid |
$9,239.15
|
| Rate for Payer: VA VA |
$17,237.22
|
|
|
IMPLANTATION, OSSEOINTEGRATED IMPLANT, SKULL; WITH MAGNETIC TRANSCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR, WITHIN THE MASTOID AND/OR RESULTING IN REMOVAL OF LESS THAN 100 SQ MM SURFACE AREA OF BONE DEEP TO THE OUTER CRANIAL CORTEX
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 69716
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,726.13 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$23,981.92
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
IMPLANTATION, OSSEOINTEGRATED IMPLANT, SKULL; WITH PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 69714
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,726.13 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$23,981.92
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
INCISIONAL BIOPSY OF SKIN (EG, WEDGE) (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$1,680.50
|
|
|
Service Code
|
CPT 11106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$1,140.93
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
INCISION AND DRAINAGE ABSCESS; PERITONSILLAR
|
Facility
|
OP
|
$637.52
|
|
|
Service Code
|
CPT 42700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$637.52 |
| Rate for Payer: Aetna Medicare |
$235.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.10
|
| Rate for Payer: BCBS Complete |
$127.46
|
| Rate for Payer: BCBS MAPPO |
$226.48
|
| Rate for Payer: BCN Medicare Advantage |
$226.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.48
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Mclaren Medicare |
$226.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.80
|
| Rate for Payer: Meridian Medicaid |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.45
|
| Rate for Payer: PACE Medicare |
$215.16
|
| Rate for Payer: PACE SWMI |
$226.48
|
| Rate for Payer: PHP Medicare Advantage |
$226.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Medicare |
$226.48
|
| Rate for Payer: Railroad Medicare Medicare |
$226.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.48
|
| Rate for Payer: UHC Exchange |
$432.83
|
| Rate for Payer: UHC Medicare Advantage |
$226.48
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$226.48
|
|
|
INCISION AND DRAINAGE ABSCESS; PERITONSILLAR
|
Facility
|
OP
|
$637.52
|
|
|
Service Code
|
CPT 42700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$637.52 |
| Rate for Payer: Aetna Medicare |
$235.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.10
|
| Rate for Payer: BCBS Complete |
$127.46
|
| Rate for Payer: BCBS MAPPO |
$226.48
|
| Rate for Payer: BCN Medicare Advantage |
$226.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.48
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Mclaren Medicare |
$226.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.80
|
| Rate for Payer: Meridian Medicaid |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.45
|
| Rate for Payer: PACE Medicare |
$215.16
|
| Rate for Payer: PACE SWMI |
$226.48
|
| Rate for Payer: PHP Medicare Advantage |
$226.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Medicare |
$226.48
|
| Rate for Payer: Railroad Medicare Medicare |
$226.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.48
|
| Rate for Payer: UHC Exchange |
$432.83
|
| Rate for Payer: UHC Medicare Advantage |
$226.48
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$226.48
|
|
|
INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 10180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 10180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 27301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 27301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
