|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$32,376.49
|
|
|
Service Code
|
APR-DRG 0091
|
| Min. Negotiated Rate |
$30,834.76 |
| Max. Negotiated Rate |
$32,376.49 |
| Rate for Payer: BCBS Complete |
$32,376.49
|
| Rate for Payer: Mclaren Medicaid |
$30,834.76
|
| Rate for Payer: Meridian Medicaid |
$32,376.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,834.76
|
| Rate for Payer: UHC Medicaid |
$30,834.76
|
| Rate for Payer: UHCCP Medicaid |
$30,834.76
|
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$70,114.45
|
|
|
Service Code
|
APR-DRG 0093
|
| Min. Negotiated Rate |
$66,775.67 |
| Max. Negotiated Rate |
$70,114.45 |
| Rate for Payer: BCBS Complete |
$70,114.45
|
| Rate for Payer: Mclaren Medicaid |
$66,775.67
|
| Rate for Payer: Meridian Medicaid |
$70,114.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$66,775.67
|
| Rate for Payer: UHC Medicaid |
$66,775.67
|
| Rate for Payer: UHCCP Medicaid |
$66,775.67
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$3,081.42
|
|
|
Service Code
|
APR-DRG 0821
|
| Min. Negotiated Rate |
$2,934.69 |
| Max. Negotiated Rate |
$3,081.42 |
| Rate for Payer: BCBS Complete |
$3,081.42
|
| Rate for Payer: Mclaren Medicaid |
$2,934.69
|
| Rate for Payer: Meridian Medicaid |
$3,081.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,934.69
|
| Rate for Payer: UHC Medicaid |
$2,934.69
|
| Rate for Payer: UHCCP Medicaid |
$2,934.69
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$9,351.54
|
|
|
Service Code
|
APR-DRG 0823
|
| Min. Negotiated Rate |
$8,906.23 |
| Max. Negotiated Rate |
$9,351.54 |
| Rate for Payer: BCBS Complete |
$9,351.54
|
| Rate for Payer: Mclaren Medicaid |
$8,906.23
|
| Rate for Payer: Meridian Medicaid |
$9,351.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,906.23
|
| Rate for Payer: UHC Medicaid |
$8,906.23
|
| Rate for Payer: UHCCP Medicaid |
$8,906.23
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$5,071.20
|
|
|
Service Code
|
APR-DRG 0822
|
| Min. Negotiated Rate |
$4,829.72 |
| Max. Negotiated Rate |
$5,071.20 |
| Rate for Payer: BCBS Complete |
$5,071.20
|
| Rate for Payer: Mclaren Medicaid |
$4,829.72
|
| Rate for Payer: Meridian Medicaid |
$5,071.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,829.72
|
| Rate for Payer: UHC Medicaid |
$4,829.72
|
| Rate for Payer: UHCCP Medicaid |
$4,829.72
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$14,185.06
|
|
|
Service Code
|
APR-DRG 0824
|
| Min. Negotiated Rate |
$13,509.58 |
| Max. Negotiated Rate |
$14,185.06 |
| Rate for Payer: BCBS Complete |
$14,185.06
|
| Rate for Payer: Mclaren Medicaid |
$13,509.58
|
| Rate for Payer: Meridian Medicaid |
$14,185.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,509.58
|
| Rate for Payer: UHC Medicaid |
$13,509.58
|
| Rate for Payer: UHCCP Medicaid |
$13,509.58
|
|
|
EYELASH TINTING
|
Professional
|
Both
|
$32.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$1,190.92
|
|
|
Service Code
|
NDC 66582041431
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$1,071.83 |
| Rate for Payer: Aetna Commercial |
$1,012.28
|
| Rate for Payer: Aetna Medicare |
$309.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.16
|
| Rate for Payer: BCBS Complete |
$220.44
|
| Rate for Payer: BCBS MAPPO |
$297.73
|
| Rate for Payer: BCBS Trust/PPO |
$979.06
|
| Rate for Payer: BCN Commercial |
$979.06
|
| Rate for Payer: BCN Medicare Advantage |
$297.73
|
| Rate for Payer: Cash Price |
$952.74
|
| Rate for Payer: Cofinity Commercial |
$1,024.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$952.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.73
|
| Rate for Payer: Healthscope Commercial |
$1,071.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$893.19
|
| Rate for Payer: Mclaren Medicaid |
$209.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.62
|
| Rate for Payer: Meridian Medicaid |
$220.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$327.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.28
|
| Rate for Payer: Nomi Health Commercial |
$976.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.19
|
| Rate for Payer: PACE Senior Care Partners |
$282.84
|
| Rate for Payer: PACE SWMI |
$297.73
|
| Rate for Payer: PHP Commercial |
$1,012.28
|
| Rate for Payer: PHP Medicare Advantage |
$297.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,036.10
|
| Rate for Payer: Priority Health Medicare |
$300.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$828.88
|
| Rate for Payer: Railroad Medicare Medicare |
$297.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,048.01
|
| Rate for Payer: UHC Core |
$994.42
|
| Rate for Payer: UHC Exchange |
$297.73
|
| Rate for Payer: UHC Medicaid |
$209.96
|
| Rate for Payer: UHC Medicare Advantage |
$297.73
|
| Rate for Payer: UHCCP Medicaid |
$209.96
|
| Rate for Payer: VA VA |
$297.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$893.19
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$81.80
|
|
|
Service Code
|
NDC 67877049030
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Aetna Commercial |
$69.53
|
| Rate for Payer: Aetna Medicare |
$21.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.56
|
| Rate for Payer: BCBS Complete |
$15.14
|
| Rate for Payer: BCBS MAPPO |
$20.45
|
| Rate for Payer: BCBS Trust/PPO |
$67.25
|
| Rate for Payer: BCN Commercial |
$67.25
|
| Rate for Payer: BCN Medicare Advantage |
$20.45
|
| Rate for Payer: Cash Price |
$65.44
|
| Rate for Payer: Cofinity Commercial |
$70.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.45
|
| Rate for Payer: Healthscope Commercial |
$73.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.35
|
| Rate for Payer: Mclaren Medicaid |
$14.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.47
|
| Rate for Payer: Meridian Medicaid |
$15.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.53
|
| Rate for Payer: Nomi Health Commercial |
$67.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.35
|
| Rate for Payer: PACE Senior Care Partners |
$19.43
|
| Rate for Payer: PACE SWMI |
$20.45
|
| Rate for Payer: PHP Commercial |
$69.53
|
| Rate for Payer: PHP Medicare Advantage |
$20.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.17
|
| Rate for Payer: Priority Health Medicare |
$20.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.93
|
| Rate for Payer: Railroad Medicare Medicare |
$20.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.98
|
| Rate for Payer: UHC Core |
$68.30
|
| Rate for Payer: UHC Exchange |
$20.45
|
| Rate for Payer: UHC Medicaid |
$14.42
|
| Rate for Payer: UHC Medicare Advantage |
$20.45
|
| Rate for Payer: UHCCP Medicaid |
$14.42
|
| Rate for Payer: VA VA |
$20.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.35
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$76.95
|
|
|
Service Code
|
NDC 00781569031
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$69.25 |
| Rate for Payer: Aetna Commercial |
$65.41
|
| Rate for Payer: Aetna Medicare |
$20.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.05
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS MAPPO |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$63.26
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: BCN Medicare Advantage |
$19.24
|
| Rate for Payer: Cash Price |
$61.56
|
| Rate for Payer: Cofinity Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$69.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.71
|
| Rate for Payer: Mclaren Medicaid |
$13.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.20
|
| Rate for Payer: Meridian Medicaid |
$14.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.41
|
| Rate for Payer: Nomi Health Commercial |
$63.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.71
|
| Rate for Payer: PACE Senior Care Partners |
$18.28
|
| Rate for Payer: PACE SWMI |
$19.24
|
| Rate for Payer: PHP Commercial |
$65.41
|
| Rate for Payer: PHP Medicare Advantage |
$19.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$19.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.56
|
| Rate for Payer: Railroad Medicare Medicare |
$19.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.72
|
| Rate for Payer: UHC Core |
$64.25
|
| Rate for Payer: UHC Exchange |
$19.24
|
| Rate for Payer: UHC Medicaid |
$13.57
|
| Rate for Payer: UHC Medicare Advantage |
$19.24
|
| Rate for Payer: UHCCP Medicaid |
$13.57
|
| Rate for Payer: VA VA |
$19.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.71
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$727.61
|
|
|
Service Code
|
NDC 00904710304
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.42 |
| Max. Negotiated Rate |
$654.85 |
| Rate for Payer: Aetna Commercial |
$618.47
|
| Rate for Payer: BCBS Trust/PPO |
$600.93
|
| Rate for Payer: BCN Commercial |
$600.93
|
| Rate for Payer: Cash Price |
$582.09
|
| Rate for Payer: Cofinity Commercial |
$625.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.09
|
| Rate for Payer: Healthscope Commercial |
$654.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$545.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.47
|
| Rate for Payer: Nomi Health Commercial |
$596.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$545.71
|
| Rate for Payer: PHP Commercial |
$618.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$633.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$506.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.30
|
| Rate for Payer: UHC Core |
$607.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$545.71
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$1,190.92
|
|
|
Service Code
|
NDC 66582041431
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$828.88 |
| Max. Negotiated Rate |
$1,071.83 |
| Rate for Payer: Aetna Commercial |
$1,012.28
|
| Rate for Payer: BCBS Trust/PPO |
$983.58
|
| Rate for Payer: BCN Commercial |
$983.58
|
| Rate for Payer: Cash Price |
$952.74
|
| Rate for Payer: Cofinity Commercial |
$1,024.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$952.74
|
| Rate for Payer: Healthscope Commercial |
$1,071.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$893.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.28
|
| Rate for Payer: Nomi Health Commercial |
$976.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.19
|
| Rate for Payer: PHP Commercial |
$1,012.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,036.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$828.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,048.01
|
| Rate for Payer: UHC Core |
$994.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$893.19
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$76.95
|
|
|
Service Code
|
NDC 00781569031
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$69.25 |
| Rate for Payer: Aetna Commercial |
$65.41
|
| Rate for Payer: BCBS Trust/PPO |
$63.55
|
| Rate for Payer: BCN Commercial |
$63.55
|
| Rate for Payer: Cash Price |
$61.56
|
| Rate for Payer: Cofinity Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.56
|
| Rate for Payer: Healthscope Commercial |
$69.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.41
|
| Rate for Payer: Nomi Health Commercial |
$63.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.71
|
| Rate for Payer: PHP Commercial |
$65.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.72
|
| Rate for Payer: UHC Core |
$64.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.71
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$727.61
|
|
|
Service Code
|
NDC 00904710304
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.28 |
| Max. Negotiated Rate |
$654.85 |
| Rate for Payer: Aetna Commercial |
$618.47
|
| Rate for Payer: Aetna Medicare |
$189.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$227.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$227.38
|
| Rate for Payer: BCBS Complete |
$134.68
|
| Rate for Payer: BCBS MAPPO |
$181.90
|
| Rate for Payer: BCBS Trust/PPO |
$598.17
|
| Rate for Payer: BCN Commercial |
$598.17
|
| Rate for Payer: BCN Medicare Advantage |
$181.90
|
| Rate for Payer: Cash Price |
$582.09
|
| Rate for Payer: Cofinity Commercial |
$625.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.90
|
| Rate for Payer: Healthscope Commercial |
$654.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$545.71
|
| Rate for Payer: Mclaren Medicaid |
$128.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.00
|
| Rate for Payer: Meridian Medicaid |
$134.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.47
|
| Rate for Payer: Nomi Health Commercial |
$596.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$545.71
|
| Rate for Payer: PACE Senior Care Partners |
$172.81
|
| Rate for Payer: PACE SWMI |
$181.90
|
| Rate for Payer: PHP Commercial |
$618.47
|
| Rate for Payer: PHP Medicare Advantage |
$181.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$633.02
|
| Rate for Payer: Priority Health Medicare |
$183.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$506.42
|
| Rate for Payer: Railroad Medicare Medicare |
$181.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.30
|
| Rate for Payer: UHC Core |
$607.55
|
| Rate for Payer: UHC Exchange |
$181.90
|
| Rate for Payer: UHC Medicaid |
$128.28
|
| Rate for Payer: UHC Medicare Advantage |
$181.90
|
| Rate for Payer: UHCCP Medicaid |
$128.28
|
| Rate for Payer: VA VA |
$181.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$545.71
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$81.80
|
|
|
Service Code
|
NDC 67877049030
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Aetna Commercial |
$69.53
|
| Rate for Payer: BCBS Trust/PPO |
$67.56
|
| Rate for Payer: BCN Commercial |
$67.56
|
| Rate for Payer: Cash Price |
$65.44
|
| Rate for Payer: Cofinity Commercial |
$70.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.44
|
| Rate for Payer: Healthscope Commercial |
$73.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.53
|
| Rate for Payer: Nomi Health Commercial |
$67.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.35
|
| Rate for Payer: PHP Commercial |
$69.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.98
|
| Rate for Payer: UHC Core |
$68.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.35
|
|
|
FACIAL
|
Professional
|
Both
|
$68.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$20,619.24
|
|
|
Service Code
|
APR-DRG 0923
|
| Min. Negotiated Rate |
$19,637.37 |
| Max. Negotiated Rate |
$20,619.24 |
| Rate for Payer: BCBS Complete |
$20,619.24
|
| Rate for Payer: Mclaren Medicaid |
$19,637.37
|
| Rate for Payer: Meridian Medicaid |
$20,619.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,637.37
|
| Rate for Payer: UHC Medicaid |
$19,637.37
|
| Rate for Payer: UHCCP Medicaid |
$19,637.37
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$10,279.65
|
|
|
Service Code
|
APR-DRG 0921
|
| Min. Negotiated Rate |
$9,790.14 |
| Max. Negotiated Rate |
$10,279.65 |
| Rate for Payer: BCBS Complete |
$10,279.65
|
| Rate for Payer: Mclaren Medicaid |
$9,790.14
|
| Rate for Payer: Meridian Medicaid |
$10,279.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,790.14
|
| Rate for Payer: UHC Medicaid |
$9,790.14
|
| Rate for Payer: UHCCP Medicaid |
$9,790.14
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$32,665.71
|
|
|
Service Code
|
APR-DRG 0924
|
| Min. Negotiated Rate |
$31,110.20 |
| Max. Negotiated Rate |
$32,665.71 |
| Rate for Payer: BCBS Complete |
$32,665.71
|
| Rate for Payer: Mclaren Medicaid |
$31,110.20
|
| Rate for Payer: Meridian Medicaid |
$32,665.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,110.20
|
| Rate for Payer: UHC Medicaid |
$31,110.20
|
| Rate for Payer: UHCCP Medicaid |
$31,110.20
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$11,564.27
|
|
|
Service Code
|
APR-DRG 0922
|
| Min. Negotiated Rate |
$11,013.59 |
| Max. Negotiated Rate |
$11,564.27 |
| Rate for Payer: BCBS Complete |
$11,564.27
|
| Rate for Payer: Mclaren Medicaid |
$11,013.59
|
| Rate for Payer: Meridian Medicaid |
$11,564.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,013.59
|
| Rate for Payer: UHC Medicaid |
$11,013.59
|
| Rate for Payer: UHCCP Medicaid |
$11,013.59
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37.40
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.03 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: BCBS Trust/PPO |
$30.89
|
| Rate for Payer: BCN Commercial |
$30.89
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Nomi Health Commercial |
$30.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.05
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.91
|
| Rate for Payer: UHC Core |
$31.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37.40
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.69
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$30.75
|
| Rate for Payer: BCN Commercial |
$30.75
|
| Rate for Payer: BCN Medicare Advantage |
$9.35
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.35
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.82
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Nomi Health Commercial |
$30.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.05
|
| Rate for Payer: PACE Senior Care Partners |
$8.88
|
| Rate for Payer: PACE SWMI |
$9.35
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: PHP Medicare Advantage |
$9.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.54
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.03
|
| Rate for Payer: Railroad Medicare Medicare |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.91
|
| Rate for Payer: UHC Core |
$31.23
|
| Rate for Payer: UHC Exchange |
$9.35
|
| Rate for Payer: UHC Medicaid |
$6.59
|
| Rate for Payer: UHC Medicare Advantage |
$9.35
|
| Rate for Payer: UHCCP Medicaid |
$6.59
|
| Rate for Payer: VA VA |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$37.40
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.03 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: BCBS Trust/PPO |
$30.89
|
| Rate for Payer: BCN Commercial |
$30.89
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Nomi Health Commercial |
$30.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.05
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.91
|
| Rate for Payer: UHC Core |
$31.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$37.40
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.69
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$30.75
|
| Rate for Payer: BCN Commercial |
$30.75
|
| Rate for Payer: BCN Medicare Advantage |
$9.35
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.35
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.82
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Nomi Health Commercial |
$30.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.05
|
| Rate for Payer: PACE Senior Care Partners |
$8.88
|
| Rate for Payer: PACE SWMI |
$9.35
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: PHP Medicare Advantage |
$9.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.54
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.03
|
| Rate for Payer: Railroad Medicare Medicare |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.91
|
| Rate for Payer: UHC Core |
$31.23
|
| Rate for Payer: UHC Exchange |
$9.35
|
| Rate for Payer: UHC Medicaid |
$6.59
|
| Rate for Payer: UHC Medicare Advantage |
$9.35
|
| Rate for Payer: UHCCP Medicaid |
$6.59
|
| Rate for Payer: VA VA |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 51079096620
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$38.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.27
|
| Rate for Payer: BCBS Complete |
$27.40
|
| Rate for Payer: BCBS MAPPO |
$37.01
|
| Rate for Payer: BCBS Trust/PPO |
$121.71
|
| Rate for Payer: BCN Commercial |
$121.71
|
| Rate for Payer: BCN Medicare Advantage |
$37.01
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.01
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Mclaren Medicaid |
$26.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.86
|
| Rate for Payer: Meridian Medicaid |
$27.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PACE Senior Care Partners |
$35.16
|
| Rate for Payer: PACE SWMI |
$37.01
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: PHP Medicare Advantage |
$37.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.80
|
| Rate for Payer: Priority Health Medicare |
$37.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.04
|
| Rate for Payer: Railroad Medicare Medicare |
$37.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.28
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicaid |
$26.10
|
| Rate for Payer: UHC Medicare Advantage |
$37.01
|
| Rate for Payer: UHCCP Medicaid |
$26.10
|
| Rate for Payer: VA VA |
$37.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
