|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
NDC 65219053550
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: BCBS Trust/PPO |
$35.51
|
| Rate for Payer: BCN Commercial |
$35.51
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.25
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
NDC 65219053501
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.44
|
| Rate for Payer: BCBS Complete |
$7.96
|
| Rate for Payer: BCBS MAPPO |
$10.75
|
| Rate for Payer: BCBS Trust/PPO |
$35.35
|
| Rate for Payer: BCN Commercial |
$35.35
|
| Rate for Payer: BCN Medicare Advantage |
$10.75
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Mclaren Medicaid |
$7.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.29
|
| Rate for Payer: Meridian Medicaid |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.25
|
| Rate for Payer: PACE Senior Care Partners |
$10.21
|
| Rate for Payer: PACE SWMI |
$10.75
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: PHP Medicare Advantage |
$10.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.41
|
| Rate for Payer: Priority Health Medicare |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.93
|
| Rate for Payer: Railroad Medicare Medicare |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.91
|
| Rate for Payer: UHC Exchange |
$10.75
|
| Rate for Payer: UHC Medicaid |
$7.58
|
| Rate for Payer: UHC Medicare Advantage |
$10.75
|
| Rate for Payer: UHCCP Medicaid |
$7.58
|
| Rate for Payer: VA VA |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
NDC 00338954007
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$3.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.22
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$3.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCN Commercial |
$11.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.38
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Mclaren Medicaid |
$2.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.54
|
| Rate for Payer: Meridian Medicaid |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Nomi Health Commercial |
$11.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PACE Senior Care Partners |
$3.21
|
| Rate for Payer: PACE SWMI |
$3.38
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: PHP Medicare Advantage |
$3.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.74
|
| Rate for Payer: Priority Health Medicare |
$3.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.88
|
| Rate for Payer: UHC Core |
$11.27
|
| Rate for Payer: UHC Exchange |
$3.38
|
| Rate for Payer: UHC Medicaid |
$2.38
|
| Rate for Payer: UHC Medicare Advantage |
$3.38
|
| Rate for Payer: UHCCP Medicaid |
$2.38
|
| Rate for Payer: VA VA |
$3.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 00338954007
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Nomi Health Commercial |
$11.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.88
|
| Rate for Payer: UHC Core |
$11.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.50
|
| Rate for Payer: BCBS Complete |
$4.44
|
| Rate for Payer: BCBS MAPPO |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.00
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Mclaren Medicaid |
$4.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.30
|
| Rate for Payer: Meridian Medicaid |
$4.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PACE Senior Care Partners |
$5.70
|
| Rate for Payer: PACE SWMI |
$6.00
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.88
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.70
|
| Rate for Payer: Railroad Medicare Medicare |
$6.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.12
|
| Rate for Payer: UHC Core |
$20.04
|
| Rate for Payer: UHC Exchange |
$6.00
|
| Rate for Payer: UHC Medicaid |
$4.23
|
| Rate for Payer: UHC Medicare Advantage |
$6.00
|
| Rate for Payer: UHCCP Medicaid |
$4.23
|
| Rate for Payer: VA VA |
$6.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.82
|
| Rate for Payer: BCN Commercial |
$19.82
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.12
|
| Rate for Payer: UHC Core |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
OP
|
$1,135.65
|
|
|
Service Code
|
NDC 64764091830
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.22 |
| Max. Negotiated Rate |
$1,022.09 |
| Rate for Payer: Aetna Commercial |
$965.30
|
| Rate for Payer: Aetna Medicare |
$295.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$354.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$354.89
|
| Rate for Payer: BCBS Complete |
$210.21
|
| Rate for Payer: BCBS MAPPO |
$283.91
|
| Rate for Payer: BCBS Trust/PPO |
$933.62
|
| Rate for Payer: BCN Commercial |
$933.62
|
| Rate for Payer: BCN Medicare Advantage |
$283.91
|
| Rate for Payer: Cash Price |
$908.52
|
| Rate for Payer: Cofinity Commercial |
$976.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.91
|
| Rate for Payer: Healthscope Commercial |
$1,022.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.74
|
| Rate for Payer: Mclaren Medicaid |
$200.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.11
|
| Rate for Payer: Meridian Medicaid |
$210.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$312.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.30
|
| Rate for Payer: Nomi Health Commercial |
$931.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.74
|
| Rate for Payer: PACE Senior Care Partners |
$269.72
|
| Rate for Payer: PACE SWMI |
$283.91
|
| Rate for Payer: PHP Commercial |
$965.30
|
| Rate for Payer: PHP Medicare Advantage |
$283.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$988.02
|
| Rate for Payer: Priority Health Medicare |
$286.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$790.41
|
| Rate for Payer: Railroad Medicare Medicare |
$283.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$999.37
|
| Rate for Payer: UHC Core |
$948.27
|
| Rate for Payer: UHC Exchange |
$283.91
|
| Rate for Payer: UHC Medicaid |
$200.22
|
| Rate for Payer: UHC Medicare Advantage |
$283.91
|
| Rate for Payer: UHCCP Medicaid |
$200.22
|
| Rate for Payer: VA VA |
$283.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.74
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
IP
|
$1,135.65
|
|
|
Service Code
|
NDC 64764091830
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$790.41 |
| Max. Negotiated Rate |
$1,022.09 |
| Rate for Payer: Aetna Commercial |
$965.30
|
| Rate for Payer: BCBS Trust/PPO |
$937.93
|
| Rate for Payer: BCN Commercial |
$937.93
|
| Rate for Payer: Cash Price |
$908.52
|
| Rate for Payer: Cofinity Commercial |
$976.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.52
|
| Rate for Payer: Healthscope Commercial |
$1,022.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.30
|
| Rate for Payer: Nomi Health Commercial |
$931.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.74
|
| Rate for Payer: PHP Commercial |
$965.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$988.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$790.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$999.37
|
| Rate for Payer: UHC Core |
$948.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.74
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$3,852.30
|
|
|
Service Code
|
APR-DRG 5312
|
| Min. Negotiated Rate |
$3,668.86 |
| Max. Negotiated Rate |
$3,852.30 |
| Rate for Payer: BCBS Complete |
$3,852.30
|
| Rate for Payer: Mclaren Medicaid |
$3,668.86
|
| Rate for Payer: Meridian Medicaid |
$3,852.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,668.86
|
| Rate for Payer: UHC Medicaid |
$3,668.86
|
| Rate for Payer: UHCCP Medicaid |
$3,668.86
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$2,846.90
|
|
|
Service Code
|
APR-DRG 5311
|
| Min. Negotiated Rate |
$2,711.33 |
| Max. Negotiated Rate |
$2,846.90 |
| Rate for Payer: BCBS Complete |
$2,846.90
|
| Rate for Payer: Mclaren Medicaid |
$2,711.33
|
| Rate for Payer: Meridian Medicaid |
$2,846.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,711.33
|
| Rate for Payer: UHC Medicaid |
$2,711.33
|
| Rate for Payer: UHCCP Medicaid |
$2,711.33
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$5,176.37
|
|
|
Service Code
|
APR-DRG 5313
|
| Min. Negotiated Rate |
$4,929.88 |
| Max. Negotiated Rate |
$5,176.37 |
| Rate for Payer: BCBS Complete |
$5,176.37
|
| Rate for Payer: Mclaren Medicaid |
$4,929.88
|
| Rate for Payer: Meridian Medicaid |
$5,176.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,929.88
|
| Rate for Payer: UHC Medicaid |
$4,929.88
|
| Rate for Payer: UHCCP Medicaid |
$4,929.88
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$8,137.90
|
|
|
Service Code
|
APR-DRG 5314
|
| Min. Negotiated Rate |
$7,750.38 |
| Max. Negotiated Rate |
$8,137.90 |
| Rate for Payer: BCBS Complete |
$8,137.90
|
| Rate for Payer: Mclaren Medicaid |
$7,750.38
|
| Rate for Payer: Meridian Medicaid |
$8,137.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,750.38
|
| Rate for Payer: UHC Medicaid |
$7,750.38
|
| Rate for Payer: UHCCP Medicaid |
$7,750.38
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$5,592.31
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$5,326.01 |
| Max. Negotiated Rate |
$5,592.31 |
| Rate for Payer: BCBS Complete |
$5,592.31
|
| Rate for Payer: Mclaren Medicaid |
$5,326.01
|
| Rate for Payer: Meridian Medicaid |
$5,592.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,326.01
|
| Rate for Payer: UHC Medicaid |
$5,326.01
|
| Rate for Payer: UHCCP Medicaid |
$5,326.01
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$7,440.64
|
|
|
Service Code
|
APR-DRG 5303
|
| Min. Negotiated Rate |
$7,086.32 |
| Max. Negotiated Rate |
$7,440.64 |
| Rate for Payer: BCBS Complete |
$7,440.64
|
| Rate for Payer: Mclaren Medicaid |
$7,086.32
|
| Rate for Payer: Meridian Medicaid |
$7,440.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,086.32
|
| Rate for Payer: UHC Medicaid |
$7,086.32
|
| Rate for Payer: UHCCP Medicaid |
$7,086.32
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$4,285.60
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$4,081.52 |
| Max. Negotiated Rate |
$4,285.60 |
| Rate for Payer: BCBS Complete |
$4,285.60
|
| Rate for Payer: Mclaren Medicaid |
$4,081.52
|
| Rate for Payer: Meridian Medicaid |
$4,285.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,081.52
|
| Rate for Payer: UHC Medicaid |
$4,081.52
|
| Rate for Payer: UHCCP Medicaid |
$4,081.52
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$12,923.04
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$12,307.66 |
| Max. Negotiated Rate |
$12,923.04 |
| Rate for Payer: BCBS Complete |
$12,923.04
|
| Rate for Payer: Mclaren Medicaid |
$12,307.66
|
| Rate for Payer: Meridian Medicaid |
$12,923.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,307.66
|
| Rate for Payer: UHC Medicaid |
$12,307.66
|
| Rate for Payer: UHCCP Medicaid |
$12,307.66
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$13,114.98
|
|
|
Service Code
|
APR-DRG 5143
|
| Min. Negotiated Rate |
$12,490.45 |
| Max. Negotiated Rate |
$13,114.98 |
| Rate for Payer: BCBS Complete |
$13,114.98
|
| Rate for Payer: Mclaren Medicaid |
$12,490.45
|
| Rate for Payer: Meridian Medicaid |
$13,114.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,490.45
|
| Rate for Payer: UHC Medicaid |
$12,490.45
|
| Rate for Payer: UHCCP Medicaid |
$12,490.45
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$27,509.32
|
|
|
Service Code
|
APR-DRG 5144
|
| Min. Negotiated Rate |
$26,199.35 |
| Max. Negotiated Rate |
$27,509.32 |
| Rate for Payer: BCBS Complete |
$27,509.32
|
| Rate for Payer: Mclaren Medicaid |
$26,199.35
|
| Rate for Payer: Meridian Medicaid |
$27,509.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,199.35
|
| Rate for Payer: UHC Medicaid |
$26,199.35
|
| Rate for Payer: UHCCP Medicaid |
$26,199.35
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$7,242.39
|
|
|
Service Code
|
APR-DRG 5141
|
| Min. Negotiated Rate |
$6,897.52 |
| Max. Negotiated Rate |
$7,242.39 |
| Rate for Payer: BCBS Complete |
$7,242.39
|
| Rate for Payer: Mclaren Medicaid |
$6,897.52
|
| Rate for Payer: Meridian Medicaid |
$7,242.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,897.52
|
| Rate for Payer: UHC Medicaid |
$6,897.52
|
| Rate for Payer: UHCCP Medicaid |
$6,897.52
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$11,071.56
|
|
|
Service Code
|
APR-DRG 5142
|
| Min. Negotiated Rate |
$10,544.34 |
| Max. Negotiated Rate |
$11,071.56 |
| Rate for Payer: BCBS Complete |
$11,071.56
|
| Rate for Payer: Mclaren Medicaid |
$10,544.34
|
| Rate for Payer: Meridian Medicaid |
$11,071.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,544.34
|
| Rate for Payer: UHC Medicaid |
$10,544.34
|
| Rate for Payer: UHCCP Medicaid |
$10,544.34
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$8.81
|
|
|
Service Code
|
NDC 60687062911
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$7.93 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$7.28
|
| Rate for Payer: BCN Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cofinity Commercial |
$7.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.05
|
| Rate for Payer: Healthscope Commercial |
$7.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.49
|
| Rate for Payer: Nomi Health Commercial |
$7.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.61
|
| Rate for Payer: PHP Commercial |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.75
|
| Rate for Payer: UHC Core |
$7.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.61
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$8.81
|
|
|
Service Code
|
NDC 60687062911
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$7.93 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.75
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS MAPPO |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$7.24
|
| Rate for Payer: BCN Commercial |
$7.24
|
| Rate for Payer: BCN Medicare Advantage |
$2.20
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cofinity Commercial |
$7.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$7.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.61
|
| Rate for Payer: Mclaren Medicaid |
$1.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.31
|
| Rate for Payer: Meridian Medicaid |
$1.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.49
|
| Rate for Payer: Nomi Health Commercial |
$7.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.61
|
| Rate for Payer: PACE Senior Care Partners |
$2.09
|
| Rate for Payer: PACE SWMI |
$2.20
|
| Rate for Payer: PHP Commercial |
$7.49
|
| Rate for Payer: PHP Medicare Advantage |
$2.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.66
|
| Rate for Payer: Priority Health Medicare |
$2.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.75
|
| Rate for Payer: UHC Core |
$7.36
|
| Rate for Payer: UHC Exchange |
$2.20
|
| Rate for Payer: UHC Medicaid |
$1.55
|
| Rate for Payer: UHC Medicare Advantage |
$2.20
|
| Rate for Payer: UHCCP Medicaid |
$1.55
|
| Rate for Payer: VA VA |
$2.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.61
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$159.99
|
|
|
Service Code
|
NDC 00904716104
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$143.99 |
| Rate for Payer: Aetna Commercial |
$135.99
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$29.61
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.53
|
| Rate for Payer: BCN Commercial |
$131.53
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$127.99
|
| Rate for Payer: Cofinity Commercial |
$137.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$143.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.99
|
| Rate for Payer: Mclaren Medicaid |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: Meridian Medicaid |
$29.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.99
|
| Rate for Payer: Nomi Health Commercial |
$131.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.99
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$135.99
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.19
|
| Rate for Payer: Priority Health Medicare |
$40.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.35
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.79
|
| Rate for Payer: UHC Core |
$133.59
|
| Rate for Payer: UHC Exchange |
$40.00
|
| Rate for Payer: UHC Medicaid |
$28.21
|
| Rate for Payer: UHC Medicare Advantage |
$40.00
|
| Rate for Payer: UHCCP Medicaid |
$28.21
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.99
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$207.36
|
|
|
Service Code
|
NDC 00904748004
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$186.62 |
| Rate for Payer: Aetna Commercial |
$176.26
|
| Rate for Payer: BCBS Trust/PPO |
$171.26
|
| Rate for Payer: BCN Commercial |
$171.26
|
| Rate for Payer: Cash Price |
$165.89
|
| Rate for Payer: Cofinity Commercial |
$178.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.89
|
| Rate for Payer: Healthscope Commercial |
$186.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.26
|
| Rate for Payer: Nomi Health Commercial |
$170.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.52
|
| Rate for Payer: PHP Commercial |
$176.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.48
|
| Rate for Payer: UHC Core |
$173.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.52
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$228.10
|
|
|
Service Code
|
NDC 60687062921
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.21 |
| Max. Negotiated Rate |
$205.29 |
| Rate for Payer: Aetna Commercial |
$193.88
|
| Rate for Payer: Aetna Medicare |
$59.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.28
|
| Rate for Payer: BCBS Complete |
$42.22
|
| Rate for Payer: BCBS MAPPO |
$57.02
|
| Rate for Payer: BCBS Trust/PPO |
$187.52
|
| Rate for Payer: BCN Commercial |
$187.52
|
| Rate for Payer: BCN Medicare Advantage |
$57.02
|
| Rate for Payer: Cash Price |
$182.48
|
| Rate for Payer: Cofinity Commercial |
$196.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.02
|
| Rate for Payer: Healthscope Commercial |
$205.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.07
|
| Rate for Payer: Mclaren Medicaid |
$40.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.88
|
| Rate for Payer: Meridian Medicaid |
$42.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.88
|
| Rate for Payer: Nomi Health Commercial |
$187.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.07
|
| Rate for Payer: PACE Senior Care Partners |
$54.17
|
| Rate for Payer: PACE SWMI |
$57.02
|
| Rate for Payer: PHP Commercial |
$193.88
|
| Rate for Payer: PHP Medicare Advantage |
$57.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.45
|
| Rate for Payer: Priority Health Medicare |
$57.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.76
|
| Rate for Payer: Railroad Medicare Medicare |
$57.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.73
|
| Rate for Payer: UHC Core |
$190.46
|
| Rate for Payer: UHC Exchange |
$57.02
|
| Rate for Payer: UHC Medicaid |
$40.21
|
| Rate for Payer: UHC Medicare Advantage |
$57.02
|
| Rate for Payer: UHCCP Medicaid |
$40.21
|
| Rate for Payer: VA VA |
$57.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.07
|
|
