|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$81.78
|
|
|
Service Code
|
NDC 16729003510
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.16 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: BCBS Trust/PPO |
$66.76
|
| Rate for Payer: BCN Commercial |
$63.20
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.51
|
| Rate for Payer: Nomi Health Commercial |
$67.06
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.16
|
| Rate for Payer: Priority Health HMO/PPO |
$71.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.97
|
| Rate for Payer: UHC Core |
$68.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
OP
|
$81.78
|
|
|
Service Code
|
NDC 16729003510
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna Medicare |
$21.26
|
| 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 |
$32.71
|
| Rate for Payer: BCBS MAPPO |
$20.44
|
| Rate for Payer: BCBS Trust/PPO |
$67.23
|
| Rate for Payer: BCN Commercial |
$63.58
|
| Rate for Payer: BCN Medicare Advantage |
$20.44
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.44
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.51
|
| Rate for Payer: Nomi Health Commercial |
$67.06
|
| Rate for Payer: PACE Senior Care Partners |
$19.42
|
| Rate for Payer: PACE SWMI |
$20.44
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: PHP Medicare Advantage |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.16
|
| Rate for Payer: Priority Health HMO/PPO |
$71.15
|
| Rate for Payer: Priority Health Medicare |
$20.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.79
|
| Rate for Payer: Railroad Medicare Medicare |
$20.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.97
|
| Rate for Payer: UHC Core |
$68.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.44
|
| Rate for Payer: UHC Exchange |
$20.44
|
| Rate for Payer: UHC Medicare Advantage |
$20.44
|
| Rate for Payer: VA VA |
$20.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
NDC 60687011211
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Nomi Health Commercial |
$3.32
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.63
|
| Rate for Payer: Priority Health HMO/PPO |
$3.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 60687011211
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: BCBS MAPPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$3.33
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.01
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.01
|
| Rate for Payer: Healthscope Commercial |
$3.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Nomi Health Commercial |
$3.32
|
| Rate for Payer: PACE Senior Care Partners |
$0.96
|
| Rate for Payer: PACE SWMI |
$1.01
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: PHP Medicare Advantage |
$1.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.63
|
| Rate for Payer: Priority Health HMO/PPO |
$3.52
|
| Rate for Payer: Priority Health Medicare |
$1.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.01
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: VA VA |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
OP
|
$121.25
|
|
|
Service Code
|
NDC 60687011221
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$109.12 |
| Rate for Payer: Aetna Commercial |
$103.06
|
| Rate for Payer: Aetna Medicare |
$31.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.89
|
| Rate for Payer: BCBS Complete |
$48.50
|
| Rate for Payer: BCBS MAPPO |
$30.31
|
| Rate for Payer: BCBS Trust/PPO |
$99.68
|
| Rate for Payer: BCN Commercial |
$94.27
|
| Rate for Payer: BCN Medicare Advantage |
$30.31
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cofinity Commercial |
$104.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.31
|
| Rate for Payer: Healthscope Commercial |
$109.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.06
|
| Rate for Payer: Nomi Health Commercial |
$99.42
|
| Rate for Payer: PACE Senior Care Partners |
$28.80
|
| Rate for Payer: PACE SWMI |
$30.31
|
| Rate for Payer: PHP Commercial |
$103.06
|
| Rate for Payer: PHP Medicare Advantage |
$30.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.81
|
| Rate for Payer: Priority Health HMO/PPO |
$105.49
|
| Rate for Payer: Priority Health Medicare |
$30.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.24
|
| Rate for Payer: Railroad Medicare Medicare |
$30.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.70
|
| Rate for Payer: UHC Core |
$101.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.31
|
| Rate for Payer: UHC Exchange |
$30.31
|
| Rate for Payer: UHC Medicare Advantage |
$30.31
|
| Rate for Payer: VA VA |
$30.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.94
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$121.25
|
|
|
Service Code
|
NDC 60687011221
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$109.12 |
| Rate for Payer: Aetna Commercial |
$103.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.98
|
| Rate for Payer: BCN Commercial |
$93.70
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cofinity Commercial |
$104.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.00
|
| Rate for Payer: Healthscope Commercial |
$109.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.06
|
| Rate for Payer: Nomi Health Commercial |
$99.42
|
| Rate for Payer: PHP Commercial |
$103.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.81
|
| Rate for Payer: Priority Health HMO/PPO |
$105.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.70
|
| Rate for Payer: UHC Core |
$101.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.94
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$140.31
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
88093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$126.28 |
| Rate for Payer: Aetna Commercial |
$119.26
|
| Rate for Payer: BCBS Trust/PPO |
$114.54
|
| Rate for Payer: BCN Commercial |
$108.43
|
| Rate for Payer: Cash Price |
$112.25
|
| Rate for Payer: Cofinity Commercial |
$120.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.25
|
| Rate for Payer: Healthscope Commercial |
$126.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.26
|
| Rate for Payer: Nomi Health Commercial |
$115.05
|
| Rate for Payer: PHP Commercial |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.20
|
| Rate for Payer: Priority Health HMO/PPO |
$122.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.47
|
| Rate for Payer: UHC Core |
$117.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.23
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$140.31
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
88093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$126.28 |
| Rate for Payer: Aetna Commercial |
$119.26
|
| Rate for Payer: Aetna Medicare |
$36.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.85
|
| Rate for Payer: BCBS Complete |
$56.12
|
| Rate for Payer: BCBS MAPPO |
$35.08
|
| Rate for Payer: BCBS Trust/PPO |
$115.35
|
| Rate for Payer: BCN Commercial |
$109.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.08
|
| Rate for Payer: Cash Price |
$112.25
|
| Rate for Payer: Cofinity Commercial |
$120.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.08
|
| Rate for Payer: Healthscope Commercial |
$126.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.26
|
| Rate for Payer: Nomi Health Commercial |
$115.05
|
| Rate for Payer: PACE Senior Care Partners |
$33.32
|
| Rate for Payer: PACE SWMI |
$35.08
|
| Rate for Payer: PHP Commercial |
$119.26
|
| Rate for Payer: PHP Medicare Advantage |
$35.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.20
|
| Rate for Payer: Priority Health HMO/PPO |
$122.07
|
| Rate for Payer: Priority Health Medicare |
$35.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.01
|
| Rate for Payer: Railroad Medicare Medicare |
$35.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.47
|
| Rate for Payer: UHC Core |
$117.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.08
|
| Rate for Payer: UHC Exchange |
$35.08
|
| Rate for Payer: UHC Medicare Advantage |
$35.08
|
| Rate for Payer: VA VA |
$35.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.23
|
|
|
ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC
|
Facility
|
OP
|
$2,039.92
|
|
|
Service Code
|
CPT 45990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.66 |
| Max. Negotiated Rate |
$2,039.92 |
| Rate for Payer: BCBS Complete |
$2,039.92
|
| Rate for Payer: Mclaren Medicaid |
$1,942.66
|
| Rate for Payer: Meridian Medicaid |
$2,039.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.66
|
| Rate for Payer: UHCCP Medicaid |
$1,942.66
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Mclaren Medicaid |
$1.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: Meridian Medicaid |
$1.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.23
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.37
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: UHCCP Medicaid |
$1.05
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Mclaren Medicaid |
$1.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: Meridian Medicaid |
$1.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.23
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.37
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: UHCCP Medicaid |
$1.05
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.78 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$182.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.45
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: BCBS MAPPO |
$175.56
|
| Rate for Payer: BCBS Trust/PPO |
$577.31
|
| Rate for Payer: BCN Commercial |
$545.99
|
| Rate for Payer: BCN Medicare Advantage |
$175.56
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Nomi Health Commercial |
$575.84
|
| Rate for Payer: PACE Senior Care Partners |
$166.78
|
| Rate for Payer: PACE SWMI |
$175.56
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: PHP Medicare Advantage |
$175.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health HMO/PPO |
$610.95
|
| Rate for Payer: Priority Health Medicare |
$177.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.50
|
| Rate for Payer: Railroad Medicare Medicare |
$175.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.97
|
| Rate for Payer: UHC Core |
$586.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.56
|
| Rate for Payer: UHC Exchange |
$175.56
|
| Rate for Payer: UHC Medicare Advantage |
$175.56
|
| Rate for Payer: VA VA |
$175.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.46 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: BCBS Trust/PPO |
$573.24
|
| Rate for Payer: BCN Commercial |
$542.69
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Nomi Health Commercial |
$575.84
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health HMO/PPO |
$610.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.97
|
| Rate for Payer: UHC Core |
$586.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.78 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$182.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.45
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: BCBS MAPPO |
$175.56
|
| Rate for Payer: BCBS Trust/PPO |
$577.31
|
| Rate for Payer: BCN Commercial |
$545.99
|
| Rate for Payer: BCN Medicare Advantage |
$175.56
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Nomi Health Commercial |
$575.84
|
| Rate for Payer: PACE Senior Care Partners |
$166.78
|
| Rate for Payer: PACE SWMI |
$175.56
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: PHP Medicare Advantage |
$175.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health HMO/PPO |
$610.95
|
| Rate for Payer: Priority Health Medicare |
$177.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.50
|
| Rate for Payer: Railroad Medicare Medicare |
$175.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.97
|
| Rate for Payer: UHC Core |
$586.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.56
|
| Rate for Payer: UHC Exchange |
$175.56
|
| Rate for Payer: UHC Medicare Advantage |
$175.56
|
| Rate for Payer: VA VA |
$175.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.46 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: BCBS Trust/PPO |
$573.24
|
| Rate for Payer: BCN Commercial |
$542.69
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Nomi Health Commercial |
$575.84
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health HMO/PPO |
$610.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.97
|
| Rate for Payer: UHC Core |
$586.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$5,119.54
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$4,875.75 |
| Max. Negotiated Rate |
$5,119.54 |
| Rate for Payer: BCBS Complete |
$5,119.54
|
| Rate for Payer: Mclaren Medicaid |
$4,875.75
|
| Rate for Payer: Meridian Medicaid |
$5,119.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,875.75
|
| Rate for Payer: UHCCP Medicaid |
$4,875.75
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$4,188.71
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$3,989.25 |
| Max. Negotiated Rate |
$4,188.71 |
| Rate for Payer: BCBS Complete |
$4,188.71
|
| Rate for Payer: Mclaren Medicaid |
$3,989.25
|
| Rate for Payer: Meridian Medicaid |
$4,188.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,989.25
|
| Rate for Payer: UHCCP Medicaid |
$3,989.25
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$3,516.45
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$3,349.00 |
| Max. Negotiated Rate |
$3,516.45 |
| Rate for Payer: BCBS Complete |
$3,516.45
|
| Rate for Payer: Mclaren Medicaid |
$3,349.00
|
| Rate for Payer: Meridian Medicaid |
$3,516.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,349.00
|
| Rate for Payer: UHCCP Medicaid |
$3,349.00
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$7,705.16
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$7,338.25 |
| Max. Negotiated Rate |
$7,705.16 |
| Rate for Payer: BCBS Complete |
$7,705.16
|
| Rate for Payer: Mclaren Medicaid |
$7,338.25
|
| Rate for Payer: Meridian Medicaid |
$7,705.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,338.25
|
| Rate for Payer: UHCCP Medicaid |
$7,338.25
|
|
|
APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$5,378.10
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$5,122.00 |
| Max. Negotiated Rate |
$5,378.10 |
| Rate for Payer: BCBS Complete |
$5,378.10
|
| Rate for Payer: Mclaren Medicaid |
$5,122.00
|
| Rate for Payer: Meridian Medicaid |
$5,378.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,122.00
|
| Rate for Payer: UHCCP Medicaid |
$5,122.00
|
|
|
APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$2,585.62
|
|
|
Service Code
|
APR-DRG 5431
|
| Min. Negotiated Rate |
$2,462.50 |
| Max. Negotiated Rate |
$2,585.62 |
| Rate for Payer: BCBS Complete |
$2,585.62
|
| Rate for Payer: Mclaren Medicaid |
$2,462.50
|
| Rate for Payer: Meridian Medicaid |
$2,585.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,462.50
|
| Rate for Payer: UHCCP Medicaid |
$2,462.50
|
|
|
APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$10,394.21
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$9,899.25 |
| Max. Negotiated Rate |
$10,394.21 |
| Rate for Payer: BCBS Complete |
$10,394.21
|
| Rate for Payer: Mclaren Medicaid |
$9,899.25
|
| Rate for Payer: Meridian Medicaid |
$10,394.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,899.25
|
| Rate for Payer: UHCCP Medicaid |
$9,899.25
|
|
