|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 23155001001
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.77 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: BCBS Trust/PPO |
$347.41
|
| Rate for Payer: BCN Commercial |
$347.41
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Nomi Health Commercial |
$344.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.17
|
| Rate for Payer: UHC Core |
$351.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
OP
|
$2.58
|
|
|
Service Code
|
NDC 50268043011
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.81
|
| Rate for Payer: BCBS Complete |
$0.48
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Mclaren Medicaid |
$0.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: Meridian Medicaid |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.19
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicaid |
$0.45
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: UHCCP Medicaid |
$0.45
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 23155001001
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.16 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Medicare |
$109.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.45
|
| Rate for Payer: BCBS Complete |
$77.86
|
| Rate for Payer: BCBS MAPPO |
$105.16
|
| Rate for Payer: BCBS Trust/PPO |
$345.82
|
| Rate for Payer: BCN Commercial |
$345.82
|
| Rate for Payer: BCN Medicare Advantage |
$105.16
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.16
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Mclaren Medicaid |
$74.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.42
|
| Rate for Payer: Meridian Medicaid |
$77.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Nomi Health Commercial |
$344.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PACE Senior Care Partners |
$99.90
|
| Rate for Payer: PACE SWMI |
$105.16
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: PHP Medicare Advantage |
$105.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Medicare |
$106.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.77
|
| Rate for Payer: Railroad Medicare Medicare |
$105.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.17
|
| Rate for Payer: UHC Core |
$351.24
|
| Rate for Payer: UHC Exchange |
$105.16
|
| Rate for Payer: UHC Medicaid |
$74.16
|
| Rate for Payer: UHC Medicare Advantage |
$105.16
|
| Rate for Payer: UHCCP Medicaid |
$74.16
|
| Rate for Payer: VA VA |
$105.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$2.58
|
|
|
Service Code
|
NDC 50268043011
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$2,168.04
|
|
|
Service Code
|
APR-DRG 1131
|
| Min. Negotiated Rate |
$2,064.80 |
| Max. Negotiated Rate |
$2,168.04 |
| Rate for Payer: BCBS Complete |
$2,168.04
|
| Rate for Payer: Mclaren Medicaid |
$2,064.80
|
| Rate for Payer: Meridian Medicaid |
$2,168.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,064.80
|
| Rate for Payer: UHC Medicaid |
$2,064.80
|
| Rate for Payer: UHCCP Medicaid |
$2,064.80
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$8,234.65
|
|
|
Service Code
|
APR-DRG 1134
|
| Min. Negotiated Rate |
$7,842.53 |
| Max. Negotiated Rate |
$8,234.65 |
| Rate for Payer: BCBS Complete |
$8,234.65
|
| Rate for Payer: Mclaren Medicaid |
$7,842.53
|
| Rate for Payer: Meridian Medicaid |
$8,234.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,842.53
|
| Rate for Payer: UHC Medicaid |
$7,842.53
|
| Rate for Payer: UHCCP Medicaid |
$7,842.53
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$4,503.82
|
|
|
Service Code
|
APR-DRG 1133
|
| Min. Negotiated Rate |
$4,289.35 |
| Max. Negotiated Rate |
$4,503.82 |
| Rate for Payer: BCBS Complete |
$4,503.82
|
| Rate for Payer: Mclaren Medicaid |
$4,289.35
|
| Rate for Payer: Meridian Medicaid |
$4,503.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,289.35
|
| Rate for Payer: UHC Medicaid |
$4,289.35
|
| Rate for Payer: UHCCP Medicaid |
$4,289.35
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$2,871.09
|
|
|
Service Code
|
APR-DRG 1132
|
| Min. Negotiated Rate |
$2,734.37 |
| Max. Negotiated Rate |
$2,871.09 |
| Rate for Payer: BCBS Complete |
$2,871.09
|
| Rate for Payer: Mclaren Medicaid |
$2,734.37
|
| Rate for Payer: Meridian Medicaid |
$2,871.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,734.37
|
| Rate for Payer: UHC Medicaid |
$2,734.37
|
| Rate for Payer: UHCCP Medicaid |
$2,734.37
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$13,154.41
|
|
|
Service Code
|
APR-DRG 7103
|
| Min. Negotiated Rate |
$12,528.01 |
| Max. Negotiated Rate |
$13,154.41 |
| Rate for Payer: BCBS Complete |
$13,154.41
|
| Rate for Payer: Mclaren Medicaid |
$12,528.01
|
| Rate for Payer: Meridian Medicaid |
$13,154.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,528.01
|
| Rate for Payer: UHC Medicaid |
$12,528.01
|
| Rate for Payer: UHCCP Medicaid |
$12,528.01
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$19,578.60
|
|
|
Service Code
|
APR-DRG 7104
|
| Min. Negotiated Rate |
$18,646.29 |
| Max. Negotiated Rate |
$19,578.60 |
| Rate for Payer: BCBS Complete |
$19,578.60
|
| Rate for Payer: Mclaren Medicaid |
$18,646.29
|
| Rate for Payer: Meridian Medicaid |
$19,578.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,646.29
|
| Rate for Payer: UHC Medicaid |
$18,646.29
|
| Rate for Payer: UHCCP Medicaid |
$18,646.29
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$7,427.49
|
|
|
Service Code
|
APR-DRG 7101
|
| Min. Negotiated Rate |
$7,073.80 |
| Max. Negotiated Rate |
$7,427.49 |
| Rate for Payer: BCBS Complete |
$7,427.49
|
| Rate for Payer: Mclaren Medicaid |
$7,073.80
|
| Rate for Payer: Meridian Medicaid |
$7,427.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,073.80
|
| Rate for Payer: UHC Medicaid |
$7,073.80
|
| Rate for Payer: UHCCP Medicaid |
$7,073.80
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$7,957.01
|
|
|
Service Code
|
APR-DRG 7102
|
| Min. Negotiated Rate |
$7,578.11 |
| Max. Negotiated Rate |
$7,957.01 |
| Rate for Payer: BCBS Complete |
$7,957.01
|
| Rate for Payer: Mclaren Medicaid |
$7,578.11
|
| Rate for Payer: Meridian Medicaid |
$7,957.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,578.11
|
| Rate for Payer: UHC Medicaid |
$7,578.11
|
| Rate for Payer: UHCCP Medicaid |
$7,578.11
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$3,191.32
|
|
|
Service Code
|
APR-DRG 2451
|
| Min. Negotiated Rate |
$3,039.36 |
| Max. Negotiated Rate |
$3,191.32 |
| Rate for Payer: BCBS Complete |
$3,191.32
|
| Rate for Payer: Mclaren Medicaid |
$3,039.36
|
| Rate for Payer: Meridian Medicaid |
$3,191.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,039.36
|
| Rate for Payer: UHC Medicaid |
$3,039.36
|
| Rate for Payer: UHCCP Medicaid |
$3,039.36
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$9,980.44
|
|
|
Service Code
|
APR-DRG 2454
|
| Min. Negotiated Rate |
$9,505.18 |
| Max. Negotiated Rate |
$9,980.44 |
| Rate for Payer: BCBS Complete |
$9,980.44
|
| Rate for Payer: Mclaren Medicaid |
$9,505.18
|
| Rate for Payer: Meridian Medicaid |
$9,980.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,505.18
|
| Rate for Payer: UHC Medicaid |
$9,505.18
|
| Rate for Payer: UHCCP Medicaid |
$9,505.18
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$7,020.49
|
|
|
Service Code
|
APR-DRG 2453
|
| Min. Negotiated Rate |
$6,686.18 |
| Max. Negotiated Rate |
$7,020.49 |
| Rate for Payer: BCBS Complete |
$7,020.49
|
| Rate for Payer: Mclaren Medicaid |
$6,686.18
|
| Rate for Payer: Meridian Medicaid |
$7,020.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,686.18
|
| Rate for Payer: UHC Medicaid |
$6,686.18
|
| Rate for Payer: UHCCP Medicaid |
$6,686.18
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$4,523.80
|
|
|
Service Code
|
APR-DRG 2452
|
| Min. Negotiated Rate |
$4,308.38 |
| Max. Negotiated Rate |
$4,523.80 |
| Rate for Payer: BCBS Complete |
$4,523.80
|
| Rate for Payer: Mclaren Medicaid |
$4,308.38
|
| Rate for Payer: Meridian Medicaid |
$4,523.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,308.38
|
| Rate for Payer: UHC Medicaid |
$4,308.38
|
| Rate for Payer: UHCCP Medicaid |
$4,308.38
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$6,424.19
|
|
|
Service Code
|
APR-DRG 2281
|
| Min. Negotiated Rate |
$6,118.27 |
| Max. Negotiated Rate |
$6,424.19 |
| Rate for Payer: BCBS Complete |
$6,424.19
|
| Rate for Payer: Mclaren Medicaid |
$6,118.27
|
| Rate for Payer: Meridian Medicaid |
$6,424.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,118.27
|
| Rate for Payer: UHC Medicaid |
$6,118.27
|
| Rate for Payer: UHCCP Medicaid |
$6,118.27
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$10,311.72
|
|
|
Service Code
|
APR-DRG 2283
|
| Min. Negotiated Rate |
$9,820.69 |
| Max. Negotiated Rate |
$10,311.72 |
| Rate for Payer: BCBS Complete |
$10,311.72
|
| Rate for Payer: Mclaren Medicaid |
$9,820.69
|
| Rate for Payer: Meridian Medicaid |
$10,311.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,820.69
|
| Rate for Payer: UHC Medicaid |
$9,820.69
|
| Rate for Payer: UHCCP Medicaid |
$9,820.69
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$18,081.01
|
|
|
Service Code
|
APR-DRG 2284
|
| Min. Negotiated Rate |
$17,220.01 |
| Max. Negotiated Rate |
$18,081.01 |
| Rate for Payer: BCBS Complete |
$18,081.01
|
| Rate for Payer: Mclaren Medicaid |
$17,220.01
|
| Rate for Payer: Meridian Medicaid |
$18,081.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,220.01
|
| Rate for Payer: UHC Medicaid |
$17,220.01
|
| Rate for Payer: UHCCP Medicaid |
$17,220.01
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$8,775.74
|
|
|
Service Code
|
APR-DRG 2282
|
| Min. Negotiated Rate |
$8,357.85 |
| Max. Negotiated Rate |
$8,775.74 |
| Rate for Payer: BCBS Complete |
$8,775.74
|
| Rate for Payer: Mclaren Medicaid |
$8,357.85
|
| Rate for Payer: Meridian Medicaid |
$8,775.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,357.85
|
| Rate for Payer: UHC Medicaid |
$8,357.85
|
| Rate for Payer: UHCCP Medicaid |
$8,357.85
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
IP
|
$29.35
|
|
|
Service Code
|
NDC 08373077478
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.43 |
| Max. Negotiated Rate |
$26.41 |
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: BCBS Trust/PPO |
$24.24
|
| Rate for Payer: BCN Commercial |
$24.24
|
| Rate for Payer: Cash Price |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$26.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: Nomi Health Commercial |
$24.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.01
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.83
|
| Rate for Payer: UHC Core |
$24.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.01
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
OP
|
$39.08
|
|
|
Service Code
|
NDC 08373747800
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$33.22
|
| Rate for Payer: Aetna Medicare |
$10.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.21
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS MAPPO |
$9.77
|
| Rate for Payer: BCBS Trust/PPO |
$32.13
|
| Rate for Payer: BCN Commercial |
$32.13
|
| Rate for Payer: BCN Medicare Advantage |
$9.77
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.31
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.26
|
| Rate for Payer: Meridian Medicaid |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.22
|
| Rate for Payer: Nomi Health Commercial |
$32.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.31
|
| Rate for Payer: PACE Senior Care Partners |
$9.28
|
| Rate for Payer: PACE SWMI |
$9.77
|
| Rate for Payer: PHP Commercial |
$33.22
|
| Rate for Payer: PHP Medicare Advantage |
$9.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.00
|
| Rate for Payer: Priority Health Medicare |
$9.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.20
|
| Rate for Payer: Railroad Medicare Medicare |
$9.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.39
|
| Rate for Payer: UHC Core |
$32.63
|
| Rate for Payer: UHC Exchange |
$9.77
|
| Rate for Payer: UHC Medicaid |
$6.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.77
|
| Rate for Payer: UHCCP Medicaid |
$6.89
|
| Rate for Payer: VA VA |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.31
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
IP
|
$39.08
|
|
|
Service Code
|
NDC 08373747800
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$33.22
|
| Rate for Payer: BCBS Trust/PPO |
$32.28
|
| Rate for Payer: BCN Commercial |
$32.28
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.26
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.22
|
| Rate for Payer: Nomi Health Commercial |
$32.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.31
|
| Rate for Payer: PHP Commercial |
$33.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.39
|
| Rate for Payer: UHC Core |
$32.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.31
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
OP
|
$29.35
|
|
|
Service Code
|
NDC 08373077478
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$26.41 |
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.17
|
| Rate for Payer: BCBS Complete |
$5.43
|
| Rate for Payer: BCBS MAPPO |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$24.13
|
| Rate for Payer: BCN Commercial |
$24.13
|
| Rate for Payer: BCN Medicare Advantage |
$7.34
|
| Rate for Payer: Cash Price |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$26.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.01
|
| Rate for Payer: Mclaren Medicaid |
$5.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.70
|
| Rate for Payer: Meridian Medicaid |
$5.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: Nomi Health Commercial |
$24.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.01
|
| Rate for Payer: PACE Senior Care Partners |
$6.97
|
| Rate for Payer: PACE SWMI |
$7.34
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: PHP Medicare Advantage |
$7.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.53
|
| Rate for Payer: Priority Health Medicare |
$7.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.43
|
| Rate for Payer: Railroad Medicare Medicare |
$7.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.83
|
| Rate for Payer: UHC Core |
$24.51
|
| Rate for Payer: UHC Exchange |
$7.34
|
| Rate for Payer: UHC Medicaid |
$5.17
|
| Rate for Payer: UHC Medicare Advantage |
$7.34
|
| Rate for Payer: UHCCP Medicaid |
$5.17
|
| Rate for Payer: VA VA |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.01
|
|
|
INHALER, ASSIST DEVICES, ACCESSORIES
|
Facility
|
OP
|
$24.83
|
|
|
Service Code
|
NDC 08373081211
|
| Hospital Charge Code |
118717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.76
|
| Rate for Payer: BCBS Complete |
$4.60
|
| Rate for Payer: BCBS MAPPO |
$6.21
|
| Rate for Payer: BCBS Trust/PPO |
$20.41
|
| Rate for Payer: BCN Commercial |
$20.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.21
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cofinity Commercial |
$21.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.21
|
| Rate for Payer: Healthscope Commercial |
$22.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.62
|
| Rate for Payer: Mclaren Medicaid |
$4.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.52
|
| Rate for Payer: Meridian Medicaid |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.62
|
| Rate for Payer: PACE Senior Care Partners |
$5.90
|
| Rate for Payer: PACE SWMI |
$6.21
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.60
|
| Rate for Payer: Priority Health Medicare |
$6.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.85
|
| Rate for Payer: UHC Core |
$20.73
|
| Rate for Payer: UHC Exchange |
$6.21
|
| Rate for Payer: UHC Medicaid |
$4.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.21
|
| Rate for Payer: UHCCP Medicaid |
$4.38
|
| Rate for Payer: VA VA |
$6.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.62
|
|
