|
MORPHINE VARIABLE DOSE
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$3.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.65
|
| Rate for Payer: BCBS Complete |
$2.16
|
| Rate for Payer: BCBS MAPPO |
$2.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Commercial |
$9.60
|
| Rate for Payer: BCN Medicare Advantage |
$2.92
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Mclaren Medicaid |
$2.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.07
|
| Rate for Payer: Meridian Medicaid |
$2.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$9.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.76
|
| Rate for Payer: PACE Senior Care Partners |
$2.77
|
| Rate for Payer: PACE SWMI |
$2.92
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$2.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.16
|
| Rate for Payer: Priority Health Medicare |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: UHC Exchange |
$2.92
|
| Rate for Payer: UHC Medicaid |
$2.06
|
| Rate for Payer: UHC Medicare Advantage |
$2.92
|
| Rate for Payer: UHCCP Medicaid |
$2.06
|
| Rate for Payer: VA VA |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$37,081.19
|
|
|
Service Code
|
APR-DRG 2994
|
| Min. Negotiated Rate |
$35,315.41 |
| Max. Negotiated Rate |
$37,081.19 |
| Rate for Payer: BCBS Complete |
$37,081.19
|
| Rate for Payer: Mclaren Medicaid |
$35,315.41
|
| Rate for Payer: Meridian Medicaid |
$37,081.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$35,315.41
|
| Rate for Payer: UHC Medicaid |
$35,315.41
|
| Rate for Payer: UHCCP Medicaid |
$35,315.41
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$28,157.68
|
|
|
Service Code
|
APR-DRG 2993
|
| Min. Negotiated Rate |
$26,816.84 |
| Max. Negotiated Rate |
$28,157.68 |
| Rate for Payer: BCBS Complete |
$28,157.68
|
| Rate for Payer: Mclaren Medicaid |
$26,816.84
|
| Rate for Payer: Meridian Medicaid |
$28,157.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,816.84
|
| Rate for Payer: UHC Medicaid |
$26,816.84
|
| Rate for Payer: UHCCP Medicaid |
$26,816.84
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$20,401.01
|
|
|
Service Code
|
APR-DRG 2992
|
| Min. Negotiated Rate |
$19,429.54 |
| Max. Negotiated Rate |
$20,401.01 |
| Rate for Payer: BCBS Complete |
$20,401.01
|
| Rate for Payer: Mclaren Medicaid |
$19,429.54
|
| Rate for Payer: Meridian Medicaid |
$20,401.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,429.54
|
| Rate for Payer: UHC Medicaid |
$19,429.54
|
| Rate for Payer: UHCCP Medicaid |
$19,429.54
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$16,897.34
|
|
|
Service Code
|
APR-DRG 2991
|
| Min. Negotiated Rate |
$16,092.71 |
| Max. Negotiated Rate |
$16,897.34 |
| Rate for Payer: BCBS Complete |
$16,897.34
|
| Rate for Payer: Mclaren Medicaid |
$16,092.71
|
| Rate for Payer: Meridian Medicaid |
$16,897.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,092.71
|
| Rate for Payer: UHC Medicaid |
$16,092.71
|
| Rate for Payer: UHCCP Medicaid |
$16,092.71
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$4,073.16
|
|
|
Service Code
|
APR-DRG 0431
|
| Min. Negotiated Rate |
$3,879.20 |
| Max. Negotiated Rate |
$4,073.16 |
| Rate for Payer: BCBS Complete |
$4,073.16
|
| Rate for Payer: Mclaren Medicaid |
$3,879.20
|
| Rate for Payer: Meridian Medicaid |
$4,073.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,879.20
|
| Rate for Payer: UHC Medicaid |
$3,879.20
|
| Rate for Payer: UHCCP Medicaid |
$3,879.20
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$4,921.86
|
|
|
Service Code
|
APR-DRG 0432
|
| Min. Negotiated Rate |
$4,687.49 |
| Max. Negotiated Rate |
$4,921.86 |
| Rate for Payer: BCBS Complete |
$4,921.86
|
| Rate for Payer: Mclaren Medicaid |
$4,687.49
|
| Rate for Payer: Meridian Medicaid |
$4,921.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,687.49
|
| Rate for Payer: UHC Medicaid |
$4,687.49
|
| Rate for Payer: UHCCP Medicaid |
$4,687.49
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$24,732.36
|
|
|
Service Code
|
APR-DRG 0434
|
| Min. Negotiated Rate |
$23,554.63 |
| Max. Negotiated Rate |
$24,732.36 |
| Rate for Payer: BCBS Complete |
$24,732.36
|
| Rate for Payer: Mclaren Medicaid |
$23,554.63
|
| Rate for Payer: Meridian Medicaid |
$24,732.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,554.63
|
| Rate for Payer: UHC Medicaid |
$23,554.63
|
| Rate for Payer: UHCCP Medicaid |
$23,554.63
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$12,224.73
|
|
|
Service Code
|
APR-DRG 0433
|
| Min. Negotiated Rate |
$11,642.60 |
| Max. Negotiated Rate |
$12,224.73 |
| Rate for Payer: BCBS Complete |
$12,224.73
|
| Rate for Payer: Mclaren Medicaid |
$11,642.60
|
| Rate for Payer: Meridian Medicaid |
$12,224.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,642.60
|
| Rate for Payer: UHC Medicaid |
$11,642.60
|
| Rate for Payer: UHCCP Medicaid |
$11,642.60
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$5,533.94
|
|
|
Service Code
|
APR-DRG 9302
|
| Min. Negotiated Rate |
$5,270.42 |
| Max. Negotiated Rate |
$5,533.94 |
| Rate for Payer: BCBS Complete |
$5,533.94
|
| Rate for Payer: Mclaren Medicaid |
$5,270.42
|
| Rate for Payer: Meridian Medicaid |
$5,533.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,270.42
|
| Rate for Payer: UHC Medicaid |
$5,270.42
|
| Rate for Payer: UHCCP Medicaid |
$5,270.42
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$4,369.73
|
|
|
Service Code
|
APR-DRG 9301
|
| Min. Negotiated Rate |
$4,161.65 |
| Max. Negotiated Rate |
$4,369.73 |
| Rate for Payer: BCBS Complete |
$4,369.73
|
| Rate for Payer: Mclaren Medicaid |
$4,161.65
|
| Rate for Payer: Meridian Medicaid |
$4,369.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,161.65
|
| Rate for Payer: UHC Medicaid |
$4,161.65
|
| Rate for Payer: UHCCP Medicaid |
$4,161.65
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$10,148.71
|
|
|
Service Code
|
APR-DRG 9303
|
| Min. Negotiated Rate |
$9,665.44 |
| Max. Negotiated Rate |
$10,148.71 |
| Rate for Payer: BCBS Complete |
$10,148.71
|
| Rate for Payer: Mclaren Medicaid |
$9,665.44
|
| Rate for Payer: Meridian Medicaid |
$10,148.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,665.44
|
| Rate for Payer: UHC Medicaid |
$9,665.44
|
| Rate for Payer: UHCCP Medicaid |
$9,665.44
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$13,680.78
|
|
|
Service Code
|
APR-DRG 9304
|
| Min. Negotiated Rate |
$13,029.31 |
| Max. Negotiated Rate |
$13,680.78 |
| Rate for Payer: BCBS Complete |
$13,680.78
|
| Rate for Payer: Mclaren Medicaid |
$13,029.31
|
| Rate for Payer: Meridian Medicaid |
$13,680.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,029.31
|
| Rate for Payer: UHC Medicaid |
$13,029.31
|
| Rate for Payer: UHCCP Medicaid |
$13,029.31
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.28 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$148.66
|
| Rate for Payer: BCN Commercial |
$148.66
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$33.32
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$147.98
|
| Rate for Payer: BCN Commercial |
$147.98
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$31.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$33.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Medicare |
$45.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.28
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Exchange |
$45.00
|
| Rate for Payer: UHC Medicaid |
$31.73
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$31.73
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.39
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Mclaren Medicaid |
$0.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: PACE Senior Care Partners |
$0.49
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.81
|
| Rate for Payer: Priority Health Medicare |
$0.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.74
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicaid |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: UHCCP Medicaid |
$0.37
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$301.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.91 |
| Max. Negotiated Rate |
$271.44 |
| Rate for Payer: Aetna Commercial |
$256.36
|
| Rate for Payer: BCBS Trust/PPO |
$249.09
|
| Rate for Payer: BCN Commercial |
$249.09
|
| Rate for Payer: Cash Price |
$241.28
|
| Rate for Payer: Cofinity Commercial |
$259.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.28
|
| Rate for Payer: Healthscope Commercial |
$271.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.36
|
| Rate for Payer: Nomi Health Commercial |
$247.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.20
|
| Rate for Payer: PHP Commercial |
$256.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.41
|
| Rate for Payer: UHC Core |
$251.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.20
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$187.20
|
|
|
Service Code
|
NDC 80681016000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Medicare |
$48.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.50
|
| Rate for Payer: BCBS Complete |
$34.65
|
| Rate for Payer: BCBS MAPPO |
$46.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.90
|
| Rate for Payer: BCN Commercial |
$153.90
|
| Rate for Payer: BCN Medicare Advantage |
$46.80
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.80
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.40
|
| Rate for Payer: Mclaren Medicaid |
$33.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.14
|
| Rate for Payer: Meridian Medicaid |
$34.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: Nomi Health Commercial |
$153.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.40
|
| Rate for Payer: PACE Senior Care Partners |
$44.46
|
| Rate for Payer: PACE SWMI |
$46.80
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: PHP Medicare Advantage |
$46.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.86
|
| Rate for Payer: Priority Health Medicare |
$47.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.29
|
| Rate for Payer: Railroad Medicare Medicare |
$46.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.74
|
| Rate for Payer: UHC Core |
$156.31
|
| Rate for Payer: UHC Exchange |
$46.80
|
| Rate for Payer: UHC Medicaid |
$33.00
|
| Rate for Payer: UHC Medicare Advantage |
$46.80
|
| Rate for Payer: UHCCP Medicaid |
$33.00
|
| Rate for Payer: VA VA |
$46.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$207.90
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.70 |
| Max. Negotiated Rate |
$187.11 |
| Rate for Payer: Aetna Commercial |
$176.72
|
| Rate for Payer: BCBS Trust/PPO |
$171.70
|
| Rate for Payer: BCN Commercial |
$171.70
|
| Rate for Payer: Cash Price |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$178.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.32
|
| Rate for Payer: Healthscope Commercial |
$187.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.72
|
| Rate for Payer: Nomi Health Commercial |
$170.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.93
|
| Rate for Payer: PHP Commercial |
$176.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.95
|
| Rate for Payer: UHC Core |
$173.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.93
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$187.20
|
|
|
Service Code
|
NDC 80681016000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.29 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: BCBS Trust/PPO |
$154.61
|
| Rate for Payer: BCN Commercial |
$154.61
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: Nomi Health Commercial |
$153.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.40
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.74
|
| Rate for Payer: UHC Core |
$156.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$207.90
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.65 |
| Max. Negotiated Rate |
$187.11 |
| Rate for Payer: Aetna Commercial |
$176.72
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.97
|
| Rate for Payer: BCBS Complete |
$38.48
|
| Rate for Payer: BCBS MAPPO |
$51.98
|
| Rate for Payer: BCBS Trust/PPO |
$170.91
|
| Rate for Payer: BCN Commercial |
$170.91
|
| Rate for Payer: BCN Medicare Advantage |
$51.98
|
| Rate for Payer: Cash Price |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$178.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.98
|
| Rate for Payer: Healthscope Commercial |
$187.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.93
|
| Rate for Payer: Mclaren Medicaid |
$36.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.57
|
| Rate for Payer: Meridian Medicaid |
$38.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.72
|
| Rate for Payer: Nomi Health Commercial |
$170.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.93
|
| Rate for Payer: PACE Senior Care Partners |
$49.38
|
| Rate for Payer: PACE SWMI |
$51.98
|
| Rate for Payer: PHP Commercial |
$176.72
|
| Rate for Payer: PHP Medicare Advantage |
$51.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.87
|
| Rate for Payer: Priority Health Medicare |
$52.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.70
|
| Rate for Payer: Railroad Medicare Medicare |
$51.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.95
|
| Rate for Payer: UHC Core |
$173.60
|
| Rate for Payer: UHC Exchange |
$51.98
|
| Rate for Payer: UHC Medicaid |
$36.65
|
| Rate for Payer: UHC Medicare Advantage |
$51.98
|
| Rate for Payer: UHCCP Medicaid |
$36.65
|
| Rate for Payer: VA VA |
$51.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.93
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$301.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$271.44 |
| Rate for Payer: Aetna Commercial |
$256.36
|
| Rate for Payer: Aetna Medicare |
$78.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.25
|
| Rate for Payer: BCBS Complete |
$55.83
|
| Rate for Payer: BCBS MAPPO |
$75.40
|
| Rate for Payer: BCBS Trust/PPO |
$247.95
|
| Rate for Payer: BCN Commercial |
$247.95
|
| Rate for Payer: BCN Medicare Advantage |
$75.40
|
| Rate for Payer: Cash Price |
$241.28
|
| Rate for Payer: Cofinity Commercial |
$259.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.40
|
| Rate for Payer: Healthscope Commercial |
$271.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.20
|
| Rate for Payer: Mclaren Medicaid |
$53.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.17
|
| Rate for Payer: Meridian Medicaid |
$55.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.36
|
| Rate for Payer: Nomi Health Commercial |
$247.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.20
|
| Rate for Payer: PACE Senior Care Partners |
$71.63
|
| Rate for Payer: PACE SWMI |
$75.40
|
| Rate for Payer: PHP Commercial |
$256.36
|
| Rate for Payer: PHP Medicare Advantage |
$75.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.39
|
| Rate for Payer: Priority Health Medicare |
$76.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.91
|
| Rate for Payer: Railroad Medicare Medicare |
$75.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.41
|
| Rate for Payer: UHC Core |
$251.84
|
| Rate for Payer: UHC Exchange |
$75.40
|
| Rate for Payer: UHC Medicaid |
$53.17
|
| Rate for Payer: UHC Medicare Advantage |
$75.40
|
| Rate for Payer: UHCCP Medicaid |
$53.17
|
| Rate for Payer: VA VA |
$75.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.20
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
NDC 00904053061
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$109.02
|
| Rate for Payer: BCN Commercial |
$109.02
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: Nomi Health Commercial |
$108.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
NDC 00904053061
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$34.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.25
|
| Rate for Payer: BCBS Complete |
$24.43
|
| Rate for Payer: BCBS MAPPO |
$33.00
|
| Rate for Payer: BCBS Trust/PPO |
$108.52
|
| Rate for Payer: BCN Commercial |
$108.52
|
| Rate for Payer: BCN Medicare Advantage |
$33.00
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.00
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Mclaren Medicaid |
$23.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.65
|
| Rate for Payer: Meridian Medicaid |
$24.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: Nomi Health Commercial |
$108.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
| Rate for Payer: PACE Senior Care Partners |
$31.35
|
| Rate for Payer: PACE SWMI |
$33.00
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: PHP Medicare Advantage |
$33.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.84
|
| Rate for Payer: Priority Health Medicare |
$33.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.87
|
| Rate for Payer: Railroad Medicare Medicare |
$33.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: UHC Exchange |
$33.00
|
| Rate for Payer: UHC Medicaid |
$23.27
|
| Rate for Payer: UHC Medicare Advantage |
$33.00
|
| Rate for Payer: UHCCP Medicaid |
$23.27
|
| Rate for Payer: VA VA |
$33.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
