|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$431.04
|
|
|
Service Code
|
NDC 00378022201
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna Medicare |
$112.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.70
|
| Rate for Payer: BCBS Complete |
$79.79
|
| Rate for Payer: BCBS MAPPO |
$107.76
|
| Rate for Payer: BCBS Trust/PPO |
$354.36
|
| Rate for Payer: BCN Commercial |
$354.36
|
| Rate for Payer: BCN Medicare Advantage |
$107.76
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.76
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Mclaren Medicaid |
$75.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.15
|
| Rate for Payer: Meridian Medicaid |
$79.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Nomi Health Commercial |
$353.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.28
|
| Rate for Payer: PACE Senior Care Partners |
$102.37
|
| Rate for Payer: PACE SWMI |
$107.76
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: PHP Medicare Advantage |
$107.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$375.00
|
| Rate for Payer: Priority Health Medicare |
$108.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.00
|
| Rate for Payer: Railroad Medicare Medicare |
$107.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.32
|
| Rate for Payer: UHC Core |
$359.92
|
| Rate for Payer: UHC Exchange |
$107.76
|
| Rate for Payer: UHC Medicaid |
$75.99
|
| Rate for Payer: UHC Medicare Advantage |
$107.76
|
| Rate for Payer: UHCCP Medicaid |
$75.99
|
| Rate for Payer: VA VA |
$107.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 00378022201
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: BCBS Trust/PPO |
$356.00
|
| Rate for Payer: BCN Commercial |
$356.00
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Nomi Health Commercial |
$353.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.28
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$375.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.32
|
| Rate for Payer: UHC Core |
$359.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$133.95
|
|
|
Service Code
|
NDC 31604001870
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.23 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: BCBS Trust/PPO |
$110.63
|
| Rate for Payer: BCN Commercial |
$110.63
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Nomi Health Commercial |
$109.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.88
|
| Rate for Payer: UHC Core |
$111.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 07610009840
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: BCBS Trust/PPO |
$116.45
|
| Rate for Payer: BCN Commercial |
$116.45
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$23.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.64
|
| Rate for Payer: BCBS Complete |
$16.96
|
| Rate for Payer: BCBS MAPPO |
$22.91
|
| Rate for Payer: BCBS Trust/PPO |
$75.35
|
| Rate for Payer: BCN Commercial |
$75.35
|
| Rate for Payer: BCN Medicare Advantage |
$22.91
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.91
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Mclaren Medicaid |
$16.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.06
|
| Rate for Payer: Meridian Medicaid |
$16.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PACE Senior Care Partners |
$21.77
|
| Rate for Payer: PACE SWMI |
$22.91
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: PHP Medicare Advantage |
$22.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Medicare |
$23.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.79
|
| Rate for Payer: Railroad Medicare Medicare |
$22.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: UHC Exchange |
$22.91
|
| Rate for Payer: UHC Medicaid |
$16.16
|
| Rate for Payer: UHC Medicare Advantage |
$22.91
|
| Rate for Payer: UHCCP Medicaid |
$16.16
|
| Rate for Payer: VA VA |
$22.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 07610009840
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$36.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.06
|
| Rate for Payer: BCBS Complete |
$26.10
|
| Rate for Payer: BCBS MAPPO |
$35.25
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: BCN Medicare Advantage |
$35.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.25
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Mclaren Medicaid |
$24.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.01
|
| Rate for Payer: Meridian Medicaid |
$26.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PACE Senior Care Partners |
$33.49
|
| Rate for Payer: PACE SWMI |
$35.25
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: PHP Medicare Advantage |
$35.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Medicare |
$35.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.14
|
| Rate for Payer: Railroad Medicare Medicare |
$35.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.73
|
| Rate for Payer: UHC Exchange |
$35.25
|
| Rate for Payer: UHC Medicaid |
$24.86
|
| Rate for Payer: UHC Medicare Advantage |
$35.25
|
| Rate for Payer: UHCCP Medicaid |
$24.86
|
| Rate for Payer: VA VA |
$35.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$75.69
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$133.95
|
|
|
Service Code
|
NDC 31604001870
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: Aetna Medicare |
$34.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.86
|
| Rate for Payer: BCBS Complete |
$24.79
|
| Rate for Payer: BCBS MAPPO |
$33.49
|
| Rate for Payer: BCBS Trust/PPO |
$110.12
|
| Rate for Payer: BCN Commercial |
$110.12
|
| Rate for Payer: BCN Medicare Advantage |
$33.49
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.49
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Mclaren Medicaid |
$23.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.16
|
| Rate for Payer: Meridian Medicaid |
$24.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Nomi Health Commercial |
$109.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: PACE Senior Care Partners |
$31.81
|
| Rate for Payer: PACE SWMI |
$33.49
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: PHP Medicare Advantage |
$33.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.54
|
| Rate for Payer: Priority Health Medicare |
$33.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.23
|
| Rate for Payer: Railroad Medicare Medicare |
$33.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.88
|
| Rate for Payer: UHC Core |
$111.85
|
| Rate for Payer: UHC Exchange |
$33.49
|
| Rate for Payer: UHC Medicaid |
$23.62
|
| Rate for Payer: UHC Medicare Advantage |
$33.49
|
| Rate for Payer: UHCCP Medicaid |
$23.62
|
| Rate for Payer: VA VA |
$33.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$6,696.05
|
|
|
Service Code
|
APR-DRG 2631
|
| Min. Negotiated Rate |
$6,377.19 |
| Max. Negotiated Rate |
$6,696.05 |
| Rate for Payer: BCBS Complete |
$6,696.05
|
| Rate for Payer: Mclaren Medicaid |
$6,377.19
|
| Rate for Payer: Meridian Medicaid |
$6,696.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,377.19
|
| Rate for Payer: UHC Medicaid |
$6,377.19
|
| Rate for Payer: UHCCP Medicaid |
$6,377.19
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$19,235.75
|
|
|
Service Code
|
APR-DRG 2634
|
| Min. Negotiated Rate |
$18,319.76 |
| Max. Negotiated Rate |
$19,235.75 |
| Rate for Payer: BCBS Complete |
$19,235.75
|
| Rate for Payer: Mclaren Medicaid |
$18,319.76
|
| Rate for Payer: Meridian Medicaid |
$19,235.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,319.76
|
| Rate for Payer: UHC Medicaid |
$18,319.76
|
| Rate for Payer: UHCCP Medicaid |
$18,319.76
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$11,643.68
|
|
|
Service Code
|
APR-DRG 2633
|
| Min. Negotiated Rate |
$11,089.21 |
| Max. Negotiated Rate |
$11,643.68 |
| Rate for Payer: BCBS Complete |
$11,643.68
|
| Rate for Payer: Mclaren Medicaid |
$11,089.21
|
| Rate for Payer: Meridian Medicaid |
$11,643.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,089.21
|
| Rate for Payer: UHC Medicaid |
$11,089.21
|
| Rate for Payer: UHCCP Medicaid |
$11,089.21
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$8,598.01
|
|
|
Service Code
|
APR-DRG 2632
|
| Min. Negotiated Rate |
$8,188.58 |
| Max. Negotiated Rate |
$8,598.01 |
| Rate for Payer: BCBS Complete |
$8,598.01
|
| Rate for Payer: Mclaren Medicaid |
$8,188.58
|
| Rate for Payer: Meridian Medicaid |
$8,598.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,188.58
|
| Rate for Payer: UHC Medicaid |
$8,188.58
|
| Rate for Payer: UHCCP Medicaid |
$8,188.58
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 49884046564
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.55
|
| Rate for Payer: BCBS Complete |
$0.92
|
| Rate for Payer: BCBS MAPPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: BCN Medicare Advantage |
$1.24
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.24
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.71
|
| Rate for Payer: Mclaren Medicaid |
$0.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.30
|
| Rate for Payer: Meridian Medicaid |
$0.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: Nomi Health Commercial |
$4.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.71
|
| Rate for Payer: PACE Senior Care Partners |
$1.18
|
| Rate for Payer: PACE SWMI |
$1.24
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$1.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.31
|
| Rate for Payer: Priority Health Medicare |
$1.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.36
|
| Rate for Payer: UHC Core |
$4.13
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Medicaid |
$0.87
|
| Rate for Payer: UHC Medicare Advantage |
$1.24
|
| Rate for Payer: UHCCP Medicaid |
$0.87
|
| Rate for Payer: VA VA |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 49884046564
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: Nomi Health Commercial |
$4.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.71
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.36
|
| Rate for Payer: UHC Core |
$4.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$233.06
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$209.75 |
| Rate for Payer: Aetna Commercial |
$198.10
|
| Rate for Payer: Aetna Medicare |
$60.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.83
|
| Rate for Payer: BCBS Complete |
$43.14
|
| Rate for Payer: BCBS MAPPO |
$58.27
|
| Rate for Payer: BCBS Trust/PPO |
$191.60
|
| Rate for Payer: BCN Commercial |
$191.60
|
| Rate for Payer: BCN Medicare Advantage |
$58.27
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cofinity Commercial |
$200.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.27
|
| Rate for Payer: Healthscope Commercial |
$209.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.79
|
| Rate for Payer: Mclaren Medicaid |
$41.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.18
|
| Rate for Payer: Meridian Medicaid |
$43.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.10
|
| Rate for Payer: Nomi Health Commercial |
$191.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.79
|
| Rate for Payer: PACE Senior Care Partners |
$55.35
|
| Rate for Payer: PACE SWMI |
$58.27
|
| Rate for Payer: PHP Commercial |
$198.10
|
| Rate for Payer: PHP Medicare Advantage |
$58.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.76
|
| Rate for Payer: Priority Health Medicare |
$58.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.21
|
| Rate for Payer: Railroad Medicare Medicare |
$58.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.09
|
| Rate for Payer: UHC Core |
$194.61
|
| Rate for Payer: UHC Exchange |
$58.27
|
| Rate for Payer: UHC Medicaid |
$41.09
|
| Rate for Payer: UHC Medicare Advantage |
$58.27
|
| Rate for Payer: UHCCP Medicaid |
$41.09
|
| Rate for Payer: VA VA |
$58.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.79
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$233.06
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$162.21 |
| Max. Negotiated Rate |
$209.75 |
| Rate for Payer: Aetna Commercial |
$198.10
|
| Rate for Payer: BCBS Trust/PPO |
$192.48
|
| Rate for Payer: BCN Commercial |
$192.48
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cofinity Commercial |
$200.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.45
|
| Rate for Payer: Healthscope Commercial |
$209.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.10
|
| Rate for Payer: Nomi Health Commercial |
$191.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.79
|
| Rate for Payer: PHP Commercial |
$198.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.09
|
| Rate for Payer: UHC Core |
$194.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.79
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$3,720.84
|
|
|
Service Code
|
APR-DRG 4702
|
| Min. Negotiated Rate |
$3,543.66 |
| Max. Negotiated Rate |
$3,720.84 |
| Rate for Payer: BCBS Complete |
$3,720.84
|
| Rate for Payer: Mclaren Medicaid |
$3,543.66
|
| Rate for Payer: Meridian Medicaid |
$3,720.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,543.66
|
| Rate for Payer: UHC Medicaid |
$3,543.66
|
| Rate for Payer: UHCCP Medicaid |
$3,543.66
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$13,002.45
|
|
|
Service Code
|
APR-DRG 4704
|
| Min. Negotiated Rate |
$12,383.28 |
| Max. Negotiated Rate |
$13,002.45 |
| Rate for Payer: BCBS Complete |
$13,002.45
|
| Rate for Payer: Mclaren Medicaid |
$12,383.28
|
| Rate for Payer: Meridian Medicaid |
$13,002.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,383.28
|
| Rate for Payer: UHC Medicaid |
$12,383.28
|
| Rate for Payer: UHCCP Medicaid |
$12,383.28
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$2,986.25
|
|
|
Service Code
|
APR-DRG 4701
|
| Min. Negotiated Rate |
$2,844.04 |
| Max. Negotiated Rate |
$2,986.25 |
| Rate for Payer: BCBS Complete |
$2,986.25
|
| Rate for Payer: Mclaren Medicaid |
$2,844.04
|
| Rate for Payer: Meridian Medicaid |
$2,986.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,844.04
|
| Rate for Payer: UHC Medicaid |
$2,844.04
|
| Rate for Payer: UHCCP Medicaid |
$2,844.04
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$6,895.87
|
|
|
Service Code
|
APR-DRG 4703
|
| Min. Negotiated Rate |
$6,567.49 |
| Max. Negotiated Rate |
$6,895.87 |
| Rate for Payer: BCBS Complete |
$6,895.87
|
| Rate for Payer: Mclaren Medicaid |
$6,567.49
|
| Rate for Payer: Meridian Medicaid |
$6,895.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,567.49
|
| Rate for Payer: UHC Medicaid |
$6,567.49
|
| Rate for Payer: UHCCP Medicaid |
$6,567.49
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$8,458.66
|
|
|
Service Code
|
APR-DRG 1404
|
| Min. Negotiated Rate |
$8,055.87 |
| Max. Negotiated Rate |
$8,458.66 |
| Rate for Payer: BCBS Complete |
$8,458.66
|
| Rate for Payer: Mclaren Medicaid |
$8,055.87
|
| Rate for Payer: Meridian Medicaid |
$8,458.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,055.87
|
| Rate for Payer: UHC Medicaid |
$8,055.87
|
| Rate for Payer: UHCCP Medicaid |
$8,055.87
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$4,008.48
|
|
|
Service Code
|
APR-DRG 1402
|
| Min. Negotiated Rate |
$3,817.60 |
| Max. Negotiated Rate |
$4,008.48 |
| Rate for Payer: BCBS Complete |
$4,008.48
|
| Rate for Payer: Mclaren Medicaid |
$3,817.60
|
| Rate for Payer: Meridian Medicaid |
$4,008.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,817.60
|
| Rate for Payer: UHC Medicaid |
$3,817.60
|
| Rate for Payer: UHCCP Medicaid |
$3,817.60
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$5,284.17
|
|
|
Service Code
|
APR-DRG 1403
|
| Min. Negotiated Rate |
$5,032.54 |
| Max. Negotiated Rate |
$5,284.17 |
| Rate for Payer: BCBS Complete |
$5,284.17
|
| Rate for Payer: Mclaren Medicaid |
$5,032.54
|
| Rate for Payer: Meridian Medicaid |
$5,284.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,032.54
|
| Rate for Payer: UHC Medicaid |
$5,032.54
|
| Rate for Payer: UHCCP Medicaid |
$5,032.54
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$3,366.43
|
|
|
Service Code
|
APR-DRG 1401
|
| Min. Negotiated Rate |
$3,206.12 |
| Max. Negotiated Rate |
$3,366.43 |
| Rate for Payer: BCBS Complete |
$3,366.43
|
| Rate for Payer: Mclaren Medicaid |
$3,206.12
|
| Rate for Payer: Meridian Medicaid |
$3,366.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,206.12
|
| Rate for Payer: UHC Medicaid |
$3,206.12
|
| Rate for Payer: UHCCP Medicaid |
$3,206.12
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$3.56
|
|
|
Service Code
|
NDC 50268017711
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.11
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$0.89
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.89
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.67
|
| Rate for Payer: Mclaren Medicaid |
$0.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.93
|
| Rate for Payer: Meridian Medicaid |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.67
|
| Rate for Payer: PACE Senior Care Partners |
$0.85
|
| Rate for Payer: PACE SWMI |
$0.89
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.10
|
| Rate for Payer: Priority Health Medicare |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.13
|
| Rate for Payer: UHC Core |
$2.97
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Medicaid |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.89
|
| Rate for Payer: UHCCP Medicaid |
$0.63
|
| Rate for Payer: VA VA |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.67
|
|
