|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$7.14
|
| Rate for Payer: BCN Commercial |
$6.46
|
| Rate for Payer: BCN Commercial |
$2.78
|
| Rate for Payer: BCN Commercial |
$7.14
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$6.73
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.04
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Nomi Health Commercial |
$6.41
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.48
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$6.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.96
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: UHC Core |
$6.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.87
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Aetna Medicare |
$0.87
|
| Rate for Payer: Aetna Medicare |
$2.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$2.16
|
| Rate for Payer: BCBS MAPPO |
$0.84
|
| Rate for Payer: BCBS MAPPO |
$1.96
|
| Rate for Payer: BCBS Trust/PPO |
$2.76
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCBS Trust/PPO |
$7.10
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: BCN Commercial |
$7.10
|
| Rate for Payer: BCN Commercial |
$2.76
|
| Rate for Payer: BCN Medicare Advantage |
$2.16
|
| Rate for Payer: BCN Medicare Advantage |
$1.96
|
| Rate for Payer: BCN Medicare Advantage |
$0.84
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$6.73
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$7.04
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.87
|
| Rate for Payer: Mclaren Medicaid |
$0.59
|
| Rate for Payer: Mclaren Medicaid |
$1.52
|
| Rate for Payer: Mclaren Medicaid |
$1.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.27
|
| Rate for Payer: Meridian Medicaid |
$1.60
|
| Rate for Payer: Meridian Medicaid |
$0.62
|
| Rate for Payer: Meridian Medicaid |
$1.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.65
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: Nomi Health Commercial |
$6.41
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: PACE Senior Care Partners |
$1.86
|
| Rate for Payer: PACE Senior Care Partners |
$0.80
|
| Rate for Payer: PACE Senior Care Partners |
$2.05
|
| Rate for Payer: PACE SWMI |
$2.16
|
| Rate for Payer: PACE SWMI |
$1.96
|
| Rate for Payer: PACE SWMI |
$0.84
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$6.65
|
| Rate for Payer: PHP Medicare Advantage |
$1.96
|
| Rate for Payer: PHP Medicare Advantage |
$0.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.52
|
| Rate for Payer: Priority Health Medicare |
$2.18
|
| Rate for Payer: Priority Health Medicare |
$1.97
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1.96
|
| Rate for Payer: Railroad Medicare Medicare |
$2.16
|
| Rate for Payer: Railroad Medicare Medicare |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.96
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: UHC Core |
$6.53
|
| Rate for Payer: UHC Exchange |
$2.16
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UHC Medicaid |
$0.59
|
| Rate for Payer: UHC Medicaid |
$1.52
|
| Rate for Payer: UHC Medicaid |
$1.38
|
| Rate for Payer: UHC Medicare Advantage |
$1.96
|
| Rate for Payer: UHC Medicare Advantage |
$0.84
|
| Rate for Payer: UHC Medicare Advantage |
$2.16
|
| Rate for Payer: UHCCP Medicaid |
$1.38
|
| Rate for Payer: UHCCP Medicaid |
$0.59
|
| Rate for Payer: UHCCP Medicaid |
$1.52
|
| Rate for Payer: VA VA |
$0.84
|
| Rate for Payer: VA VA |
$2.16
|
| Rate for Payer: VA VA |
$1.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$153.30
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: Aetna Medicare |
$39.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.91
|
| Rate for Payer: BCBS Complete |
$28.38
|
| Rate for Payer: BCBS MAPPO |
$38.33
|
| Rate for Payer: BCBS Trust/PPO |
$126.03
|
| Rate for Payer: BCN Commercial |
$126.03
|
| Rate for Payer: BCN Medicare Advantage |
$38.33
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cofinity Commercial |
$131.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.33
|
| Rate for Payer: Healthscope Commercial |
$137.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.97
|
| Rate for Payer: Mclaren Medicaid |
$27.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.24
|
| Rate for Payer: Meridian Medicaid |
$28.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.31
|
| Rate for Payer: Nomi Health Commercial |
$125.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.97
|
| Rate for Payer: PACE Senior Care Partners |
$36.41
|
| Rate for Payer: PACE SWMI |
$38.33
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: PHP Medicare Advantage |
$38.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.37
|
| Rate for Payer: Priority Health Medicare |
$38.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.70
|
| Rate for Payer: Railroad Medicare Medicare |
$38.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.90
|
| Rate for Payer: UHC Core |
$128.01
|
| Rate for Payer: UHC Exchange |
$38.33
|
| Rate for Payer: UHC Medicaid |
$27.03
|
| Rate for Payer: UHC Medicare Advantage |
$38.33
|
| Rate for Payer: UHCCP Medicaid |
$27.03
|
| Rate for Payer: VA VA |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.97
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$153.30
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: BCBS Trust/PPO |
$126.61
|
| Rate for Payer: BCN Commercial |
$126.61
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cofinity Commercial |
$131.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.64
|
| Rate for Payer: Healthscope Commercial |
$137.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.31
|
| Rate for Payer: Nomi Health Commercial |
$125.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.97
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.90
|
| Rate for Payer: UHC Core |
$128.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.97
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: BCBS Trust/PPO |
$90.19
|
| Rate for Payer: BCN Commercial |
$90.19
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$93.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$98.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Nomi Health Commercial |
$89.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.90
|
| Rate for Payer: PHP Commercial |
$92.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.10
|
| Rate for Payer: UHC Core |
$91.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: Aetna Medicare |
$28.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.12
|
| Rate for Payer: BCBS Complete |
$20.21
|
| Rate for Payer: BCBS MAPPO |
$27.30
|
| Rate for Payer: BCBS Trust/PPO |
$89.77
|
| Rate for Payer: BCN Commercial |
$89.77
|
| Rate for Payer: BCN Medicare Advantage |
$27.30
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$93.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$98.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.90
|
| Rate for Payer: Mclaren Medicaid |
$19.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.66
|
| Rate for Payer: Meridian Medicaid |
$20.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Nomi Health Commercial |
$89.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.90
|
| Rate for Payer: PACE Senior Care Partners |
$25.93
|
| Rate for Payer: PACE SWMI |
$27.30
|
| Rate for Payer: PHP Commercial |
$92.82
|
| Rate for Payer: PHP Medicare Advantage |
$27.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.00
|
| Rate for Payer: Priority Health Medicare |
$27.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.00
|
| Rate for Payer: Railroad Medicare Medicare |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.10
|
| Rate for Payer: UHC Core |
$91.18
|
| Rate for Payer: UHC Exchange |
$27.30
|
| Rate for Payer: UHC Medicaid |
$19.25
|
| Rate for Payer: UHC Medicare Advantage |
$27.30
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: VA VA |
$27.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$49.70
|
|
|
Service Code
|
NDC 00054074287
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$44.73 |
| Rate for Payer: Aetna Commercial |
$42.24
|
| Rate for Payer: BCBS Trust/PPO |
$41.05
|
| Rate for Payer: BCN Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cofinity Commercial |
$42.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.76
|
| Rate for Payer: Healthscope Commercial |
$44.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.24
|
| Rate for Payer: Nomi Health Commercial |
$40.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.27
|
| Rate for Payer: PHP Commercial |
$42.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.74
|
| Rate for Payer: UHC Core |
$41.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.27
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$49.70
|
|
|
Service Code
|
NDC 00054074287
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$44.73 |
| Rate for Payer: Aetna Commercial |
$42.24
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.53
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$12.43
|
| Rate for Payer: BCBS Trust/PPO |
$40.86
|
| Rate for Payer: BCN Commercial |
$40.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.43
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cofinity Commercial |
$42.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.43
|
| Rate for Payer: Healthscope Commercial |
$44.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.27
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.05
|
| Rate for Payer: Meridian Medicaid |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.24
|
| Rate for Payer: Nomi Health Commercial |
$40.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.27
|
| Rate for Payer: PACE Senior Care Partners |
$11.80
|
| Rate for Payer: PACE SWMI |
$12.43
|
| Rate for Payer: PHP Commercial |
$42.24
|
| Rate for Payer: PHP Medicare Advantage |
$12.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.24
|
| Rate for Payer: Priority Health Medicare |
$12.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.74
|
| Rate for Payer: UHC Core |
$41.50
|
| Rate for Payer: UHC Exchange |
$12.43
|
| Rate for Payer: UHC Medicaid |
$8.76
|
| Rate for Payer: UHC Medicare Advantage |
$12.43
|
| Rate for Payer: UHCCP Medicaid |
$8.76
|
| Rate for Payer: VA VA |
$12.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.27
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$153.30
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: BCBS Trust/PPO |
$126.61
|
| Rate for Payer: BCN Commercial |
$126.61
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cofinity Commercial |
$131.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.64
|
| Rate for Payer: Healthscope Commercial |
$137.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.31
|
| Rate for Payer: Nomi Health Commercial |
$125.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.97
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.90
|
| Rate for Payer: UHC Core |
$128.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.97
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$153.30
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: Aetna Medicare |
$39.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.91
|
| Rate for Payer: BCBS Complete |
$28.38
|
| Rate for Payer: BCBS MAPPO |
$38.33
|
| Rate for Payer: BCBS Trust/PPO |
$126.03
|
| Rate for Payer: BCN Commercial |
$126.03
|
| Rate for Payer: BCN Medicare Advantage |
$38.33
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cofinity Commercial |
$131.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.33
|
| Rate for Payer: Healthscope Commercial |
$137.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.97
|
| Rate for Payer: Mclaren Medicaid |
$27.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.24
|
| Rate for Payer: Meridian Medicaid |
$28.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.31
|
| Rate for Payer: Nomi Health Commercial |
$125.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.97
|
| Rate for Payer: PACE Senior Care Partners |
$36.41
|
| Rate for Payer: PACE SWMI |
$38.33
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: PHP Medicare Advantage |
$38.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.37
|
| Rate for Payer: Priority Health Medicare |
$38.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.70
|
| Rate for Payer: Railroad Medicare Medicare |
$38.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.90
|
| Rate for Payer: UHC Core |
$128.01
|
| Rate for Payer: UHC Exchange |
$38.33
|
| Rate for Payer: UHC Medicaid |
$27.03
|
| Rate for Payer: UHC Medicare Advantage |
$38.33
|
| Rate for Payer: UHCCP Medicaid |
$27.03
|
| Rate for Payer: VA VA |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.97
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$12,062.24
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$11,487.85 |
| Max. Negotiated Rate |
$12,062.24 |
| Rate for Payer: BCBS Complete |
$12,062.24
|
| Rate for Payer: Mclaren Medicaid |
$11,487.85
|
| Rate for Payer: Meridian Medicaid |
$12,062.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,487.85
|
| Rate for Payer: UHC Medicaid |
$11,487.85
|
| Rate for Payer: UHCCP Medicaid |
$11,487.85
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$2,955.22
|
|
|
Service Code
|
APR-DRG 7751
|
| Min. Negotiated Rate |
$2,814.50 |
| Max. Negotiated Rate |
$2,955.22 |
| Rate for Payer: BCBS Complete |
$2,955.22
|
| Rate for Payer: Mclaren Medicaid |
$2,814.50
|
| Rate for Payer: Meridian Medicaid |
$2,955.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,814.50
|
| Rate for Payer: UHC Medicaid |
$2,814.50
|
| Rate for Payer: UHCCP Medicaid |
$2,814.50
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$5,971.96
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$5,687.59 |
| Max. Negotiated Rate |
$5,971.96 |
| Rate for Payer: BCBS Complete |
$5,971.96
|
| Rate for Payer: Mclaren Medicaid |
$5,687.59
|
| Rate for Payer: Meridian Medicaid |
$5,971.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,687.59
|
| Rate for Payer: UHC Medicaid |
$5,687.59
|
| Rate for Payer: UHCCP Medicaid |
$5,687.59
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,619.36
|
|
|
Service Code
|
APR-DRG 7752
|
| Min. Negotiated Rate |
$3,447.01 |
| Max. Negotiated Rate |
$3,619.36 |
| Rate for Payer: BCBS Complete |
$3,619.36
|
| Rate for Payer: Mclaren Medicaid |
$3,447.01
|
| Rate for Payer: Meridian Medicaid |
$3,619.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,447.01
|
| Rate for Payer: UHC Medicaid |
$3,447.01
|
| Rate for Payer: UHCCP Medicaid |
$3,447.01
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$3,129.27
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$2,980.26 |
| Max. Negotiated Rate |
$3,129.27 |
| Rate for Payer: BCBS Complete |
$3,129.27
|
| Rate for Payer: Mclaren Medicaid |
$2,980.26
|
| Rate for Payer: Meridian Medicaid |
$3,129.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,980.26
|
| Rate for Payer: UHC Medicaid |
$2,980.26
|
| Rate for Payer: UHCCP Medicaid |
$2,980.26
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$5,775.30
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$5,500.29 |
| Max. Negotiated Rate |
$5,775.30 |
| Rate for Payer: BCBS Complete |
$5,775.30
|
| Rate for Payer: Mclaren Medicaid |
$5,500.29
|
| Rate for Payer: Meridian Medicaid |
$5,775.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,500.29
|
| Rate for Payer: UHC Medicaid |
$5,500.29
|
| Rate for Payer: UHCCP Medicaid |
$5,500.29
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$4,177.27
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$3,978.36 |
| Max. Negotiated Rate |
$4,177.27 |
| Rate for Payer: BCBS Complete |
$4,177.27
|
| Rate for Payer: Mclaren Medicaid |
$3,978.36
|
| Rate for Payer: Meridian Medicaid |
$4,177.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,978.36
|
| Rate for Payer: UHC Medicaid |
$3,978.36
|
| Rate for Payer: UHCCP Medicaid |
$3,978.36
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$13,493.05
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$12,850.53 |
| Max. Negotiated Rate |
$13,493.05 |
| Rate for Payer: BCBS Complete |
$13,493.05
|
| Rate for Payer: Mclaren Medicaid |
$12,850.53
|
| Rate for Payer: Meridian Medicaid |
$13,493.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,850.53
|
| Rate for Payer: UHC Medicaid |
$12,850.53
|
| Rate for Payer: UHCCP Medicaid |
$12,850.53
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$2,112.30
|
|
|
Service Code
|
APR-DRG 8112
|
| Min. Negotiated Rate |
$2,011.71 |
| Max. Negotiated Rate |
$2,112.30 |
| Rate for Payer: BCBS Complete |
$2,112.30
|
| Rate for Payer: Mclaren Medicaid |
$2,011.71
|
| Rate for Payer: Meridian Medicaid |
$2,112.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,011.71
|
| Rate for Payer: UHC Medicaid |
$2,011.71
|
| Rate for Payer: UHCCP Medicaid |
$2,011.71
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$1,463.41
|
|
|
Service Code
|
APR-DRG 8111
|
| Min. Negotiated Rate |
$1,393.73 |
| Max. Negotiated Rate |
$1,463.41 |
| Rate for Payer: BCBS Complete |
$1,463.41
|
| Rate for Payer: Mclaren Medicaid |
$1,393.73
|
| Rate for Payer: Meridian Medicaid |
$1,463.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,393.73
|
| Rate for Payer: UHC Medicaid |
$1,393.73
|
| Rate for Payer: UHCCP Medicaid |
$1,393.73
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$4,688.39
|
|
|
Service Code
|
APR-DRG 8113
|
| Min. Negotiated Rate |
$4,465.13 |
| Max. Negotiated Rate |
$4,688.39 |
| Rate for Payer: BCBS Complete |
$4,688.39
|
| Rate for Payer: Mclaren Medicaid |
$4,465.13
|
| Rate for Payer: Meridian Medicaid |
$4,688.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,465.13
|
| Rate for Payer: UHC Medicaid |
$4,465.13
|
| Rate for Payer: UHCCP Medicaid |
$4,465.13
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$9,430.94
|
|
|
Service Code
|
APR-DRG 8114
|
| Min. Negotiated Rate |
$8,981.85 |
| Max. Negotiated Rate |
$9,430.94 |
| Rate for Payer: BCBS Complete |
$9,430.94
|
| Rate for Payer: Mclaren Medicaid |
$8,981.85
|
| Rate for Payer: Meridian Medicaid |
$9,430.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,981.85
|
| Rate for Payer: UHC Medicaid |
$8,981.85
|
| Rate for Payer: UHCCP Medicaid |
$8,981.85
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$124,000.96
|
|
|
Service Code
|
APR-DRG 0074
|
| Min. Negotiated Rate |
$118,096.15 |
| Max. Negotiated Rate |
$124,000.96 |
| Rate for Payer: BCBS Complete |
$124,000.96
|
| Rate for Payer: Mclaren Medicaid |
$118,096.15
|
| Rate for Payer: Meridian Medicaid |
$124,000.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$118,096.15
|
| Rate for Payer: UHC Medicaid |
$118,096.15
|
| Rate for Payer: UHCCP Medicaid |
$118,096.15
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$56,801.76
|
|
|
Service Code
|
APR-DRG 0072
|
| Min. Negotiated Rate |
$54,096.92 |
| Max. Negotiated Rate |
$56,801.76 |
| Rate for Payer: BCBS Complete |
$56,801.76
|
| Rate for Payer: Mclaren Medicaid |
$54,096.92
|
| Rate for Payer: Meridian Medicaid |
$56,801.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$54,096.92
|
| Rate for Payer: UHC Medicaid |
$54,096.92
|
| Rate for Payer: UHCCP Medicaid |
$54,096.92
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$59,119.67
|
|
|
Service Code
|
APR-DRG 0073
|
| Min. Negotiated Rate |
$56,304.44 |
| Max. Negotiated Rate |
$59,119.67 |
| Rate for Payer: BCBS Complete |
$59,119.67
|
| Rate for Payer: Mclaren Medicaid |
$56,304.44
|
| Rate for Payer: Meridian Medicaid |
$59,119.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$56,304.44
|
| Rate for Payer: UHC Medicaid |
$56,304.44
|
| Rate for Payer: UHCCP Medicaid |
$56,304.44
|
|
