|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
OP
|
$563.91
|
|
|
Service Code
|
NDC 59762045001
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$507.52 |
| Rate for Payer: Aetna Commercial |
$479.32
|
| Rate for Payer: Aetna Medicare |
$146.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.22
|
| Rate for Payer: BCBS Complete |
$104.38
|
| Rate for Payer: BCBS MAPPO |
$140.98
|
| Rate for Payer: BCBS Trust/PPO |
$463.59
|
| Rate for Payer: BCN Commercial |
$463.59
|
| Rate for Payer: BCN Medicare Advantage |
$140.98
|
| Rate for Payer: Cash Price |
$451.13
|
| Rate for Payer: Cofinity Commercial |
$484.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.98
|
| Rate for Payer: Healthscope Commercial |
$507.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.93
|
| Rate for Payer: Mclaren Medicaid |
$99.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.03
|
| Rate for Payer: Meridian Medicaid |
$104.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$155.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.32
|
| Rate for Payer: Nomi Health Commercial |
$462.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.93
|
| Rate for Payer: PACE Senior Care Partners |
$133.93
|
| Rate for Payer: PACE SWMI |
$140.98
|
| Rate for Payer: PHP Commercial |
$479.32
|
| Rate for Payer: PHP Medicare Advantage |
$140.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$490.60
|
| Rate for Payer: Priority Health Medicare |
$142.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.48
|
| Rate for Payer: Railroad Medicare Medicare |
$140.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.24
|
| Rate for Payer: UHC Core |
$470.86
|
| Rate for Payer: UHC Exchange |
$140.98
|
| Rate for Payer: UHC Medicaid |
$99.42
|
| Rate for Payer: UHC Medicare Advantage |
$140.98
|
| Rate for Payer: UHCCP Medicaid |
$99.42
|
| Rate for Payer: VA VA |
$140.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.93
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$1,137.57
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$791.75 |
| Max. Negotiated Rate |
$1,023.81 |
| Rate for Payer: Aetna Commercial |
$966.93
|
| Rate for Payer: BCBS Trust/PPO |
$939.52
|
| Rate for Payer: BCN Commercial |
$939.52
|
| Rate for Payer: Cash Price |
$910.06
|
| Rate for Payer: Cofinity Commercial |
$978.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.06
|
| Rate for Payer: Healthscope Commercial |
$1,023.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.93
|
| Rate for Payer: Nomi Health Commercial |
$932.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$853.18
|
| Rate for Payer: PHP Commercial |
$966.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$989.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$791.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,001.06
|
| Rate for Payer: UHC Core |
$949.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.18
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$1,137.57
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.55 |
| Max. Negotiated Rate |
$1,023.81 |
| Rate for Payer: Aetna Commercial |
$966.93
|
| Rate for Payer: Aetna Medicare |
$295.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$355.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$355.49
|
| Rate for Payer: BCBS Complete |
$210.56
|
| Rate for Payer: BCBS MAPPO |
$284.39
|
| Rate for Payer: BCBS Trust/PPO |
$935.20
|
| Rate for Payer: BCN Commercial |
$935.20
|
| Rate for Payer: BCN Medicare Advantage |
$284.39
|
| Rate for Payer: Cash Price |
$910.06
|
| Rate for Payer: Cofinity Commercial |
$978.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.39
|
| Rate for Payer: Healthscope Commercial |
$1,023.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.18
|
| Rate for Payer: Mclaren Medicaid |
$200.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.61
|
| Rate for Payer: Meridian Medicaid |
$210.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$312.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.93
|
| Rate for Payer: Nomi Health Commercial |
$932.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$853.18
|
| Rate for Payer: PACE Senior Care Partners |
$270.17
|
| Rate for Payer: PACE SWMI |
$284.39
|
| Rate for Payer: PHP Commercial |
$966.93
|
| Rate for Payer: PHP Medicare Advantage |
$284.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$989.69
|
| Rate for Payer: Priority Health Medicare |
$287.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$791.75
|
| Rate for Payer: Railroad Medicare Medicare |
$284.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,001.06
|
| Rate for Payer: UHC Core |
$949.87
|
| Rate for Payer: UHC Exchange |
$284.39
|
| Rate for Payer: UHC Medicaid |
$200.55
|
| Rate for Payer: UHC Medicare Advantage |
$284.39
|
| Rate for Payer: UHCCP Medicaid |
$200.55
|
| Rate for Payer: VA VA |
$284.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.18
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S) OF THE CERVIX
|
Facility
|
OP
|
$295.08
|
|
|
Service Code
|
CPT 57460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$295.08 |
| Max. Negotiated Rate |
$295.08 |
| Rate for Payer: BCCCP Commercial |
$295.08
|
|
|
COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID
|
Facility
|
OP
|
$192.99
|
|
|
Service Code
|
NDC 00574030216
|
| Hospital Charge Code |
119062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.02 |
| Max. Negotiated Rate |
$173.69 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$50.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.31
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: BCBS MAPPO |
$48.25
|
| Rate for Payer: BCBS Trust/PPO |
$158.66
|
| Rate for Payer: BCN Commercial |
$158.66
|
| Rate for Payer: BCN Medicare Advantage |
$48.25
|
| Rate for Payer: Cash Price |
$154.39
|
| Rate for Payer: Cofinity Commercial |
$165.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.25
|
| Rate for Payer: Healthscope Commercial |
$173.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.74
|
| Rate for Payer: Mclaren Medicaid |
$34.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.66
|
| Rate for Payer: Meridian Medicaid |
$35.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.04
|
| Rate for Payer: Nomi Health Commercial |
$158.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.74
|
| Rate for Payer: PACE Senior Care Partners |
$45.84
|
| Rate for Payer: PACE SWMI |
$48.25
|
| Rate for Payer: PHP Commercial |
$164.04
|
| Rate for Payer: PHP Medicare Advantage |
$48.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.90
|
| Rate for Payer: Priority Health Medicare |
$48.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.32
|
| Rate for Payer: Railroad Medicare Medicare |
$48.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.83
|
| Rate for Payer: UHC Core |
$161.15
|
| Rate for Payer: UHC Exchange |
$48.25
|
| Rate for Payer: UHC Medicaid |
$34.02
|
| Rate for Payer: UHC Medicare Advantage |
$48.25
|
| Rate for Payer: UHCCP Medicaid |
$34.02
|
| Rate for Payer: VA VA |
$48.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.74
|
|
|
COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID
|
Facility
|
IP
|
$192.99
|
|
|
Service Code
|
NDC 00574030216
|
| Hospital Charge Code |
119062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$173.69 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: BCBS Trust/PPO |
$159.39
|
| Rate for Payer: BCN Commercial |
$159.39
|
| Rate for Payer: Cash Price |
$154.39
|
| Rate for Payer: Cofinity Commercial |
$165.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.39
|
| Rate for Payer: Healthscope Commercial |
$173.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.04
|
| Rate for Payer: Nomi Health Commercial |
$158.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.74
|
| Rate for Payer: PHP Commercial |
$164.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.83
|
| Rate for Payer: UHC Core |
$161.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.74
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$293.81
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$293.81 |
| Max. Negotiated Rate |
$293.81 |
| Rate for Payer: BCCCP Commercial |
$293.81
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
OP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.90 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna Medicare |
$681.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$818.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$818.74
|
| Rate for Payer: BCBS Complete |
$484.96
|
| Rate for Payer: BCBS MAPPO |
$654.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,153.88
|
| Rate for Payer: BCN Commercial |
$2,153.88
|
| Rate for Payer: BCN Medicare Advantage |
$654.99
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.99
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: Mclaren Medicaid |
$461.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.74
|
| Rate for Payer: Meridian Medicaid |
$484.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$753.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$720.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Nomi Health Commercial |
$2,148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PACE Senior Care Partners |
$622.24
|
| Rate for Payer: PACE SWMI |
$654.99
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: PHP Medicare Advantage |
$654.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,279.37
|
| Rate for Payer: Priority Health Medicare |
$661.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,823.50
|
| Rate for Payer: Railroad Medicare Medicare |
$654.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,305.57
|
| Rate for Payer: UHC Core |
$2,187.67
|
| Rate for Payer: UHC Exchange |
$654.99
|
| Rate for Payer: UHC Medicaid |
$461.90
|
| Rate for Payer: UHC Medicare Advantage |
$654.99
|
| Rate for Payer: UHCCP Medicaid |
$461.90
|
| Rate for Payer: VA VA |
$654.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
IP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,823.50 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,163.83
|
| Rate for Payer: BCN Commercial |
$2,163.83
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Nomi Health Commercial |
$2,148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,279.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,823.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,305.57
|
| Rate for Payer: UHC Core |
$2,187.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
OP
|
$1,615.11
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$284.74 |
| Max. Negotiated Rate |
$1,453.60 |
| Rate for Payer: Aetna Commercial |
$1,372.84
|
| Rate for Payer: Aetna Medicare |
$419.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$504.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$504.72
|
| Rate for Payer: BCBS Complete |
$298.96
|
| Rate for Payer: BCBS MAPPO |
$403.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.78
|
| Rate for Payer: BCN Commercial |
$1,327.78
|
| Rate for Payer: BCN Medicare Advantage |
$403.78
|
| Rate for Payer: Cash Price |
$1,292.09
|
| Rate for Payer: Cofinity Commercial |
$1,388.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,292.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.78
|
| Rate for Payer: Healthscope Commercial |
$1,453.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,211.33
|
| Rate for Payer: Mclaren Medicaid |
$284.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.97
|
| Rate for Payer: Meridian Medicaid |
$298.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$464.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$444.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,372.84
|
| Rate for Payer: Nomi Health Commercial |
$1,324.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,211.33
|
| Rate for Payer: PACE Senior Care Partners |
$383.59
|
| Rate for Payer: PACE SWMI |
$403.78
|
| Rate for Payer: PHP Commercial |
$1,372.84
|
| Rate for Payer: PHP Medicare Advantage |
$403.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,405.15
|
| Rate for Payer: Priority Health Medicare |
$407.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,124.12
|
| Rate for Payer: Railroad Medicare Medicare |
$403.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,421.30
|
| Rate for Payer: UHC Core |
$1,348.62
|
| Rate for Payer: UHC Exchange |
$403.78
|
| Rate for Payer: UHC Medicaid |
$284.74
|
| Rate for Payer: UHC Medicare Advantage |
$403.78
|
| Rate for Payer: UHCCP Medicaid |
$284.74
|
| Rate for Payer: VA VA |
$403.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,211.33
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,615.11
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,124.12 |
| Max. Negotiated Rate |
$1,453.60 |
| Rate for Payer: Aetna Commercial |
$1,372.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,333.92
|
| Rate for Payer: BCN Commercial |
$1,333.92
|
| Rate for Payer: Cash Price |
$1,292.09
|
| Rate for Payer: Cofinity Commercial |
$1,388.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,292.09
|
| Rate for Payer: Healthscope Commercial |
$1,453.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,211.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,372.84
|
| Rate for Payer: Nomi Health Commercial |
$1,324.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,211.33
|
| Rate for Payer: PHP Commercial |
$1,372.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,405.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,124.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,421.30
|
| Rate for Payer: UHC Core |
$1,348.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,211.33
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
OP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.90 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna Medicare |
$681.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$818.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$818.74
|
| Rate for Payer: BCBS Complete |
$484.96
|
| Rate for Payer: BCBS MAPPO |
$654.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,153.88
|
| Rate for Payer: BCN Commercial |
$2,153.88
|
| Rate for Payer: BCN Medicare Advantage |
$654.99
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.99
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: Mclaren Medicaid |
$461.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.74
|
| Rate for Payer: Meridian Medicaid |
$484.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$753.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$720.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Nomi Health Commercial |
$2,148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PACE Senior Care Partners |
$622.24
|
| Rate for Payer: PACE SWMI |
$654.99
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: PHP Medicare Advantage |
$654.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,279.37
|
| Rate for Payer: Priority Health Medicare |
$661.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,823.50
|
| Rate for Payer: Railroad Medicare Medicare |
$654.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,305.57
|
| Rate for Payer: UHC Core |
$2,187.67
|
| Rate for Payer: UHC Exchange |
$654.99
|
| Rate for Payer: UHC Medicaid |
$461.90
|
| Rate for Payer: UHC Medicare Advantage |
$654.99
|
| Rate for Payer: UHCCP Medicaid |
$461.90
|
| Rate for Payer: VA VA |
$654.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
IP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,823.50 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,163.83
|
| Rate for Payer: BCN Commercial |
$2,163.83
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Nomi Health Commercial |
$2,148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,279.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,823.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,305.57
|
| Rate for Payer: UHC Core |
$2,187.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$7,938.08
|
|
|
Service Code
|
APR-DRG 3463
|
| Min. Negotiated Rate |
$7,560.08 |
| Max. Negotiated Rate |
$7,938.08 |
| Rate for Payer: BCBS Complete |
$7,938.08
|
| Rate for Payer: Mclaren Medicaid |
$7,560.08
|
| Rate for Payer: Meridian Medicaid |
$7,938.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,560.08
|
| Rate for Payer: UHC Medicaid |
$7,560.08
|
| Rate for Payer: UHCCP Medicaid |
$7,560.08
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$14,726.15
|
|
|
Service Code
|
APR-DRG 3464
|
| Min. Negotiated Rate |
$14,024.90 |
| Max. Negotiated Rate |
$14,726.15 |
| Rate for Payer: BCBS Complete |
$14,726.15
|
| Rate for Payer: Mclaren Medicaid |
$14,024.90
|
| Rate for Payer: Meridian Medicaid |
$14,726.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,024.90
|
| Rate for Payer: UHC Medicaid |
$14,024.90
|
| Rate for Payer: UHCCP Medicaid |
$14,024.90
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$4,811.44
|
|
|
Service Code
|
APR-DRG 3461
|
| Min. Negotiated Rate |
$4,582.32 |
| Max. Negotiated Rate |
$4,811.44 |
| Rate for Payer: BCBS Complete |
$4,811.44
|
| Rate for Payer: Mclaren Medicaid |
$4,582.32
|
| Rate for Payer: Meridian Medicaid |
$4,811.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,582.32
|
| Rate for Payer: UHC Medicaid |
$4,582.32
|
| Rate for Payer: UHCCP Medicaid |
$4,582.32
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$5,746.38
|
|
|
Service Code
|
APR-DRG 3462
|
| Min. Negotiated Rate |
$5,472.74 |
| Max. Negotiated Rate |
$5,746.38 |
| Rate for Payer: BCBS Complete |
$5,746.38
|
| Rate for Payer: Mclaren Medicaid |
$5,472.74
|
| Rate for Payer: Meridian Medicaid |
$5,746.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,472.74
|
| Rate for Payer: UHC Medicaid |
$5,472.74
|
| Rate for Payer: UHCCP Medicaid |
$5,472.74
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$3,728.73
|
|
|
Service Code
|
APR-DRG 3841
|
| Min. Negotiated Rate |
$3,551.17 |
| Max. Negotiated Rate |
$3,728.73 |
| Rate for Payer: BCBS Complete |
$3,728.73
|
| Rate for Payer: Mclaren Medicaid |
$3,551.17
|
| Rate for Payer: Meridian Medicaid |
$3,728.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,551.17
|
| Rate for Payer: UHC Medicaid |
$3,551.17
|
| Rate for Payer: UHCCP Medicaid |
$3,551.17
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$7,535.81
|
|
|
Service Code
|
APR-DRG 3843
|
| Min. Negotiated Rate |
$7,176.96 |
| Max. Negotiated Rate |
$7,535.81 |
| Rate for Payer: BCBS Complete |
$7,535.81
|
| Rate for Payer: Mclaren Medicaid |
$7,176.96
|
| Rate for Payer: Meridian Medicaid |
$7,535.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,176.96
|
| Rate for Payer: UHC Medicaid |
$7,176.96
|
| Rate for Payer: UHCCP Medicaid |
$7,176.96
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$13,593.49
|
|
|
Service Code
|
APR-DRG 3844
|
| Min. Negotiated Rate |
$12,946.18 |
| Max. Negotiated Rate |
$13,593.49 |
| Rate for Payer: BCBS Complete |
$13,593.49
|
| Rate for Payer: Mclaren Medicaid |
$12,946.18
|
| Rate for Payer: Meridian Medicaid |
$13,593.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,946.18
|
| Rate for Payer: UHC Medicaid |
$12,946.18
|
| Rate for Payer: UHCCP Medicaid |
$12,946.18
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$4,686.29
|
|
|
Service Code
|
APR-DRG 3842
|
| Min. Negotiated Rate |
$4,463.13 |
| Max. Negotiated Rate |
$4,686.29 |
| Rate for Payer: BCBS Complete |
$4,686.29
|
| Rate for Payer: Mclaren Medicaid |
$4,463.13
|
| Rate for Payer: Meridian Medicaid |
$4,686.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,463.13
|
| Rate for Payer: UHC Medicaid |
$4,463.13
|
| Rate for Payer: UHCCP Medicaid |
$4,463.13
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$21,109.32
|
|
|
Service Code
|
APR-DRG 1651
|
| Min. Negotiated Rate |
$20,104.12 |
| Max. Negotiated Rate |
$21,109.32 |
| Rate for Payer: BCBS Complete |
$21,109.32
|
| Rate for Payer: Mclaren Medicaid |
$20,104.12
|
| Rate for Payer: Meridian Medicaid |
$21,109.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,104.12
|
| Rate for Payer: UHC Medicaid |
$20,104.12
|
| Rate for Payer: UHCCP Medicaid |
$20,104.12
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$32,863.42
|
|
|
Service Code
|
APR-DRG 1654
|
| Min. Negotiated Rate |
$31,298.50 |
| Max. Negotiated Rate |
$32,863.42 |
| Rate for Payer: BCBS Complete |
$32,863.42
|
| Rate for Payer: Mclaren Medicaid |
$31,298.50
|
| Rate for Payer: Meridian Medicaid |
$32,863.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,298.50
|
| Rate for Payer: UHC Medicaid |
$31,298.50
|
| Rate for Payer: UHCCP Medicaid |
$31,298.50
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$29,067.91
|
|
|
Service Code
|
APR-DRG 1653
|
| Min. Negotiated Rate |
$27,683.72 |
| Max. Negotiated Rate |
$29,067.91 |
| Rate for Payer: BCBS Complete |
$29,067.91
|
| Rate for Payer: Mclaren Medicaid |
$27,683.72
|
| Rate for Payer: Meridian Medicaid |
$29,067.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,683.72
|
| Rate for Payer: UHC Medicaid |
$27,683.72
|
| Rate for Payer: UHCCP Medicaid |
$27,683.72
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$24,244.38
|
|
|
Service Code
|
APR-DRG 1652
|
| Min. Negotiated Rate |
$23,089.88 |
| Max. Negotiated Rate |
$24,244.38 |
| Rate for Payer: BCBS Complete |
$24,244.38
|
| Rate for Payer: Mclaren Medicaid |
$23,089.88
|
| Rate for Payer: Meridian Medicaid |
$24,244.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,089.88
|
| Rate for Payer: UHC Medicaid |
$23,089.88
|
| Rate for Payer: UHCCP Medicaid |
$23,089.88
|
|
