|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$17,092.96
|
|
|
Service Code
|
APR-DRG 1661
|
| Min. Negotiated Rate |
$16,279.00 |
| Max. Negotiated Rate |
$17,092.96 |
| Rate for Payer: BCBS Complete |
$17,092.96
|
| Rate for Payer: Mclaren Medicaid |
$16,279.00
|
| Rate for Payer: Meridian Medicaid |
$17,092.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,279.00
|
| Rate for Payer: UHC Medicaid |
$16,279.00
|
| Rate for Payer: UHCCP Medicaid |
$16,279.00
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$21,633.06
|
|
|
Service Code
|
APR-DRG 1663
|
| Min. Negotiated Rate |
$20,602.91 |
| Max. Negotiated Rate |
$21,633.06 |
| Rate for Payer: BCBS Complete |
$21,633.06
|
| Rate for Payer: Mclaren Medicaid |
$20,602.91
|
| Rate for Payer: Meridian Medicaid |
$21,633.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,602.91
|
| Rate for Payer: UHC Medicaid |
$20,602.91
|
| Rate for Payer: UHCCP Medicaid |
$20,602.91
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$32,747.74
|
|
|
Service Code
|
APR-DRG 1664
|
| Min. Negotiated Rate |
$31,188.32 |
| Max. Negotiated Rate |
$32,747.74 |
| Rate for Payer: BCBS Complete |
$32,747.74
|
| Rate for Payer: Mclaren Medicaid |
$31,188.32
|
| Rate for Payer: Meridian Medicaid |
$32,747.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,188.32
|
| Rate for Payer: UHC Medicaid |
$31,188.32
|
| Rate for Payer: UHCCP Medicaid |
$31,188.32
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$20,513.54
|
|
|
Service Code
|
APR-DRG 1662
|
| Min. Negotiated Rate |
$19,536.71 |
| Max. Negotiated Rate |
$20,513.54 |
| Rate for Payer: BCBS Complete |
$20,513.54
|
| Rate for Payer: Mclaren Medicaid |
$19,536.71
|
| Rate for Payer: Meridian Medicaid |
$20,513.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,536.71
|
| Rate for Payer: UHC Medicaid |
$19,536.71
|
| Rate for Payer: UHCCP Medicaid |
$19,536.71
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$131.82
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.24 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Medicare |
$34.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.19
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$108.37
|
| Rate for Payer: BCN Commercial |
$108.37
|
| Rate for Payer: BCN Medicare Advantage |
$32.95
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.95
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Mclaren Medicaid |
$23.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.60
|
| Rate for Payer: Meridian Medicaid |
$24.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Nomi Health Commercial |
$108.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.86
|
| Rate for Payer: PACE Senior Care Partners |
$31.31
|
| Rate for Payer: PACE SWMI |
$32.95
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: PHP Medicare Advantage |
$32.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.68
|
| Rate for Payer: Priority Health Medicare |
$33.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.75
|
| Rate for Payer: Railroad Medicare Medicare |
$32.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.00
|
| Rate for Payer: UHC Core |
$110.07
|
| Rate for Payer: UHC Exchange |
$32.95
|
| Rate for Payer: UHC Medicaid |
$23.24
|
| Rate for Payer: UHC Medicare Advantage |
$32.95
|
| Rate for Payer: UHCCP Medicaid |
$23.24
|
| Rate for Payer: VA VA |
$32.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$131.82
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.75 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: BCBS Trust/PPO |
$108.87
|
| Rate for Payer: BCN Commercial |
$108.87
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Nomi Health Commercial |
$108.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.86
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.00
|
| Rate for Payer: UHC Core |
$110.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
|
|
CPT 0255T
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$351.75 |
| Rate for Payer: Aetna Medicare |
$234.50
|
| Rate for Payer: BCBS Complete |
$187.60
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.75
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$31,173.37
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$29,688.93 |
| Max. Negotiated Rate |
$31,173.37 |
| Rate for Payer: BCBS Complete |
$31,173.37
|
| Rate for Payer: Mclaren Medicaid |
$29,688.93
|
| Rate for Payer: Meridian Medicaid |
$31,173.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,688.93
|
| Rate for Payer: UHC Medicaid |
$29,688.93
|
| Rate for Payer: UHCCP Medicaid |
$29,688.93
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$18,142.01
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$17,278.10 |
| Max. Negotiated Rate |
$18,142.01 |
| Rate for Payer: BCBS Complete |
$18,142.01
|
| Rate for Payer: Mclaren Medicaid |
$17,278.10
|
| Rate for Payer: Meridian Medicaid |
$18,142.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,278.10
|
| Rate for Payer: UHC Medicaid |
$17,278.10
|
| Rate for Payer: UHCCP Medicaid |
$17,278.10
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$14,431.68
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$13,744.46 |
| Max. Negotiated Rate |
$14,431.68 |
| Rate for Payer: BCBS Complete |
$14,431.68
|
| Rate for Payer: Mclaren Medicaid |
$13,744.46
|
| Rate for Payer: Meridian Medicaid |
$14,431.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,744.46
|
| Rate for Payer: UHC Medicaid |
$13,744.46
|
| Rate for Payer: UHCCP Medicaid |
$13,744.46
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$26,458.17
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$25,198.25 |
| Max. Negotiated Rate |
$26,458.17 |
| Rate for Payer: BCBS Complete |
$26,458.17
|
| Rate for Payer: Mclaren Medicaid |
$25,198.25
|
| Rate for Payer: Meridian Medicaid |
$26,458.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,198.25
|
| Rate for Payer: UHC Medicaid |
$25,198.25
|
| Rate for Payer: UHCCP Medicaid |
$25,198.25
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$4,463.33
|
|
|
Service Code
|
APR-DRG 0451
|
| Min. Negotiated Rate |
$4,250.79 |
| Max. Negotiated Rate |
$4,463.33 |
| Rate for Payer: BCBS Complete |
$4,463.33
|
| Rate for Payer: Mclaren Medicaid |
$4,250.79
|
| Rate for Payer: Meridian Medicaid |
$4,463.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,250.79
|
| Rate for Payer: UHC Medicaid |
$4,250.79
|
| Rate for Payer: UHCCP Medicaid |
$4,250.79
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$5,915.17
|
|
|
Service Code
|
APR-DRG 0452
|
| Min. Negotiated Rate |
$5,633.50 |
| Max. Negotiated Rate |
$5,915.17 |
| Rate for Payer: BCBS Complete |
$5,915.17
|
| Rate for Payer: Mclaren Medicaid |
$5,633.50
|
| Rate for Payer: Meridian Medicaid |
$5,915.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,633.50
|
| Rate for Payer: UHC Medicaid |
$5,633.50
|
| Rate for Payer: UHCCP Medicaid |
$5,633.50
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$8,890.90
|
|
|
Service Code
|
APR-DRG 0453
|
| Min. Negotiated Rate |
$8,467.53 |
| Max. Negotiated Rate |
$8,890.90 |
| Rate for Payer: BCBS Complete |
$8,890.90
|
| Rate for Payer: Mclaren Medicaid |
$8,467.53
|
| Rate for Payer: Meridian Medicaid |
$8,890.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,467.53
|
| Rate for Payer: UHC Medicaid |
$8,467.53
|
| Rate for Payer: UHCCP Medicaid |
$8,467.53
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$13,017.17
|
|
|
Service Code
|
APR-DRG 0454
|
| Min. Negotiated Rate |
$12,397.30 |
| Max. Negotiated Rate |
$13,017.17 |
| Rate for Payer: BCBS Complete |
$13,017.17
|
| Rate for Payer: Mclaren Medicaid |
$12,397.30
|
| Rate for Payer: Meridian Medicaid |
$13,017.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,397.30
|
| Rate for Payer: UHC Medicaid |
$12,397.30
|
| Rate for Payer: UHCCP Medicaid |
$12,397.30
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$12.14
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: Aetna Commercial |
$10.32
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna Medicare |
$3.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS MAPPO |
$3.04
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$9.98
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCN Commercial |
$14.42
|
| Rate for Payer: BCN Commercial |
$9.98
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.04
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$10.44
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.04
|
| Rate for Payer: Healthscope Commercial |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Mclaren Medicaid |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.19
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.32
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Nomi Health Commercial |
$9.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PACE Senior Care Partners |
$4.17
|
| Rate for Payer: PACE Senior Care Partners |
$2.88
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PACE SWMI |
$3.04
|
| Rate for Payer: PHP Commercial |
$10.32
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Medicare Advantage |
$3.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.56
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: UHC Core |
$10.14
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Exchange |
$3.04
|
| Rate for Payer: UHC Medicaid |
$3.09
|
| Rate for Payer: UHC Medicaid |
$2.14
|
| Rate for Payer: UHC Medicare Advantage |
$3.04
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: UHCCP Medicaid |
$2.14
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: VA VA |
$3.04
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.11
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$12.14
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: Aetna Commercial |
$10.32
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: BCBS Trust/PPO |
$10.03
|
| Rate for Payer: BCBS Trust/PPO |
$14.49
|
| Rate for Payer: BCN Commercial |
$10.03
|
| Rate for Payer: BCN Commercial |
$14.49
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$9.95
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$10.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$10.14
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
NDC 77333093825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Commercial |
$3.34
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Nomi Health Commercial |
$3.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.26 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Medicare |
$105.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.31
|
| Rate for Payer: BCBS Complete |
$74.82
|
| Rate for Payer: BCBS MAPPO |
$101.05
|
| Rate for Payer: BCBS Trust/PPO |
$332.29
|
| Rate for Payer: BCN Commercial |
$332.29
|
| Rate for Payer: BCN Medicare Advantage |
$101.05
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.05
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Mclaren Medicaid |
$71.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.10
|
| Rate for Payer: Meridian Medicaid |
$74.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PACE Senior Care Partners |
$96.00
|
| Rate for Payer: PACE SWMI |
$101.05
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Medicare Advantage |
$101.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Medicare |
$102.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.32
|
| Rate for Payer: Railroad Medicare Medicare |
$101.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: UHC Exchange |
$101.05
|
| Rate for Payer: UHC Medicaid |
$71.26
|
| Rate for Payer: UHC Medicare Advantage |
$101.05
|
| Rate for Payer: UHCCP Medicaid |
$71.26
|
| Rate for Payer: VA VA |
$101.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 77333093825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.75
|
| Rate for Payer: BCBS MAPPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$3.33
|
| Rate for Payer: BCN Commercial |
$3.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.01
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.01
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Mclaren Medicaid |
$0.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: Meridian Medicaid |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Nomi Health Commercial |
$3.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PACE Senior Care Partners |
$0.96
|
| Rate for Payer: PACE SWMI |
$1.01
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: PHP Medicare Advantage |
$1.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.52
|
| Rate for Payer: Priority Health Medicare |
$1.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Medicaid |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: UHCCP Medicaid |
$0.71
|
| Rate for Payer: VA VA |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.32 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: BCBS Trust/PPO |
$333.83
|
| Rate for Payer: BCN Commercial |
$333.83
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
NDC 79854020060
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.26 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.50
|
| Rate for Payer: BCBS Complete |
$37.02
|
| Rate for Payer: BCBS MAPPO |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.42
|
| Rate for Payer: BCN Commercial |
$164.42
|
| Rate for Payer: BCN Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Mclaren Medicaid |
$35.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.50
|
| Rate for Payer: Meridian Medicaid |
$37.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PACE Senior Care Partners |
$47.50
|
| Rate for Payer: PACE SWMI |
$50.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$50.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Medicare |
$50.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.20
|
| Rate for Payer: Railroad Medicare Medicare |
$50.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: UHC Exchange |
$50.00
|
| Rate for Payer: UHC Medicaid |
$35.26
|
| Rate for Payer: UHC Medicare Advantage |
$50.00
|
| Rate for Payer: UHCCP Medicaid |
$35.26
|
| Rate for Payer: VA VA |
$50.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
NDC 77333093725
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.33
|
| Rate for Payer: BCN Commercial |
$1.33
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cofinity Commercial |
$1.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.29
|
| Rate for Payer: Healthscope Commercial |
$1.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.37
|
| Rate for Payer: Nomi Health Commercial |
$1.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.21
|
| Rate for Payer: PHP Commercial |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.42
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.21
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$160.60
|
|
|
Service Code
|
NDC 77333093710
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$144.54 |
| Rate for Payer: Aetna Commercial |
$136.51
|
| Rate for Payer: Aetna Medicare |
$41.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.19
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: BCBS MAPPO |
$40.15
|
| Rate for Payer: BCBS Trust/PPO |
$132.03
|
| Rate for Payer: BCN Commercial |
$132.03
|
| Rate for Payer: BCN Medicare Advantage |
$40.15
|
| Rate for Payer: Cash Price |
$128.48
|
| Rate for Payer: Cofinity Commercial |
$138.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.15
|
| Rate for Payer: Healthscope Commercial |
$144.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.45
|
| Rate for Payer: Mclaren Medicaid |
$28.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.16
|
| Rate for Payer: Meridian Medicaid |
$29.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.51
|
| Rate for Payer: Nomi Health Commercial |
$131.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.45
|
| Rate for Payer: PACE Senior Care Partners |
$38.14
|
| Rate for Payer: PACE SWMI |
$40.15
|
| Rate for Payer: PHP Commercial |
$136.51
|
| Rate for Payer: PHP Medicare Advantage |
$40.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.72
|
| Rate for Payer: Priority Health Medicare |
$40.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.78
|
| Rate for Payer: Railroad Medicare Medicare |
$40.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.33
|
| Rate for Payer: UHC Core |
$134.10
|
| Rate for Payer: UHC Exchange |
$40.15
|
| Rate for Payer: UHC Medicaid |
$28.31
|
| Rate for Payer: UHC Medicare Advantage |
$40.15
|
| Rate for Payer: UHCCP Medicaid |
$28.31
|
| Rate for Payer: VA VA |
$40.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.45
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$160.60
|
|
|
Service Code
|
NDC 77333093710
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.78 |
| Max. Negotiated Rate |
$144.54 |
| Rate for Payer: Aetna Commercial |
$136.51
|
| Rate for Payer: BCBS Trust/PPO |
$132.64
|
| Rate for Payer: BCN Commercial |
$132.64
|
| Rate for Payer: Cash Price |
$128.48
|
| Rate for Payer: Cofinity Commercial |
$138.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.48
|
| Rate for Payer: Healthscope Commercial |
$144.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.51
|
| Rate for Payer: Nomi Health Commercial |
$131.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.45
|
| Rate for Payer: PHP Commercial |
$136.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.33
|
| Rate for Payer: UHC Core |
$134.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.45
|
|
