|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
OP
|
$214.38
|
|
|
Service Code
|
NDC 00074445651
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: Aetna Medicare |
$55.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.99
|
| Rate for Payer: BCBS Complete |
$39.68
|
| Rate for Payer: BCBS MAPPO |
$53.59
|
| Rate for Payer: BCBS Trust/PPO |
$176.24
|
| Rate for Payer: BCN Commercial |
$176.24
|
| Rate for Payer: BCN Medicare Advantage |
$53.59
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.59
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: Mclaren Medicaid |
$37.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.27
|
| Rate for Payer: Meridian Medicaid |
$39.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.22
|
| Rate for Payer: Nomi Health Commercial |
$175.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.78
|
| Rate for Payer: PACE Senior Care Partners |
$50.92
|
| Rate for Payer: PACE SWMI |
$53.59
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: PHP Medicare Advantage |
$53.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$186.51
|
| Rate for Payer: Priority Health Medicare |
$54.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.21
|
| Rate for Payer: Railroad Medicare Medicare |
$53.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.65
|
| Rate for Payer: UHC Core |
$179.01
|
| Rate for Payer: UHC Exchange |
$53.59
|
| Rate for Payer: UHC Medicaid |
$37.80
|
| Rate for Payer: UHC Medicare Advantage |
$53.59
|
| Rate for Payer: UHCCP Medicaid |
$37.80
|
| Rate for Payer: VA VA |
$53.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
IP
|
$214.38
|
|
|
Service Code
|
NDC 00074445651
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.21 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: BCBS Trust/PPO |
$177.06
|
| Rate for Payer: BCN Commercial |
$177.06
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.22
|
| Rate for Payer: Nomi Health Commercial |
$175.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.78
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$186.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.65
|
| Rate for Payer: UHC Core |
$179.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
OP
|
$211.75
|
|
|
Service Code
|
NDC 66794002225
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna Commercial |
$179.99
|
| Rate for Payer: Aetna Medicare |
$55.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.17
|
| Rate for Payer: BCBS Complete |
$39.19
|
| Rate for Payer: BCBS MAPPO |
$52.94
|
| Rate for Payer: BCBS Trust/PPO |
$174.08
|
| Rate for Payer: BCN Commercial |
$174.08
|
| Rate for Payer: BCN Medicare Advantage |
$52.94
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$182.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.94
|
| Rate for Payer: Healthscope Commercial |
$190.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.81
|
| Rate for Payer: Mclaren Medicaid |
$37.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.58
|
| Rate for Payer: Meridian Medicaid |
$39.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.99
|
| Rate for Payer: Nomi Health Commercial |
$173.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.81
|
| Rate for Payer: PACE Senior Care Partners |
$50.29
|
| Rate for Payer: PACE SWMI |
$52.94
|
| Rate for Payer: PHP Commercial |
$179.99
|
| Rate for Payer: PHP Medicare Advantage |
$52.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.22
|
| Rate for Payer: Priority Health Medicare |
$53.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.38
|
| Rate for Payer: Railroad Medicare Medicare |
$52.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.34
|
| Rate for Payer: UHC Core |
$176.81
|
| Rate for Payer: UHC Exchange |
$52.94
|
| Rate for Payer: UHC Medicaid |
$37.33
|
| Rate for Payer: UHC Medicare Advantage |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$37.33
|
| Rate for Payer: VA VA |
$52.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.81
|
|
|
SEVOFLURANE 99.97 % INHALATION LIQUID
|
Facility
|
OP
|
$214.38
|
|
|
Service Code
|
NDC 00074445604
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: Aetna Medicare |
$55.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.99
|
| Rate for Payer: BCBS Complete |
$39.68
|
| Rate for Payer: BCBS MAPPO |
$53.59
|
| Rate for Payer: BCBS Trust/PPO |
$176.24
|
| Rate for Payer: BCN Commercial |
$176.24
|
| Rate for Payer: BCN Medicare Advantage |
$53.59
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.59
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: Mclaren Medicaid |
$37.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.27
|
| Rate for Payer: Meridian Medicaid |
$39.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.22
|
| Rate for Payer: Nomi Health Commercial |
$175.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.78
|
| Rate for Payer: PACE Senior Care Partners |
$50.92
|
| Rate for Payer: PACE SWMI |
$53.59
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: PHP Medicare Advantage |
$53.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$186.51
|
| Rate for Payer: Priority Health Medicare |
$54.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.21
|
| Rate for Payer: Railroad Medicare Medicare |
$53.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.65
|
| Rate for Payer: UHC Core |
$179.01
|
| Rate for Payer: UHC Exchange |
$53.59
|
| Rate for Payer: UHC Medicaid |
$37.80
|
| Rate for Payer: UHC Medicare Advantage |
$53.59
|
| Rate for Payer: UHCCP Medicaid |
$37.80
|
| Rate for Payer: VA VA |
$53.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$11,526.41
|
|
|
Service Code
|
APR-DRG 3222
|
| Min. Negotiated Rate |
$10,977.54 |
| Max. Negotiated Rate |
$11,526.41 |
| Rate for Payer: BCBS Complete |
$11,526.41
|
| Rate for Payer: Mclaren Medicaid |
$10,977.54
|
| Rate for Payer: Meridian Medicaid |
$11,526.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,977.54
|
| Rate for Payer: UHC Medicaid |
$10,977.54
|
| Rate for Payer: UHCCP Medicaid |
$10,977.54
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$9,311.57
|
|
|
Service Code
|
APR-DRG 3221
|
| Min. Negotiated Rate |
$8,868.17 |
| Max. Negotiated Rate |
$9,311.57 |
| Rate for Payer: BCBS Complete |
$9,311.57
|
| Rate for Payer: Mclaren Medicaid |
$8,868.17
|
| Rate for Payer: Meridian Medicaid |
$9,311.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,868.17
|
| Rate for Payer: UHC Medicaid |
$8,868.17
|
| Rate for Payer: UHCCP Medicaid |
$8,868.17
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$21,758.73
|
|
|
Service Code
|
APR-DRG 3224
|
| Min. Negotiated Rate |
$20,722.60 |
| Max. Negotiated Rate |
$21,758.73 |
| Rate for Payer: BCBS Complete |
$21,758.73
|
| Rate for Payer: Mclaren Medicaid |
$20,722.60
|
| Rate for Payer: Meridian Medicaid |
$21,758.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,722.60
|
| Rate for Payer: UHC Medicaid |
$20,722.60
|
| Rate for Payer: UHCCP Medicaid |
$20,722.60
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$15,236.74
|
|
|
Service Code
|
APR-DRG 3223
|
| Min. Negotiated Rate |
$14,511.18 |
| Max. Negotiated Rate |
$15,236.74 |
| Rate for Payer: BCBS Complete |
$15,236.74
|
| Rate for Payer: Mclaren Medicaid |
$14,511.18
|
| Rate for Payer: Meridian Medicaid |
$15,236.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,511.18
|
| Rate for Payer: UHC Medicaid |
$14,511.18
|
| Rate for Payer: UHCCP Medicaid |
$14,511.18
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$7,168.25
|
|
|
Service Code
|
APR-DRG 3151
|
| Min. Negotiated Rate |
$6,826.91 |
| Max. Negotiated Rate |
$7,168.25 |
| Rate for Payer: BCBS Complete |
$7,168.25
|
| Rate for Payer: Mclaren Medicaid |
$6,826.91
|
| Rate for Payer: Meridian Medicaid |
$7,168.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,826.91
|
| Rate for Payer: UHC Medicaid |
$6,826.91
|
| Rate for Payer: UHCCP Medicaid |
$6,826.91
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$14,185.06
|
|
|
Service Code
|
APR-DRG 3153
|
| Min. Negotiated Rate |
$13,509.58 |
| Max. Negotiated Rate |
$14,185.06 |
| Rate for Payer: BCBS Complete |
$14,185.06
|
| Rate for Payer: Mclaren Medicaid |
$13,509.58
|
| Rate for Payer: Meridian Medicaid |
$14,185.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,509.58
|
| Rate for Payer: UHC Medicaid |
$13,509.58
|
| Rate for Payer: UHCCP Medicaid |
$13,509.58
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$22,253.55
|
|
|
Service Code
|
APR-DRG 3154
|
| Min. Negotiated Rate |
$21,193.86 |
| Max. Negotiated Rate |
$22,253.55 |
| Rate for Payer: BCBS Complete |
$22,253.55
|
| Rate for Payer: Mclaren Medicaid |
$21,193.86
|
| Rate for Payer: Meridian Medicaid |
$22,253.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,193.86
|
| Rate for Payer: UHC Medicaid |
$21,193.86
|
| Rate for Payer: UHCCP Medicaid |
$21,193.86
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$10,659.83
|
|
|
Service Code
|
APR-DRG 3152
|
| Min. Negotiated Rate |
$10,152.22 |
| Max. Negotiated Rate |
$10,659.83 |
| Rate for Payer: BCBS Complete |
$10,659.83
|
| Rate for Payer: Mclaren Medicaid |
$10,152.22
|
| Rate for Payer: Meridian Medicaid |
$10,659.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,152.22
|
| Rate for Payer: UHC Medicaid |
$10,152.22
|
| Rate for Payer: UHCCP Medicaid |
$10,152.22
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$3,021.48
|
|
|
Service Code
|
APR-DRG 6621
|
| Min. Negotiated Rate |
$2,877.60 |
| Max. Negotiated Rate |
$3,021.48 |
| Rate for Payer: BCBS Complete |
$3,021.48
|
| Rate for Payer: Mclaren Medicaid |
$2,877.60
|
| Rate for Payer: Meridian Medicaid |
$3,021.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,877.60
|
| Rate for Payer: UHC Medicaid |
$2,877.60
|
| Rate for Payer: UHCCP Medicaid |
$2,877.60
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$4,383.93
|
|
|
Service Code
|
APR-DRG 6622
|
| Min. Negotiated Rate |
$4,175.17 |
| Max. Negotiated Rate |
$4,383.93 |
| Rate for Payer: BCBS Complete |
$4,383.93
|
| Rate for Payer: Mclaren Medicaid |
$4,175.17
|
| Rate for Payer: Meridian Medicaid |
$4,383.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,175.17
|
| Rate for Payer: UHC Medicaid |
$4,175.17
|
| Rate for Payer: UHCCP Medicaid |
$4,175.17
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$11,644.73
|
|
|
Service Code
|
APR-DRG 6624
|
| Min. Negotiated Rate |
$11,090.22 |
| Max. Negotiated Rate |
$11,644.73 |
| Rate for Payer: BCBS Complete |
$11,644.73
|
| Rate for Payer: Mclaren Medicaid |
$11,090.22
|
| Rate for Payer: Meridian Medicaid |
$11,644.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,090.22
|
| Rate for Payer: UHC Medicaid |
$11,090.22
|
| Rate for Payer: UHCCP Medicaid |
$11,090.22
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$7,544.23
|
|
|
Service Code
|
APR-DRG 6623
|
| Min. Negotiated Rate |
$7,184.98 |
| Max. Negotiated Rate |
$7,544.23 |
| Rate for Payer: BCBS Complete |
$7,544.23
|
| Rate for Payer: Mclaren Medicaid |
$7,184.98
|
| Rate for Payer: Meridian Medicaid |
$7,544.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,184.98
|
| Rate for Payer: UHC Medicaid |
$7,184.98
|
| Rate for Payer: UHCCP Medicaid |
$7,184.98
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$3,854.41
|
|
|
Service Code
|
APR-DRG 8612
|
| Min. Negotiated Rate |
$3,670.86 |
| Max. Negotiated Rate |
$3,854.41 |
| Rate for Payer: BCBS Complete |
$3,854.41
|
| Rate for Payer: Mclaren Medicaid |
$3,670.86
|
| Rate for Payer: Meridian Medicaid |
$3,854.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,670.86
|
| Rate for Payer: UHC Medicaid |
$3,670.86
|
| Rate for Payer: UHCCP Medicaid |
$3,670.86
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$8,518.61
|
|
|
Service Code
|
APR-DRG 8614
|
| Min. Negotiated Rate |
$8,112.96 |
| Max. Negotiated Rate |
$8,518.61 |
| Rate for Payer: BCBS Complete |
$8,518.61
|
| Rate for Payer: Mclaren Medicaid |
$8,112.96
|
| Rate for Payer: Meridian Medicaid |
$8,518.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,112.96
|
| Rate for Payer: UHC Medicaid |
$8,112.96
|
| Rate for Payer: UHCCP Medicaid |
$8,112.96
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$2,535.07
|
|
|
Service Code
|
APR-DRG 8611
|
| Min. Negotiated Rate |
$2,414.36 |
| Max. Negotiated Rate |
$2,535.07 |
| Rate for Payer: BCBS Complete |
$2,535.07
|
| Rate for Payer: Mclaren Medicaid |
$2,414.36
|
| Rate for Payer: Meridian Medicaid |
$2,535.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,414.36
|
| Rate for Payer: UHC Medicaid |
$2,414.36
|
| Rate for Payer: UHCCP Medicaid |
$2,414.36
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$6,232.78
|
|
|
Service Code
|
APR-DRG 8613
|
| Min. Negotiated Rate |
$5,935.98 |
| Max. Negotiated Rate |
$6,232.78 |
| Rate for Payer: BCBS Complete |
$6,232.78
|
| Rate for Payer: Mclaren Medicaid |
$5,935.98
|
| Rate for Payer: Meridian Medicaid |
$6,232.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,935.98
|
| Rate for Payer: UHC Medicaid |
$5,935.98
|
| Rate for Payer: UHCCP Medicaid |
$5,935.98
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK
|
Facility
|
OP
|
$5.16
|
|
|
Service Code
|
NDC 09900000976
|
| Hospital Charge Code |
11359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS MAPPO |
$1.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.24
|
| Rate for Payer: BCN Commercial |
$4.24
|
| Rate for Payer: BCN Medicare Advantage |
$1.29
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$4.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.29
|
| Rate for Payer: Healthscope Commercial |
$4.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.87
|
| Rate for Payer: Mclaren Medicaid |
$0.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.35
|
| Rate for Payer: Meridian Medicaid |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.87
|
| Rate for Payer: PACE Senior Care Partners |
$1.23
|
| Rate for Payer: PACE SWMI |
$1.29
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$1.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.49
|
| Rate for Payer: Priority Health Medicare |
$1.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.54
|
| Rate for Payer: UHC Core |
$4.31
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Medicaid |
$0.91
|
| Rate for Payer: UHC Medicare Advantage |
$1.29
|
| Rate for Payer: UHCCP Medicaid |
$0.91
|
| Rate for Payer: VA VA |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.87
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK
|
Facility
|
IP
|
$5.16
|
|
|
Service Code
|
NDC 09900000976
|
| Hospital Charge Code |
11359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: BCBS Trust/PPO |
$4.26
|
| Rate for Payer: BCN Commercial |
$4.26
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$4.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$4.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.87
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.54
|
| Rate for Payer: UHC Core |
$4.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.87
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$32.38
|
|
|
Service Code
|
NDC 67877012450
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna Medicare |
$8.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.12
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS MAPPO |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$26.62
|
| Rate for Payer: BCN Commercial |
$26.62
|
| Rate for Payer: BCN Medicare Advantage |
$8.10
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$5.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.50
|
| Rate for Payer: Meridian Medicaid |
$5.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$26.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.29
|
| Rate for Payer: PACE Senior Care Partners |
$7.69
|
| Rate for Payer: PACE SWMI |
$8.10
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: PHP Medicare Advantage |
$8.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.17
|
| Rate for Payer: Priority Health Medicare |
$8.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.54
|
| Rate for Payer: Railroad Medicare Medicare |
$8.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.49
|
| Rate for Payer: UHC Core |
$27.04
|
| Rate for Payer: UHC Exchange |
$8.10
|
| Rate for Payer: UHC Medicaid |
$5.71
|
| Rate for Payer: UHC Medicare Advantage |
$8.10
|
| Rate for Payer: UHCCP Medicaid |
$5.71
|
| Rate for Payer: VA VA |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.29
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$134.40
|
|
|
Service Code
|
NDC 67877012440
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$114.24
|
| Rate for Payer: Aetna Medicare |
$34.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.00
|
| Rate for Payer: BCBS Complete |
$24.88
|
| Rate for Payer: BCBS MAPPO |
$33.60
|
| Rate for Payer: BCBS Trust/PPO |
$110.49
|
| Rate for Payer: BCN Commercial |
$110.49
|
| Rate for Payer: BCN Medicare Advantage |
$33.60
|
| Rate for Payer: Cash Price |
$107.52
|
| Rate for Payer: Cofinity Commercial |
$115.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$120.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.80
|
| Rate for Payer: Mclaren Medicaid |
$23.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.28
|
| Rate for Payer: Meridian Medicaid |
$24.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.24
|
| Rate for Payer: Nomi Health Commercial |
$110.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.80
|
| Rate for Payer: PACE Senior Care Partners |
$31.92
|
| Rate for Payer: PACE SWMI |
$33.60
|
| Rate for Payer: PHP Commercial |
$114.24
|
| Rate for Payer: PHP Medicare Advantage |
$33.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.93
|
| Rate for Payer: Priority Health Medicare |
$33.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.54
|
| Rate for Payer: Railroad Medicare Medicare |
$33.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.27
|
| Rate for Payer: UHC Core |
$112.22
|
| Rate for Payer: UHC Exchange |
$33.60
|
| Rate for Payer: UHC Medicaid |
$23.69
|
| Rate for Payer: UHC Medicare Advantage |
$33.60
|
| Rate for Payer: UHCCP Medicaid |
$23.69
|
| Rate for Payer: VA VA |
$33.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.80
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$32.38
|
|
|
Service Code
|
NDC 67877012405
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna Medicare |
$8.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.12
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS MAPPO |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$26.62
|
| Rate for Payer: BCN Commercial |
$26.62
|
| Rate for Payer: BCN Medicare Advantage |
$8.10
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$5.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.50
|
| Rate for Payer: Meridian Medicaid |
$5.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$26.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.29
|
| Rate for Payer: PACE Senior Care Partners |
$7.69
|
| Rate for Payer: PACE SWMI |
$8.10
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: PHP Medicare Advantage |
$8.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.17
|
| Rate for Payer: Priority Health Medicare |
$8.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.54
|
| Rate for Payer: Railroad Medicare Medicare |
$8.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.49
|
| Rate for Payer: UHC Core |
$27.04
|
| Rate for Payer: UHC Exchange |
$8.10
|
| Rate for Payer: UHC Medicaid |
$5.71
|
| Rate for Payer: UHC Medicare Advantage |
$8.10
|
| Rate for Payer: UHCCP Medicaid |
$5.71
|
| Rate for Payer: VA VA |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.29
|
|
