|
ULIPRISTAL 30 MG TABLET
|
Facility
|
OP
|
$139.79
|
|
|
Service Code
|
NDC 73302045601
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$125.81 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Aetna Medicare |
$36.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.68
|
| Rate for Payer: BCBS Complete |
$25.88
|
| Rate for Payer: BCBS MAPPO |
$34.95
|
| Rate for Payer: BCBS Trust/PPO |
$114.92
|
| Rate for Payer: BCN Commercial |
$114.92
|
| Rate for Payer: BCN Medicare Advantage |
$34.95
|
| Rate for Payer: Cash Price |
$111.83
|
| Rate for Payer: Cofinity Commercial |
$120.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.95
|
| Rate for Payer: Healthscope Commercial |
$125.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.84
|
| Rate for Payer: Mclaren Medicaid |
$24.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.69
|
| Rate for Payer: Meridian Medicaid |
$25.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.82
|
| Rate for Payer: Nomi Health Commercial |
$114.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.84
|
| Rate for Payer: PACE Senior Care Partners |
$33.20
|
| Rate for Payer: PACE SWMI |
$34.95
|
| Rate for Payer: PHP Commercial |
$118.82
|
| Rate for Payer: PHP Medicare Advantage |
$34.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.62
|
| Rate for Payer: Priority Health Medicare |
$35.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.29
|
| Rate for Payer: Railroad Medicare Medicare |
$34.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.02
|
| Rate for Payer: UHC Core |
$116.72
|
| Rate for Payer: UHC Exchange |
$34.95
|
| Rate for Payer: UHC Medicaid |
$24.64
|
| Rate for Payer: UHC Medicare Advantage |
$34.95
|
| Rate for Payer: UHCCP Medicaid |
$24.64
|
| Rate for Payer: VA VA |
$34.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.84
|
|
|
ULIPRISTAL 30 MG TABLET
|
Facility
|
IP
|
$139.79
|
|
|
Service Code
|
NDC 73302045601
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.29 |
| Max. Negotiated Rate |
$125.81 |
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: BCBS Trust/PPO |
$115.45
|
| Rate for Payer: BCN Commercial |
$115.45
|
| Rate for Payer: Cash Price |
$111.83
|
| Rate for Payer: Cofinity Commercial |
$120.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.83
|
| Rate for Payer: Healthscope Commercial |
$125.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.82
|
| Rate for Payer: Nomi Health Commercial |
$114.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.84
|
| Rate for Payer: PHP Commercial |
$118.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.02
|
| Rate for Payer: UHC Core |
$116.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.84
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$1,152.59
|
|
|
Service Code
|
NDC 00173087310
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$802.20 |
| Max. Negotiated Rate |
$1,037.33 |
| Rate for Payer: Aetna Commercial |
$979.70
|
| Rate for Payer: BCBS Trust/PPO |
$951.92
|
| Rate for Payer: BCN Commercial |
$951.92
|
| Rate for Payer: Cash Price |
$922.07
|
| Rate for Payer: Cofinity Commercial |
$991.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$922.07
|
| Rate for Payer: Healthscope Commercial |
$1,037.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.70
|
| Rate for Payer: Nomi Health Commercial |
$945.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$864.44
|
| Rate for Payer: PHP Commercial |
$979.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,002.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,014.28
|
| Rate for Payer: UHC Core |
$962.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.44
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$108.71
|
|
|
Service Code
|
NDC 00173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$97.84 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Aetna Medicare |
$28.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.97
|
| Rate for Payer: BCBS Complete |
$20.12
|
| Rate for Payer: BCBS MAPPO |
$27.18
|
| Rate for Payer: BCBS Trust/PPO |
$89.37
|
| Rate for Payer: BCN Commercial |
$89.37
|
| Rate for Payer: BCN Medicare Advantage |
$27.18
|
| Rate for Payer: Cash Price |
$86.97
|
| Rate for Payer: Cofinity Commercial |
$93.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.18
|
| Rate for Payer: Healthscope Commercial |
$97.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.53
|
| Rate for Payer: Mclaren Medicaid |
$19.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.54
|
| Rate for Payer: Meridian Medicaid |
$20.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.40
|
| Rate for Payer: Nomi Health Commercial |
$89.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.53
|
| Rate for Payer: PACE Senior Care Partners |
$25.82
|
| Rate for Payer: PACE SWMI |
$27.18
|
| Rate for Payer: PHP Commercial |
$92.40
|
| Rate for Payer: PHP Medicare Advantage |
$27.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.58
|
| Rate for Payer: Priority Health Medicare |
$27.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.66
|
| Rate for Payer: Railroad Medicare Medicare |
$27.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.66
|
| Rate for Payer: UHC Core |
$90.77
|
| Rate for Payer: UHC Exchange |
$27.18
|
| Rate for Payer: UHC Medicaid |
$19.17
|
| Rate for Payer: UHC Medicare Advantage |
$27.18
|
| Rate for Payer: UHCCP Medicaid |
$19.17
|
| Rate for Payer: VA VA |
$27.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.53
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$1,152.59
|
|
|
Service Code
|
NDC 00173087310
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$1,037.33 |
| Rate for Payer: Aetna Commercial |
$979.70
|
| Rate for Payer: Aetna Medicare |
$299.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$360.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$360.18
|
| Rate for Payer: BCBS Complete |
$213.34
|
| Rate for Payer: BCBS MAPPO |
$288.15
|
| Rate for Payer: BCBS Trust/PPO |
$947.54
|
| Rate for Payer: BCN Commercial |
$947.54
|
| Rate for Payer: BCN Medicare Advantage |
$288.15
|
| Rate for Payer: Cash Price |
$922.07
|
| Rate for Payer: Cofinity Commercial |
$991.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$922.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.15
|
| Rate for Payer: Healthscope Commercial |
$1,037.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.44
|
| Rate for Payer: Mclaren Medicaid |
$203.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.55
|
| Rate for Payer: Meridian Medicaid |
$213.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$316.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.70
|
| Rate for Payer: Nomi Health Commercial |
$945.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$864.44
|
| Rate for Payer: PACE Senior Care Partners |
$273.74
|
| Rate for Payer: PACE SWMI |
$288.15
|
| Rate for Payer: PHP Commercial |
$979.70
|
| Rate for Payer: PHP Medicare Advantage |
$288.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,002.75
|
| Rate for Payer: Priority Health Medicare |
$291.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.20
|
| Rate for Payer: Railroad Medicare Medicare |
$288.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,014.28
|
| Rate for Payer: UHC Core |
$962.41
|
| Rate for Payer: UHC Exchange |
$288.15
|
| Rate for Payer: UHC Medicaid |
$203.20
|
| Rate for Payer: UHC Medicare Advantage |
$288.15
|
| Rate for Payer: UHCCP Medicaid |
$203.20
|
| Rate for Payer: VA VA |
$288.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.44
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$108.71
|
|
|
Service Code
|
NDC 00173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.66 |
| Max. Negotiated Rate |
$97.84 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: BCBS Trust/PPO |
$89.78
|
| Rate for Payer: BCN Commercial |
$89.78
|
| Rate for Payer: Cash Price |
$86.97
|
| Rate for Payer: Cofinity Commercial |
$93.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.97
|
| Rate for Payer: Healthscope Commercial |
$97.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.40
|
| Rate for Payer: Nomi Health Commercial |
$89.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.53
|
| Rate for Payer: PHP Commercial |
$92.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.66
|
| Rate for Payer: UHC Core |
$90.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.53
|
|
|
UMECLIDINIUM 62.5 MCG-VILANTEROL 25 MCG/ACTUATION POWDR FOR INHALATION
|
Facility
|
OP
|
$217.63
|
|
|
Service Code
|
NDC 00173086906
|
| Hospital Charge Code |
169758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$195.87 |
| Rate for Payer: Aetna Commercial |
$184.99
|
| Rate for Payer: Aetna Medicare |
$56.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.01
|
| Rate for Payer: BCBS Complete |
$40.28
|
| Rate for Payer: BCBS MAPPO |
$54.41
|
| Rate for Payer: BCBS Trust/PPO |
$178.91
|
| Rate for Payer: BCN Commercial |
$178.91
|
| Rate for Payer: BCN Medicare Advantage |
$54.41
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cofinity Commercial |
$187.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.41
|
| Rate for Payer: Healthscope Commercial |
$195.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.22
|
| Rate for Payer: Mclaren Medicaid |
$38.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.13
|
| Rate for Payer: Meridian Medicaid |
$40.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.99
|
| Rate for Payer: Nomi Health Commercial |
$178.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.22
|
| Rate for Payer: PACE Senior Care Partners |
$51.69
|
| Rate for Payer: PACE SWMI |
$54.41
|
| Rate for Payer: PHP Commercial |
$184.99
|
| Rate for Payer: PHP Medicare Advantage |
$54.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.34
|
| Rate for Payer: Priority Health Medicare |
$54.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.47
|
| Rate for Payer: Railroad Medicare Medicare |
$54.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.51
|
| Rate for Payer: UHC Core |
$181.72
|
| Rate for Payer: UHC Exchange |
$54.41
|
| Rate for Payer: UHC Medicaid |
$38.37
|
| Rate for Payer: UHC Medicare Advantage |
$54.41
|
| Rate for Payer: UHCCP Medicaid |
$38.37
|
| Rate for Payer: VA VA |
$54.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.22
|
|
|
UMECLIDINIUM 62.5 MCG-VILANTEROL 25 MCG/ACTUATION POWDR FOR INHALATION
|
Facility
|
IP
|
$217.63
|
|
|
Service Code
|
NDC 00173086906
|
| Hospital Charge Code |
169758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.47 |
| Max. Negotiated Rate |
$195.87 |
| Rate for Payer: Aetna Commercial |
$184.99
|
| Rate for Payer: BCBS Trust/PPO |
$179.74
|
| Rate for Payer: BCN Commercial |
$179.74
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cofinity Commercial |
$187.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.10
|
| Rate for Payer: Healthscope Commercial |
$195.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.99
|
| Rate for Payer: Nomi Health Commercial |
$178.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.22
|
| Rate for Payer: PHP Commercial |
$184.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.51
|
| Rate for Payer: UHC Core |
$181.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.22
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$15,759.95
|
|
|
Service Code
|
APR-DRG 4464
|
| Min. Negotiated Rate |
$15,009.48 |
| Max. Negotiated Rate |
$15,759.95 |
| Rate for Payer: BCBS Complete |
$15,759.95
|
| Rate for Payer: Mclaren Medicaid |
$15,009.48
|
| Rate for Payer: Meridian Medicaid |
$15,759.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,009.48
|
| Rate for Payer: UHC Medicaid |
$15,009.48
|
| Rate for Payer: UHCCP Medicaid |
$15,009.48
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$6,954.23
|
|
|
Service Code
|
APR-DRG 4462
|
| Min. Negotiated Rate |
$6,623.08 |
| Max. Negotiated Rate |
$6,954.23 |
| Rate for Payer: BCBS Complete |
$6,954.23
|
| Rate for Payer: Mclaren Medicaid |
$6,623.08
|
| Rate for Payer: Meridian Medicaid |
$6,954.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,623.08
|
| Rate for Payer: UHC Medicaid |
$6,623.08
|
| Rate for Payer: UHCCP Medicaid |
$6,623.08
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$6,189.66
|
|
|
Service Code
|
APR-DRG 4461
|
| Min. Negotiated Rate |
$5,894.92 |
| Max. Negotiated Rate |
$6,189.66 |
| Rate for Payer: BCBS Complete |
$6,189.66
|
| Rate for Payer: Mclaren Medicaid |
$5,894.92
|
| Rate for Payer: Meridian Medicaid |
$6,189.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,894.92
|
| Rate for Payer: UHC Medicaid |
$5,894.92
|
| Rate for Payer: UHCCP Medicaid |
$5,894.92
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$10,221.28
|
|
|
Service Code
|
APR-DRG 4463
|
| Min. Negotiated Rate |
$9,734.55 |
| Max. Negotiated Rate |
$10,221.28 |
| Rate for Payer: BCBS Complete |
$10,221.28
|
| Rate for Payer: Mclaren Medicaid |
$9,734.55
|
| Rate for Payer: Meridian Medicaid |
$10,221.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,734.55
|
| Rate for Payer: UHC Medicaid |
$9,734.55
|
| Rate for Payer: UHCCP Medicaid |
$9,734.55
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$6,157.06
|
|
|
Service Code
|
APR-DRG 4653
|
| Min. Negotiated Rate |
$5,863.87 |
| Max. Negotiated Rate |
$6,157.06 |
| Rate for Payer: BCBS Complete |
$6,157.06
|
| Rate for Payer: Mclaren Medicaid |
$5,863.87
|
| Rate for Payer: Meridian Medicaid |
$6,157.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,863.87
|
| Rate for Payer: UHC Medicaid |
$5,863.87
|
| Rate for Payer: UHCCP Medicaid |
$5,863.87
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$3,109.29
|
|
|
Service Code
|
APR-DRG 4651
|
| Min. Negotiated Rate |
$2,961.23 |
| Max. Negotiated Rate |
$3,109.29 |
| Rate for Payer: BCBS Complete |
$3,109.29
|
| Rate for Payer: Mclaren Medicaid |
$2,961.23
|
| Rate for Payer: Meridian Medicaid |
$3,109.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,961.23
|
| Rate for Payer: UHC Medicaid |
$2,961.23
|
| Rate for Payer: UHCCP Medicaid |
$2,961.23
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$4,757.27
|
|
|
Service Code
|
APR-DRG 4652
|
| Min. Negotiated Rate |
$4,530.74 |
| Max. Negotiated Rate |
$4,757.27 |
| Rate for Payer: BCBS Complete |
$4,757.27
|
| Rate for Payer: Mclaren Medicaid |
$4,530.74
|
| Rate for Payer: Meridian Medicaid |
$4,757.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,530.74
|
| Rate for Payer: UHC Medicaid |
$4,530.74
|
| Rate for Payer: UHCCP Medicaid |
$4,530.74
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$11,469.10
|
|
|
Service Code
|
APR-DRG 4654
|
| Min. Negotiated Rate |
$10,922.95 |
| Max. Negotiated Rate |
$11,469.10 |
| Rate for Payer: BCBS Complete |
$11,469.10
|
| Rate for Payer: Mclaren Medicaid |
$10,922.95
|
| Rate for Payer: Meridian Medicaid |
$11,469.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,922.95
|
| Rate for Payer: UHC Medicaid |
$10,922.95
|
| Rate for Payer: UHCCP Medicaid |
$10,922.95
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$366.24
|
|
|
Service Code
|
NDC 00904716806
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.57 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: Aetna Medicare |
$95.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.45
|
| Rate for Payer: BCBS Complete |
$67.79
|
| Rate for Payer: BCBS MAPPO |
$91.56
|
| Rate for Payer: BCBS Trust/PPO |
$301.09
|
| Rate for Payer: BCN Commercial |
$301.09
|
| Rate for Payer: BCN Medicare Advantage |
$91.56
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.56
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Mclaren Medicaid |
$64.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.14
|
| Rate for Payer: Meridian Medicaid |
$67.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.68
|
| Rate for Payer: PACE Senior Care Partners |
$86.98
|
| Rate for Payer: PACE SWMI |
$91.56
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: PHP Medicare Advantage |
$91.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Medicare |
$92.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.90
|
| Rate for Payer: Railroad Medicare Medicare |
$91.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: UHC Exchange |
$91.56
|
| Rate for Payer: UHC Medicaid |
$64.57
|
| Rate for Payer: UHC Medicare Advantage |
$91.56
|
| Rate for Payer: UHCCP Medicaid |
$64.57
|
| Rate for Payer: VA VA |
$91.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$1,209.16
|
|
|
Service Code
|
NDC 00904716861
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$841.58 |
| Max. Negotiated Rate |
$1,088.24 |
| Rate for Payer: Aetna Commercial |
$1,027.79
|
| Rate for Payer: BCBS Trust/PPO |
$998.65
|
| Rate for Payer: BCN Commercial |
$998.65
|
| Rate for Payer: Cash Price |
$967.33
|
| Rate for Payer: Cofinity Commercial |
$1,039.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.33
|
| Rate for Payer: Healthscope Commercial |
$1,088.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.79
|
| Rate for Payer: Nomi Health Commercial |
$991.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.87
|
| Rate for Payer: PHP Commercial |
$1,027.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,051.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$841.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,064.06
|
| Rate for Payer: UHC Core |
$1,009.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.87
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$366.24
|
|
|
Service Code
|
NDC 00904716806
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.90 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: BCBS Trust/PPO |
$302.48
|
| Rate for Payer: BCN Commercial |
$302.48
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.68
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$1,209.16
|
|
|
Service Code
|
NDC 00904716861
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.17 |
| Max. Negotiated Rate |
$1,088.24 |
| Rate for Payer: Aetna Commercial |
$1,027.79
|
| Rate for Payer: Aetna Medicare |
$314.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$377.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$377.86
|
| Rate for Payer: BCBS Complete |
$223.82
|
| Rate for Payer: BCBS MAPPO |
$302.29
|
| Rate for Payer: BCBS Trust/PPO |
$994.05
|
| Rate for Payer: BCN Commercial |
$994.05
|
| Rate for Payer: BCN Medicare Advantage |
$302.29
|
| Rate for Payer: Cash Price |
$967.33
|
| Rate for Payer: Cofinity Commercial |
$1,039.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.29
|
| Rate for Payer: Healthscope Commercial |
$1,088.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.87
|
| Rate for Payer: Mclaren Medicaid |
$213.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.40
|
| Rate for Payer: Meridian Medicaid |
$223.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$332.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.79
|
| Rate for Payer: Nomi Health Commercial |
$991.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.87
|
| Rate for Payer: PACE Senior Care Partners |
$287.18
|
| Rate for Payer: PACE SWMI |
$302.29
|
| Rate for Payer: PHP Commercial |
$1,027.79
|
| Rate for Payer: PHP Medicare Advantage |
$302.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,051.97
|
| Rate for Payer: Priority Health Medicare |
$305.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$841.58
|
| Rate for Payer: Railroad Medicare Medicare |
$302.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,064.06
|
| Rate for Payer: UHC Core |
$1,009.65
|
| Rate for Payer: UHC Exchange |
$302.29
|
| Rate for Payer: UHC Medicaid |
$213.17
|
| Rate for Payer: UHC Medicare Advantage |
$302.29
|
| Rate for Payer: UHCCP Medicaid |
$213.17
|
| Rate for Payer: VA VA |
$302.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.87
|
|
|
VAGINAL DELIVERY
|
Facility
|
IP
|
$2,618.68
|
|
|
Service Code
|
APR-DRG 5602
|
| Min. Negotiated Rate |
$2,493.98 |
| Max. Negotiated Rate |
$2,618.68 |
| Rate for Payer: BCBS Complete |
$2,618.68
|
| Rate for Payer: Mclaren Medicaid |
$2,493.98
|
| Rate for Payer: Meridian Medicaid |
$2,618.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,493.98
|
| Rate for Payer: UHC Medicaid |
$2,493.98
|
| Rate for Payer: UHCCP Medicaid |
$2,493.98
|
|
|
VAGINAL DELIVERY
|
Facility
|
IP
|
$2,220.10
|
|
|
Service Code
|
APR-DRG 5601
|
| Min. Negotiated Rate |
$2,114.38 |
| Max. Negotiated Rate |
$2,220.10 |
| Rate for Payer: BCBS Complete |
$2,220.10
|
| Rate for Payer: Mclaren Medicaid |
$2,114.38
|
| Rate for Payer: Meridian Medicaid |
$2,220.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,114.38
|
| Rate for Payer: UHC Medicaid |
$2,114.38
|
| Rate for Payer: UHCCP Medicaid |
$2,114.38
|
|
|
VAGINAL DELIVERY
|
Facility
|
IP
|
$8,255.16
|
|
|
Service Code
|
APR-DRG 5604
|
| Min. Negotiated Rate |
$7,862.06 |
| Max. Negotiated Rate |
$8,255.16 |
| Rate for Payer: BCBS Complete |
$8,255.16
|
| Rate for Payer: Mclaren Medicaid |
$7,862.06
|
| Rate for Payer: Meridian Medicaid |
$8,255.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,862.06
|
| Rate for Payer: UHC Medicaid |
$7,862.06
|
| Rate for Payer: UHCCP Medicaid |
$7,862.06
|
|
|
VAGINAL DELIVERY
|
Facility
|
IP
|
$3,631.45
|
|
|
Service Code
|
APR-DRG 5603
|
| Min. Negotiated Rate |
$3,458.52 |
| Max. Negotiated Rate |
$3,631.45 |
| Rate for Payer: BCBS Complete |
$3,631.45
|
| Rate for Payer: Mclaren Medicaid |
$3,458.52
|
| Rate for Payer: Meridian Medicaid |
$3,631.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,458.52
|
| Rate for Payer: UHC Medicaid |
$3,458.52
|
| Rate for Payer: UHCCP Medicaid |
$3,458.52
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$2,628.15
|
|
|
Service Code
|
APR-DRG 5421
|
| Min. Negotiated Rate |
$2,503.00 |
| Max. Negotiated Rate |
$2,628.15 |
| Rate for Payer: BCBS Complete |
$2,628.15
|
| Rate for Payer: Mclaren Medicaid |
$2,503.00
|
| Rate for Payer: Meridian Medicaid |
$2,628.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,503.00
|
| Rate for Payer: UHC Medicaid |
$2,503.00
|
| Rate for Payer: UHCCP Medicaid |
$2,503.00
|
|
