|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,115.78
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$306.39
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.20
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$59.27
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,115.78
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$306.39
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.20
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$59.27
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,640.71
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,921.91 |
| Max. Negotiated Rate |
$5,976.64 |
| Rate for Payer: Aetna American Axle |
$4,316.46
|
| Rate for Payer: Aetna American Axle |
$455.45
|
| Rate for Payer: Aetna American Axle |
$330.86
|
| Rate for Payer: Aetna American Axle |
$250.11
|
| Rate for Payer: Aetna American Axle |
$360.27
|
| Rate for Payer: Aetna American Axle |
$374.28
|
| Rate for Payer: Aetna American Axle |
$327.53
|
| Rate for Payer: Aetna American Axle |
$314.28
|
| Rate for Payer: Aetna Commercial |
$489.45
|
| Rate for Payer: Aetna Commercial |
$327.07
|
| Rate for Payer: Aetna Commercial |
$595.59
|
| Rate for Payer: Aetna Commercial |
$410.98
|
| Rate for Payer: Aetna Commercial |
$5,644.60
|
| Rate for Payer: Aetna Commercial |
$428.31
|
| Rate for Payer: Aetna Commercial |
$432.67
|
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,316.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.28
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$460.66
|
| Rate for Payer: Cash Price |
$560.55
|
| Rate for Payer: Cash Price |
$403.11
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$386.80
|
| Rate for Payer: Cash Price |
$407.22
|
| Rate for Payer: Cash Price |
$307.83
|
| Rate for Payer: Cofinity Commercial |
$4,648.50
|
| Rate for Payer: Cofinity Commercial |
$338.45
|
| Rate for Payer: Cofinity Commercial |
$415.81
|
| Rate for Payer: Cofinity Commercial |
$356.31
|
| Rate for Payer: Cofinity Commercial |
$495.21
|
| Rate for Payer: Cofinity Commercial |
$403.07
|
| Rate for Payer: Cofinity Commercial |
$330.92
|
| Rate for Payer: Cofinity Commercial |
$269.35
|
| Rate for Payer: Cofinity Commercial |
$352.72
|
| Rate for Payer: Cofinity Commercial |
$433.35
|
| Rate for Payer: Cofinity Commercial |
$437.76
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Commercial |
$387.98
|
| Rate for Payer: Cofinity Commercial |
$490.48
|
| Rate for Payer: Cofinity Commercial |
$5,711.01
|
| Rate for Payer: Cofinity Commercial |
$602.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,312.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.55
|
| Rate for Payer: Healthscope Commercial |
$346.31
|
| Rate for Payer: Healthscope Commercial |
$518.24
|
| Rate for Payer: Healthscope Commercial |
$453.50
|
| Rate for Payer: Healthscope Commercial |
$630.62
|
| Rate for Payer: Healthscope Commercial |
$5,976.64
|
| Rate for Payer: Healthscope Commercial |
$435.15
|
| Rate for Payer: Healthscope Commercial |
$458.12
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$490.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,648.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,980.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$431.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$432.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,644.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$471.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$410.98
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: PHP Commercial |
$410.98
|
| Rate for Payer: PHP Commercial |
$428.31
|
| Rate for Payer: PHP Commercial |
$327.07
|
| Rate for Payer: PHP Commercial |
$489.45
|
| Rate for Payer: PHP Commercial |
$595.59
|
| Rate for Payer: PHP Commercial |
$5,644.60
|
| Rate for Payer: PHP Commercial |
$432.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,648.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.07
|
| Rate for Payer: Priority Health SBD |
$4,183.65
|
| Rate for Payer: Priority Health SBD |
$320.68
|
| Rate for Payer: Priority Health SBD |
$317.45
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: Priority Health SBD |
$304.60
|
| Rate for Payer: Priority Health SBD |
$362.77
|
| Rate for Payer: Priority Health SBD |
$242.42
|
| Rate for Payer: Priority Health SBD |
$441.43
|
| Rate for Payer: UMR Bronson Commercial |
$169.31
|
| Rate for Payer: UMR Bronson Commercial |
$253.36
|
| Rate for Payer: UMR Bronson Commercial |
$243.87
|
| Rate for Payer: UMR Bronson Commercial |
$221.71
|
| Rate for Payer: UMR Bronson Commercial |
$223.97
|
| Rate for Payer: UMR Bronson Commercial |
$212.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,921.91
|
| Rate for Payer: UMR Bronson Commercial |
$308.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,980.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$431.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.52
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$901.88
|
|
|
Service Code
|
HCPCS J0893
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$811.69 |
| Rate for Payer: Aetna American Axle |
$586.22
|
| Rate for Payer: Aetna Commercial |
$766.60
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.97
|
| Rate for Payer: BCBS Complete |
$0.45
|
| Rate for Payer: BCBS MAPPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Medicare Advantage |
$0.78
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cofinity Commercial |
$631.32
|
| Rate for Payer: Cofinity Commercial |
$775.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.78
|
| Rate for Payer: Healthscope Commercial |
$811.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$631.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$676.41
|
| Rate for Payer: Mclaren Medicaid |
$0.43
|
| Rate for Payer: Mclaren Medicare |
$0.78
|
| Rate for Payer: Meridian Medicaid |
$0.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$766.60
|
| Rate for Payer: PACE Medicare |
$0.74
|
| Rate for Payer: PACE SWMI |
$0.78
|
| Rate for Payer: PHP Commercial |
$766.60
|
| Rate for Payer: PHP Medicare Advantage |
$0.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.24
|
| Rate for Payer: Priority Health Medicare |
$0.78
|
| Rate for Payer: Priority Health Narrow Network |
$4.99
|
| Rate for Payer: Priority Health SBD |
$568.18
|
| Rate for Payer: Railroad Medicare Medicare |
$0.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.78
|
| Rate for Payer: UHC Medicare Advantage |
$0.80
|
| Rate for Payer: UMR Bronson Commercial |
$333.70
|
| Rate for Payer: VA VA |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$676.41
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$483.50
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$435.15 |
| Rate for Payer: Aetna American Axle |
$314.28
|
| Rate for Payer: Aetna American Axle |
$755.62
|
| Rate for Payer: Aetna American Axle |
$646.05
|
| Rate for Payer: Aetna American Axle |
$250.11
|
| Rate for Payer: Aetna American Axle |
$360.27
|
| Rate for Payer: Aetna American Axle |
$559.16
|
| Rate for Payer: Aetna American Axle |
$487.86
|
| Rate for Payer: Aetna American Axle |
$4,316.46
|
| Rate for Payer: Aetna American Axle |
$327.53
|
| Rate for Payer: Aetna American Axle |
$330.86
|
| Rate for Payer: Aetna American Axle |
$374.28
|
| Rate for Payer: Aetna Commercial |
$327.07
|
| Rate for Payer: Aetna Commercial |
$637.97
|
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$988.12
|
| Rate for Payer: Aetna Commercial |
$5,644.60
|
| Rate for Payer: Aetna Commercial |
$410.98
|
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: Aetna Commercial |
$489.45
|
| Rate for Payer: Aetna Commercial |
$432.67
|
| Rate for Payer: Aetna Commercial |
$428.31
|
| Rate for Payer: Aetna Commercial |
$844.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,316.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.62
|
| Rate for Payer: BCBS Complete |
$193.40
|
| Rate for Payer: BCBS Complete |
$203.61
|
| Rate for Payer: BCBS Complete |
$344.10
|
| Rate for Payer: BCBS Complete |
$2,656.28
|
| Rate for Payer: BCBS Complete |
$221.70
|
| Rate for Payer: BCBS Complete |
$153.92
|
| Rate for Payer: BCBS Complete |
$230.33
|
| Rate for Payer: BCBS Complete |
$397.57
|
| Rate for Payer: BCBS Complete |
$201.56
|
| Rate for Payer: BCBS Complete |
$300.22
|
| Rate for Payer: BCBS Complete |
$465.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: Cash Price |
$386.80
|
| Rate for Payer: Cash Price |
$460.66
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cash Price |
$403.11
|
| Rate for Payer: Cash Price |
$386.80
|
| Rate for Payer: Cash Price |
$600.44
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$600.44
|
| Rate for Payer: Cash Price |
$403.11
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$407.22
|
| Rate for Payer: Cash Price |
$460.66
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$307.83
|
| Rate for Payer: Cash Price |
$307.83
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$407.22
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cofinity Commercial |
$403.07
|
| Rate for Payer: Cofinity Commercial |
$813.75
|
| Rate for Payer: Cofinity Commercial |
$999.75
|
| Rate for Payer: Cofinity Commercial |
$269.35
|
| Rate for Payer: Cofinity Commercial |
$330.92
|
| Rate for Payer: Cofinity Commercial |
$338.45
|
| Rate for Payer: Cofinity Commercial |
$415.81
|
| Rate for Payer: Cofinity Commercial |
$352.72
|
| Rate for Payer: Cofinity Commercial |
$433.35
|
| Rate for Payer: Cofinity Commercial |
$356.31
|
| Rate for Payer: Cofinity Commercial |
$437.76
|
| Rate for Payer: Cofinity Commercial |
$387.98
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Commercial |
$495.21
|
| Rate for Payer: Cofinity Commercial |
$4,648.50
|
| Rate for Payer: Cofinity Commercial |
$5,711.01
|
| Rate for Payer: Cofinity Commercial |
$525.38
|
| Rate for Payer: Cofinity Commercial |
$645.47
|
| Rate for Payer: Cofinity Commercial |
$602.18
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Cofinity Commercial |
$695.74
|
| Rate for Payer: Cofinity Commercial |
$854.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,312.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$930.00
|
| Rate for Payer: Healthscope Commercial |
$774.22
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Healthscope Commercial |
$346.31
|
| Rate for Payer: Healthscope Commercial |
$894.53
|
| Rate for Payer: Healthscope Commercial |
$453.50
|
| Rate for Payer: Healthscope Commercial |
$458.12
|
| Rate for Payer: Healthscope Commercial |
$518.24
|
| Rate for Payer: Healthscope Commercial |
$1,046.25
|
| Rate for Payer: Healthscope Commercial |
$435.15
|
| Rate for Payer: Healthscope Commercial |
$5,976.64
|
| Rate for Payer: Healthscope Commercial |
$675.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$813.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$695.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,648.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$525.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$431.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$562.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$871.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,980.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$844.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,644.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$988.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$471.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$410.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$637.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$432.67
|
| Rate for Payer: PHP Commercial |
$428.31
|
| Rate for Payer: PHP Commercial |
$637.97
|
| Rate for Payer: PHP Commercial |
$844.83
|
| Rate for Payer: PHP Commercial |
$327.07
|
| Rate for Payer: PHP Commercial |
$5,644.60
|
| Rate for Payer: PHP Commercial |
$489.45
|
| Rate for Payer: PHP Commercial |
$410.98
|
| Rate for Payer: PHP Commercial |
$988.12
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: PHP Commercial |
$432.67
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,648.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.74
|
| Rate for Payer: Priority Health SBD |
$541.96
|
| Rate for Payer: Priority Health SBD |
$320.68
|
| Rate for Payer: Priority Health SBD |
$304.60
|
| Rate for Payer: Priority Health SBD |
$4,183.65
|
| Rate for Payer: Priority Health SBD |
$732.38
|
| Rate for Payer: Priority Health SBD |
$317.45
|
| Rate for Payer: Priority Health SBD |
$242.42
|
| Rate for Payer: Priority Health SBD |
$472.85
|
| Rate for Payer: Priority Health SBD |
$626.17
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: Priority Health SBD |
$362.77
|
| Rate for Payer: UMR Bronson Commercial |
$430.12
|
| Rate for Payer: UMR Bronson Commercial |
$188.34
|
| Rate for Payer: UMR Bronson Commercial |
$142.37
|
| Rate for Payer: UMR Bronson Commercial |
$318.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,457.06
|
| Rate for Payer: UMR Bronson Commercial |
$213.05
|
| Rate for Payer: UMR Bronson Commercial |
$178.90
|
| Rate for Payer: UMR Bronson Commercial |
$205.08
|
| Rate for Payer: UMR Bronson Commercial |
$186.44
|
| Rate for Payer: UMR Bronson Commercial |
$367.75
|
| Rate for Payer: UMR Bronson Commercial |
$277.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$562.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,980.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$871.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$431.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.76
|
|
|
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.90 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.39
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$394.90
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC
|
Facility
|
IP
|
$22,040.65
|
|
|
Service Code
|
MS-DRG 294
|
| Min. Negotiated Rate |
$8,493.44 |
| Max. Negotiated Rate |
$22,040.65 |
| Rate for Payer: Aetna Medicare |
$9,298.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,175.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,175.58
|
| Rate for Payer: BCBS MAPPO |
$8,940.46
|
| Rate for Payer: BCBS Trust/PPO |
$22,040.65
|
| Rate for Payer: BCN Medicare Advantage |
$8,940.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,940.46
|
| Rate for Payer: Mclaren Medicare |
$8,940.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,387.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,281.53
|
| Rate for Payer: PACE Medicare |
$8,493.44
|
| Rate for Payer: PACE SWMI |
$8,940.46
|
| Rate for Payer: PHP Medicare Advantage |
$8,940.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,694.51
|
| Rate for Payer: Priority Health Medicare |
$8,940.46
|
| Rate for Payer: Priority Health Narrow Network |
$12,555.61
|
| Rate for Payer: Railroad Medicare Medicare |
$8,940.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,683.30
|
| Rate for Payer: UHC Core |
$13,680.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,940.46
|
| Rate for Payer: UHC Exchange |
$10,875.75
|
| Rate for Payer: UHC Medicare Advantage |
$9,208.67
|
| Rate for Payer: VA VA |
$8,940.46
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,727.84
|
|
|
Service Code
|
MS-DRG 295
|
| Min. Negotiated Rate |
$6,279.64 |
| Max. Negotiated Rate |
$12,727.84 |
| Rate for Payer: Aetna Medicare |
$6,921.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,318.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,318.55
|
| Rate for Payer: BCBS MAPPO |
$6,654.84
|
| Rate for Payer: BCBS Trust/PPO |
$12,727.84
|
| Rate for Payer: BCN Medicare Advantage |
$6,654.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,654.84
|
| Rate for Payer: Mclaren Medicare |
$6,654.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,987.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,653.07
|
| Rate for Payer: PACE Medicare |
$6,322.10
|
| Rate for Payer: PACE SWMI |
$6,654.84
|
| Rate for Payer: PHP Medicare Advantage |
$6,654.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,061.97
|
| Rate for Payer: Priority Health Medicare |
$6,654.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,249.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6,654.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,632.90
|
| Rate for Payer: UHC Core |
$7,898.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,654.84
|
| Rate for Payer: UHC Exchange |
$6,279.64
|
| Rate for Payer: UHC Medicare Advantage |
$6,854.49
|
| Rate for Payer: VA VA |
$6,654.84
|
|
|
DEFERASIROX 180 MG TABLET
|
Facility
|
IP
|
$10,060.49
|
|
|
Service Code
|
NDC 0078-0655-15
|
| Hospital Charge Code |
163508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,426.62 |
| Max. Negotiated Rate |
$9,054.44 |
| Rate for Payer: Aetna American Axle |
$6,539.32
|
| Rate for Payer: Aetna Commercial |
$8,551.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,539.32
|
| Rate for Payer: Cash Price |
$8,048.39
|
| Rate for Payer: Cofinity Commercial |
$7,042.34
|
| Rate for Payer: Cofinity Commercial |
$8,652.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,048.39
|
| Rate for Payer: Healthscope Commercial |
$9,054.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,042.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,545.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,551.42
|
| Rate for Payer: PHP Commercial |
$8,551.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,042.34
|
| Rate for Payer: Priority Health SBD |
$6,338.11
|
| Rate for Payer: UMR Bronson Commercial |
$4,426.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,545.37
|
|
|
DEFERASIROX 180 MG TABLET
|
Facility
|
IP
|
$136.80
|
|
|
Service Code
|
NDC 70700-270-30
|
| Hospital Charge Code |
163508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Aetna American Axle |
$88.92
|
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.92
|
| Rate for Payer: Cash Price |
$109.44
|
| Rate for Payer: Cofinity Commercial |
$117.65
|
| Rate for Payer: Cofinity Commercial |
$95.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.44
|
| Rate for Payer: Healthscope Commercial |
$123.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.28
|
| Rate for Payer: PHP Commercial |
$116.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.76
|
| Rate for Payer: Priority Health SBD |
$86.18
|
| Rate for Payer: UMR Bronson Commercial |
$60.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.60
|
|
|
DEFERASIROX 180 MG TABLET
|
Facility
|
IP
|
$133.78
|
|
|
Service Code
|
NDC 43598-852-30
|
| Hospital Charge Code |
163508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.86 |
| Max. Negotiated Rate |
$120.40 |
| Rate for Payer: Aetna American Axle |
$86.96
|
| Rate for Payer: Aetna Commercial |
$113.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.96
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Cofinity Commercial |
$115.05
|
| Rate for Payer: Cofinity Commercial |
$93.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.02
|
| Rate for Payer: Healthscope Commercial |
$120.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.71
|
| Rate for Payer: PHP Commercial |
$113.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.65
|
| Rate for Payer: Priority Health SBD |
$84.28
|
| Rate for Payer: UMR Bronson Commercial |
$58.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.34
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET
|
Facility
|
IP
|
$1,307.81
|
|
|
Service Code
|
NDC 43598-856-30
|
| Hospital Charge Code |
43416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$575.44 |
| Max. Negotiated Rate |
$1,177.03 |
| Rate for Payer: Aetna American Axle |
$850.08
|
| Rate for Payer: Aetna Commercial |
$1,111.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.08
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cofinity Commercial |
$1,124.72
|
| Rate for Payer: Cofinity Commercial |
$915.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.25
|
| Rate for Payer: Healthscope Commercial |
$1,177.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,111.64
|
| Rate for Payer: PHP Commercial |
$1,111.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.47
|
| Rate for Payer: Priority Health SBD |
$823.92
|
| Rate for Payer: UMR Bronson Commercial |
$575.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.86
|
|
|
DEFERASIROX 360 MG TABLET
|
Facility
|
IP
|
$234.29
|
|
|
Service Code
|
NDC 43598-851-30
|
| Hospital Charge Code |
163509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$210.86 |
| Rate for Payer: Aetna American Axle |
$152.29
|
| Rate for Payer: Aetna Commercial |
$199.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.29
|
| Rate for Payer: Cash Price |
$187.43
|
| Rate for Payer: Cofinity Commercial |
$164.00
|
| Rate for Payer: Cofinity Commercial |
$201.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.43
|
| Rate for Payer: Healthscope Commercial |
$210.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.15
|
| Rate for Payer: PHP Commercial |
$199.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.00
|
| Rate for Payer: Priority Health SBD |
$147.60
|
| Rate for Payer: UMR Bronson Commercial |
$103.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.72
|
|
|
DEFERASIROX 90 MG TABLET
|
Facility
|
IP
|
$5,030.30
|
|
|
Service Code
|
NDC 0078-0654-15
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,213.33 |
| Max. Negotiated Rate |
$4,527.27 |
| Rate for Payer: Aetna American Axle |
$3,269.70
|
| Rate for Payer: Aetna Commercial |
$4,275.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,269.70
|
| Rate for Payer: Cash Price |
$4,024.24
|
| Rate for Payer: Cofinity Commercial |
$3,521.21
|
| Rate for Payer: Cofinity Commercial |
$4,326.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,024.24
|
| Rate for Payer: Healthscope Commercial |
$4,527.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,521.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,772.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,275.76
|
| Rate for Payer: PHP Commercial |
$4,275.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,521.21
|
| Rate for Payer: Priority Health SBD |
$3,169.09
|
| Rate for Payer: UMR Bronson Commercial |
$2,213.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,772.72
|
|
|
DEFERASIROX 90 MG TABLET
|
Facility
|
IP
|
$83.81
|
|
|
Service Code
|
NDC 43598-853-30
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.88 |
| Max. Negotiated Rate |
$75.43 |
| Rate for Payer: Aetna American Axle |
$54.48
|
| Rate for Payer: Aetna Commercial |
$71.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.48
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Cofinity Commercial |
$72.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.05
|
| Rate for Payer: Healthscope Commercial |
$75.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.24
|
| Rate for Payer: PHP Commercial |
$71.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.67
|
| Rate for Payer: Priority Health SBD |
$52.80
|
| Rate for Payer: UMR Bronson Commercial |
$36.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.86
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$128.30
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$115.47 |
| Rate for Payer: Aetna American Axle |
$83.40
|
| Rate for Payer: Aetna American Axle |
$66.10
|
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna Commercial |
$86.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.40
|
| Rate for Payer: BCBS Complete |
$40.68
|
| Rate for Payer: BCBS Complete |
$51.32
|
| Rate for Payer: BCBS Trust/PPO |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$27.75
|
| Rate for Payer: Cash Price |
$102.64
|
| Rate for Payer: Cash Price |
$102.64
|
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Commercial |
$87.45
|
| Rate for Payer: Cofinity Commercial |
$89.81
|
| Rate for Payer: Cofinity Commercial |
$110.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.64
|
| Rate for Payer: Healthscope Commercial |
$91.52
|
| Rate for Payer: Healthscope Commercial |
$115.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.06
|
| Rate for Payer: PHP Commercial |
$109.06
|
| Rate for Payer: PHP Commercial |
$86.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.81
|
| Rate for Payer: Priority Health SBD |
$64.06
|
| Rate for Payer: Priority Health SBD |
$80.83
|
| Rate for Payer: UMR Bronson Commercial |
$37.63
|
| Rate for Payer: UMR Bronson Commercial |
$47.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.27
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$128.30
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$115.47 |
| Rate for Payer: Aetna American Axle |
$83.40
|
| Rate for Payer: Aetna American Axle |
$49.91
|
| Rate for Payer: Aetna American Axle |
$66.10
|
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna Commercial |
$86.44
|
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.10
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Cash Price |
$102.64
|
| Rate for Payer: Cofinity Commercial |
$110.34
|
| Rate for Payer: Cofinity Commercial |
$87.45
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Commercial |
$89.81
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Healthscope Commercial |
$69.11
|
| Rate for Payer: Healthscope Commercial |
$91.52
|
| Rate for Payer: Healthscope Commercial |
$115.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.44
|
| Rate for Payer: PHP Commercial |
$65.27
|
| Rate for Payer: PHP Commercial |
$109.06
|
| Rate for Payer: PHP Commercial |
$86.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.75
|
| Rate for Payer: Priority Health SBD |
$80.83
|
| Rate for Payer: Priority Health SBD |
$48.38
|
| Rate for Payer: Priority Health SBD |
$64.06
|
| Rate for Payer: UMR Bronson Commercial |
$56.45
|
| Rate for Payer: UMR Bronson Commercial |
$44.74
|
| Rate for Payer: UMR Bronson Commercial |
$33.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.27
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
IP
|
$143.70
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.23 |
| Max. Negotiated Rate |
$129.33 |
| Rate for Payer: Aetna American Axle |
$93.40
|
| Rate for Payer: Aetna American Axle |
$23.61
|
| Rate for Payer: Aetna Commercial |
$122.14
|
| Rate for Payer: Aetna Commercial |
$30.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.40
|
| Rate for Payer: Cash Price |
$29.06
|
| Rate for Payer: Cash Price |
$114.96
|
| Rate for Payer: Cofinity Commercial |
$25.43
|
| Rate for Payer: Cofinity Commercial |
$31.24
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$123.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.96
|
| Rate for Payer: Healthscope Commercial |
$32.70
|
| Rate for Payer: Healthscope Commercial |
$129.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.14
|
| Rate for Payer: PHP Commercial |
$122.14
|
| Rate for Payer: PHP Commercial |
$30.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.59
|
| Rate for Payer: Priority Health SBD |
$22.89
|
| Rate for Payer: Priority Health SBD |
$90.53
|
| Rate for Payer: UMR Bronson Commercial |
$15.99
|
| Rate for Payer: UMR Bronson Commercial |
$63.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.78
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$36.33
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$32.70 |
| Rate for Payer: Aetna American Axle |
$23.61
|
| Rate for Payer: Aetna American Axle |
$93.40
|
| Rate for Payer: Aetna American Axle |
$34.80
|
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Commercial |
$30.88
|
| Rate for Payer: Aetna Commercial |
$122.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.61
|
| Rate for Payer: Cash Price |
$29.06
|
| Rate for Payer: Cash Price |
$114.96
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$25.43
|
| Rate for Payer: Cofinity Commercial |
$31.24
|
| Rate for Payer: Cofinity Commercial |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.96
|
| Rate for Payer: Healthscope Commercial |
$129.33
|
| Rate for Payer: Healthscope Commercial |
$48.19
|
| Rate for Payer: Healthscope Commercial |
$32.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.88
|
| Rate for Payer: PHP Commercial |
$122.14
|
| Rate for Payer: PHP Commercial |
$30.88
|
| Rate for Payer: PHP Commercial |
$45.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.48
|
| Rate for Payer: Priority Health SBD |
$22.89
|
| Rate for Payer: Priority Health SBD |
$90.53
|
| Rate for Payer: Priority Health SBD |
$33.73
|
| Rate for Payer: UMR Bronson Commercial |
$23.56
|
| Rate for Payer: UMR Bronson Commercial |
$63.23
|
| Rate for Payer: UMR Bronson Commercial |
$15.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.78
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$36.33
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$32.70 |
| Rate for Payer: Aetna American Axle |
$23.61
|
| Rate for Payer: Aetna American Axle |
$34.80
|
| Rate for Payer: Aetna American Axle |
$24.04
|
| Rate for Payer: Aetna American Axle |
$93.40
|
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Commercial |
$122.14
|
| Rate for Payer: Aetna Commercial |
$30.88
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: BCBS Complete |
$14.79
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS Complete |
$21.42
|
| Rate for Payer: BCBS Complete |
$14.53
|
| Rate for Payer: BCBS Trust/PPO |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$27.75
|
| Rate for Payer: Cash Price |
$114.96
|
| Rate for Payer: Cash Price |
$114.96
|
| Rate for Payer: Cash Price |
$29.06
|
| Rate for Payer: Cash Price |
$29.06
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Cofinity Commercial |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$31.24
|
| Rate for Payer: Cofinity Commercial |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$25.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Healthscope Commercial |
$32.70
|
| Rate for Payer: Healthscope Commercial |
$129.33
|
| Rate for Payer: Healthscope Commercial |
$48.19
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.14
|
| Rate for Payer: PHP Commercial |
$45.51
|
| Rate for Payer: PHP Commercial |
$122.14
|
| Rate for Payer: PHP Commercial |
$30.88
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.48
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: Priority Health SBD |
$90.53
|
| Rate for Payer: Priority Health SBD |
$33.73
|
| Rate for Payer: Priority Health SBD |
$22.89
|
| Rate for Payer: UMR Bronson Commercial |
$19.81
|
| Rate for Payer: UMR Bronson Commercial |
$13.68
|
| Rate for Payer: UMR Bronson Commercial |
$53.17
|
| Rate for Payer: UMR Bronson Commercial |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.16
|
|
|
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,535.97
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$4,082.37 |
| Rate for Payer: Aetna American Axle |
$2,948.38
|
| Rate for Payer: Aetna American Axle |
$1,474.19
|
| Rate for Payer: Aetna Commercial |
$3,855.57
|
| Rate for Payer: Aetna Commercial |
$1,927.79
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,948.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,474.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.23
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.19
|
| Rate for Payer: BCBS MAPPO |
$4.19
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: BCN Medicare Advantage |
$4.19
|
| Rate for Payer: BCN Medicare Advantage |
$4.19
|
| Rate for Payer: Cash Price |
$3,628.78
|
| Rate for Payer: Cash Price |
$1,814.39
|
| Rate for Payer: Cash Price |
$3,628.78
|
| Rate for Payer: Cash Price |
$1,814.39
|
| Rate for Payer: Cofinity Commercial |
$3,175.18
|
| Rate for Payer: Cofinity Commercial |
$3,900.93
|
| Rate for Payer: Cofinity Commercial |
$1,587.59
|
| Rate for Payer: Cofinity Commercial |
$1,950.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,628.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,814.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.19
|
| Rate for Payer: Healthscope Commercial |
$2,041.19
|
| Rate for Payer: Healthscope Commercial |
$4,082.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,587.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,175.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,401.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,700.99
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.19
|
| Rate for Payer: Mclaren Medicare |
$4.19
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,855.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,927.79
|
| Rate for Payer: PACE Medicare |
$3.98
|
| Rate for Payer: PACE Medicare |
$3.98
|
| Rate for Payer: PACE SWMI |
$4.19
|
| Rate for Payer: PACE SWMI |
$4.19
|
| Rate for Payer: PHP Commercial |
$1,927.79
|
| Rate for Payer: PHP Commercial |
$3,855.57
|
| Rate for Payer: PHP Medicare Advantage |
$4.19
|
| Rate for Payer: PHP Medicare Advantage |
$4.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,175.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.11
|
| Rate for Payer: Priority Health Medicare |
$4.19
|
| Rate for Payer: Priority Health Medicare |
$4.19
|
| Rate for Payer: Priority Health Narrow Network |
$9.69
|
| Rate for Payer: Priority Health Narrow Network |
$9.69
|
| Rate for Payer: Priority Health SBD |
$2,857.66
|
| Rate for Payer: Priority Health SBD |
$1,428.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.19
|
| Rate for Payer: Railroad Medicare Medicare |
$4.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.19
|
| Rate for Payer: UHC Medicare Advantage |
$4.31
|
| Rate for Payer: UHC Medicare Advantage |
$4.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,678.31
|
| Rate for Payer: UMR Bronson Commercial |
$839.16
|
| Rate for Payer: VA VA |
$4.19
|
| Rate for Payer: VA VA |
$4.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,700.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,401.98
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$1,453.64
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$1,308.28 |
| Rate for Payer: Aetna American Axle |
$944.87
|
| Rate for Payer: Aetna Commercial |
$1,235.59
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.23
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.19
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: BCN Medicare Advantage |
$4.19
|
| Rate for Payer: Cash Price |
$1,162.91
|
| Rate for Payer: Cash Price |
$1,162.91
|
| Rate for Payer: Cofinity Commercial |
$1,017.55
|
| Rate for Payer: Cofinity Commercial |
$1,250.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.19
|
| Rate for Payer: Healthscope Commercial |
$1,308.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,017.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,090.23
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.19
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,235.59
|
| Rate for Payer: PACE Medicare |
$3.98
|
| Rate for Payer: PACE SWMI |
$4.19
|
| Rate for Payer: PHP Commercial |
$1,235.59
|
| Rate for Payer: PHP Medicare Advantage |
$4.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.11
|
| Rate for Payer: Priority Health Medicare |
$4.19
|
| Rate for Payer: Priority Health Narrow Network |
$9.69
|
| Rate for Payer: Priority Health SBD |
$915.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.19
|
| Rate for Payer: UHC Medicare Advantage |
$4.31
|
| Rate for Payer: UMR Bronson Commercial |
$537.85
|
| Rate for Payer: VA VA |
$4.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,090.23
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$45,724.73
|
|
|
Service Code
|
MS-DRG 056
|
| Min. Negotiated Rate |
$18,012.57 |
| Max. Negotiated Rate |
$45,724.73 |
| Rate for Payer: Aetna Medicare |
$19,719.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,700.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,700.75
|
| Rate for Payer: BCBS MAPPO |
$18,960.60
|
| Rate for Payer: BCBS Trust/PPO |
$45,724.73
|
| Rate for Payer: BCN Medicare Advantage |
$18,960.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,960.60
|
| Rate for Payer: Mclaren Medicare |
$18,960.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,908.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,804.69
|
| Rate for Payer: PACE Medicare |
$18,012.57
|
| Rate for Payer: PACE SWMI |
$18,960.60
|
| Rate for Payer: PHP Medicare Advantage |
$18,960.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,353.71
|
| Rate for Payer: Priority Health Medicare |
$18,960.60
|
| Rate for Payer: Priority Health Narrow Network |
$27,482.97
|
| Rate for Payer: Railroad Medicare Medicare |
$18,960.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,518.08
|
| Rate for Payer: UHC Core |
$29,944.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,960.60
|
| Rate for Payer: UHC Exchange |
$23,805.94
|
| Rate for Payer: UHC Medicare Advantage |
$19,529.42
|
| Rate for Payer: VA VA |
$18,960.60
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$32,010.68
|
|
|
Service Code
|
MS-DRG 057
|
| Min. Negotiated Rate |
$10,466.34 |
| Max. Negotiated Rate |
$32,010.68 |
| Rate for Payer: Aetna Medicare |
$11,457.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,771.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,771.50
|
| Rate for Payer: BCBS MAPPO |
$11,017.20
|
| Rate for Payer: BCBS Trust/PPO |
$32,010.68
|
| Rate for Payer: BCN Medicare Advantage |
$11,017.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,017.20
|
| Rate for Payer: Mclaren Medicare |
$11,017.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,568.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,669.78
|
| Rate for Payer: PACE Medicare |
$10,466.34
|
| Rate for Payer: PACE SWMI |
$11,017.20
|
| Rate for Payer: PHP Medicare Advantage |
$11,017.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,561.81
|
| Rate for Payer: Priority Health Medicare |
$11,017.20
|
| Rate for Payer: Priority Health Narrow Network |
$15,649.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11,017.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,794.25
|
| Rate for Payer: UHC Core |
$17,050.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,017.20
|
| Rate for Payer: UHC Exchange |
$13,555.66
|
| Rate for Payer: UHC Medicare Advantage |
$11,347.72
|
| Rate for Payer: VA VA |
$11,017.20
|
|
|
DEIONIZED WATER
|
Facility
|
IP
|
$889.48
|
|
|
Service Code
|
NDC 0990-0000-39
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$391.37 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna American Axle |
$578.16
|
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Commercial |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.58
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$622.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.06
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.64
|
| Rate for Payer: Priority Health SBD |
$560.37
|
| Rate for Payer: UMR Bronson Commercial |
$391.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.11
|
|
