|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$35.96
|
|
|
Service Code
|
NDC 0536-1266-59
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.82 |
| Max. Negotiated Rate |
$32.36 |
| Rate for Payer: Aetna American Axle |
$23.37
|
| Rate for Payer: Aetna Commercial |
$30.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.37
|
| Rate for Payer: Cash Price |
$28.77
|
| Rate for Payer: Cofinity Commercial |
$25.17
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$32.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.57
|
| Rate for Payer: PHP Commercial |
$30.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.17
|
| Rate for Payer: Priority Health SBD |
$22.65
|
| Rate for Payer: UMR Bronson Commercial |
$15.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.97
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$27.19
|
|
|
Service Code
|
NDC 57237-301-24
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$24.47 |
| Rate for Payer: Aetna American Axle |
$17.67
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$19.03
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.11
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.03
|
| Rate for Payer: Priority Health SBD |
$17.13
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 9900-0000-19
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna American Axle |
$2.60
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 9900-0005-65
|
| Hospital Charge Code |
15168
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna American Axle |
$2.60
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
|
IP
|
$18,399.37
|
|
|
Service Code
|
MS-DRG 549
|
| Min. Negotiated Rate |
$9,317.00 |
| Max. Negotiated Rate |
$18,399.37 |
| Rate for Payer: Aetna Medicare |
$10,199.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,259.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,259.21
|
| Rate for Payer: BCBS MAPPO |
$9,807.37
|
| Rate for Payer: BCBS Trust/PPO |
$17,949.64
|
| Rate for Payer: BCN Medicare Advantage |
$9,807.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,807.37
|
| Rate for Payer: Mclaren Medicare |
$9,807.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,297.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,278.48
|
| Rate for Payer: PACE Medicare |
$9,317.00
|
| Rate for Payer: PACE SWMI |
$9,807.37
|
| Rate for Payer: PHP Medicare Advantage |
$9,807.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,308.87
|
| Rate for Payer: Priority Health Medicare |
$9,807.37
|
| Rate for Payer: Priority Health Narrow Network |
$13,847.10
|
| Rate for Payer: Railroad Medicare Medicare |
$9,807.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,399.37
|
| Rate for Payer: UHC Core |
$15,087.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,807.37
|
| Rate for Payer: UHC Exchange |
$11,994.45
|
| Rate for Payer: UHC Medicare Advantage |
$10,101.59
|
| Rate for Payer: VA VA |
$9,807.37
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
|
IP
|
$31,308.22
|
|
|
Service Code
|
MS-DRG 548
|
| Min. Negotiated Rate |
$14,760.70 |
| Max. Negotiated Rate |
$31,308.22 |
| Rate for Payer: Aetna Medicare |
$16,159.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,421.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,421.98
|
| Rate for Payer: BCBS MAPPO |
$15,537.58
|
| Rate for Payer: BCBS Trust/PPO |
$31,308.22
|
| Rate for Payer: BCN Medicare Advantage |
$15,537.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,537.58
|
| Rate for Payer: Mclaren Medicare |
$15,537.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,314.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,868.22
|
| Rate for Payer: PACE Medicare |
$14,760.70
|
| Rate for Payer: PACE SWMI |
$15,537.58
|
| Rate for Payer: PHP Medicare Advantage |
$15,537.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,979.47
|
| Rate for Payer: Priority Health Medicare |
$15,537.58
|
| Rate for Payer: Priority Health Narrow Network |
$22,383.58
|
| Rate for Payer: Railroad Medicare Medicare |
$15,537.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,742.25
|
| Rate for Payer: UHC Core |
$24,388.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,537.58
|
| Rate for Payer: UHC Exchange |
$19,388.81
|
| Rate for Payer: UHC Medicare Advantage |
$16,003.71
|
| Rate for Payer: VA VA |
$15,537.58
|
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$15,821.22
|
|
|
Service Code
|
MS-DRG 550
|
| Min. Negotiated Rate |
$7,393.84 |
| Max. Negotiated Rate |
$15,821.22 |
| Rate for Payer: Aetna Medicare |
$8,094.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,728.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,728.74
|
| Rate for Payer: BCBS MAPPO |
$7,782.99
|
| Rate for Payer: BCBS Trust/PPO |
$15,821.22
|
| Rate for Payer: BCN Medicare Advantage |
$7,782.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,782.99
|
| Rate for Payer: Mclaren Medicare |
$7,782.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,172.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,950.44
|
| Rate for Payer: PACE Medicare |
$7,393.84
|
| Rate for Payer: PACE SWMI |
$7,782.99
|
| Rate for Payer: PHP Medicare Advantage |
$7,782.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,213.41
|
| Rate for Payer: Priority Health Medicare |
$7,782.99
|
| Rate for Payer: Priority Health Narrow Network |
$10,570.73
|
| Rate for Payer: Railroad Medicare Medicare |
$7,782.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,045.88
|
| Rate for Payer: UHC Core |
$11,517.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,782.99
|
| Rate for Payer: UHC Exchange |
$9,156.44
|
| Rate for Payer: UHC Medicare Advantage |
$8,016.48
|
| Rate for Payer: VA VA |
$7,782.99
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$134,849.75
|
|
|
Service Code
|
MS-DRG 870
|
| Min. Negotiated Rate |
$51,474.90 |
| Max. Negotiated Rate |
$134,849.75 |
| Rate for Payer: Aetna Medicare |
$56,351.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67,730.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67,730.14
|
| Rate for Payer: BCBS MAPPO |
$54,184.11
|
| Rate for Payer: BCBS Trust/PPO |
$134,849.75
|
| Rate for Payer: BCN Medicare Advantage |
$54,184.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54,184.11
|
| Rate for Payer: Mclaren Medicare |
$54,184.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56,893.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62,311.73
|
| Rate for Payer: PACE Medicare |
$51,474.90
|
| Rate for Payer: PACE SWMI |
$54,184.11
|
| Rate for Payer: PHP Medicare Advantage |
$54,184.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99,945.76
|
| Rate for Payer: Priority Health Medicare |
$54,184.11
|
| Rate for Payer: Priority Health Narrow Network |
$79,956.61
|
| Rate for Payer: Railroad Medicare Medicare |
$54,184.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106,242.58
|
| Rate for Payer: UHC Core |
$87,116.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$54,184.11
|
| Rate for Payer: UHC Exchange |
$69,258.97
|
| Rate for Payer: UHC Medicare Advantage |
$55,809.63
|
| Rate for Payer: VA VA |
$54,184.11
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$33,313.52
|
|
|
Service Code
|
MS-DRG 871
|
| Min. Negotiated Rate |
$15,000.82 |
| Max. Negotiated Rate |
$33,313.52 |
| Rate for Payer: Aetna Medicare |
$16,421.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,737.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,737.92
|
| Rate for Payer: BCBS MAPPO |
$15,790.34
|
| Rate for Payer: BCBS Trust/PPO |
$33,313.52
|
| Rate for Payer: BCN Medicare Advantage |
$15,790.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,790.34
|
| Rate for Payer: Mclaren Medicare |
$15,790.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,579.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,158.89
|
| Rate for Payer: PACE Medicare |
$15,000.82
|
| Rate for Payer: PACE SWMI |
$15,790.34
|
| Rate for Payer: PHP Medicare Advantage |
$15,790.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,450.15
|
| Rate for Payer: Priority Health Medicare |
$15,790.34
|
| Rate for Payer: Priority Health Narrow Network |
$22,760.12
|
| Rate for Payer: Railroad Medicare Medicare |
$15,790.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,242.58
|
| Rate for Payer: UHC Core |
$24,798.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,790.34
|
| Rate for Payer: UHC Exchange |
$19,714.97
|
| Rate for Payer: UHC Medicare Advantage |
$16,264.05
|
| Rate for Payer: VA VA |
$15,790.34
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$15,710.09
|
|
|
Service Code
|
MS-DRG 872
|
| Min. Negotiated Rate |
$8,026.36 |
| Max. Negotiated Rate |
$15,710.09 |
| Rate for Payer: Aetna Medicare |
$8,786.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,561.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,561.00
|
| Rate for Payer: BCBS MAPPO |
$8,448.80
|
| Rate for Payer: BCBS Trust/PPO |
$15,416.64
|
| Rate for Payer: BCN Medicare Advantage |
$8,448.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,448.80
|
| Rate for Payer: Mclaren Medicare |
$8,448.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,871.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,716.12
|
| Rate for Payer: PACE Medicare |
$8,026.36
|
| Rate for Payer: PACE SWMI |
$8,448.80
|
| Rate for Payer: PHP Medicare Advantage |
$8,448.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,778.98
|
| Rate for Payer: Priority Health Medicare |
$8,448.80
|
| Rate for Payer: Priority Health Narrow Network |
$11,823.18
|
| Rate for Payer: Railroad Medicare Medicare |
$8,448.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,710.09
|
| Rate for Payer: UHC Core |
$12,881.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,448.80
|
| Rate for Payer: UHC Exchange |
$10,241.33
|
| Rate for Payer: UHC Medicare Advantage |
$8,702.26
|
| Rate for Payer: VA VA |
$8,448.80
|
|
|
SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WITH GRAFT
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 30520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$668.96 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,146.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.86
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$668.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$213.12
|
|
|
Service Code
|
NDC 64980-409-06
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$191.81 |
| Rate for Payer: Aetna American Axle |
$138.53
|
| Rate for Payer: Aetna Commercial |
$181.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.53
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cofinity Commercial |
$149.18
|
| Rate for Payer: Cofinity Commercial |
$183.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.50
|
| Rate for Payer: Healthscope Commercial |
$191.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.15
|
| Rate for Payer: PHP Commercial |
$181.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health SBD |
$134.27
|
| Rate for Payer: UMR Bronson Commercial |
$93.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.84
|
|
|
SERTRALINE 20 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$249.70
|
|
|
Service Code
|
NDC 59762-0067-1
|
| Hospital Charge Code |
28011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.87 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna American Axle |
$162.30
|
| Rate for Payer: Aetna Commercial |
$212.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.30
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$174.79
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.24
|
| Rate for Payer: PHP Commercial |
$212.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.79
|
| Rate for Payer: Priority Health SBD |
$157.31
|
| Rate for Payer: UMR Bronson Commercial |
$109.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.28
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$57.11
|
|
|
Service Code
|
NDC 68180-351-09
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$51.40 |
| Rate for Payer: Aetna American Axle |
$37.12
|
| Rate for Payer: Aetna Commercial |
$48.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Cash Price |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.69
|
| Rate for Payer: Healthscope Commercial |
$51.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.54
|
| Rate for Payer: PHP Commercial |
$48.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.98
|
| Rate for Payer: Priority Health SBD |
$35.98
|
| Rate for Payer: UMR Bronson Commercial |
$25.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.83
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 60687-231-11
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna American Axle |
$1.58
|
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.58
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.53
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$242.25
|
|
|
Service Code
|
NDC 60687-231-01
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$218.02 |
| Rate for Payer: Aetna American Axle |
$157.46
|
| Rate for Payer: Aetna Commercial |
$205.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.46
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cofinity Commercial |
$169.58
|
| Rate for Payer: Cofinity Commercial |
$208.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.80
|
| Rate for Payer: Healthscope Commercial |
$218.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.91
|
| Rate for Payer: PHP Commercial |
$205.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.58
|
| Rate for Payer: Priority Health SBD |
$152.62
|
| Rate for Payer: UMR Bronson Commercial |
$106.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.69
|
|
|
SERTRALINE 25 MG TABLET
|
Facility
|
IP
|
$156.51
|
|
|
Service Code
|
NDC 69097-833-05
|
| Hospital Charge Code |
19882
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.86 |
| Max. Negotiated Rate |
$140.86 |
| Rate for Payer: Aetna American Axle |
$101.73
|
| Rate for Payer: Aetna Commercial |
$133.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.73
|
| Rate for Payer: Cash Price |
$125.21
|
| Rate for Payer: Cofinity Commercial |
$109.56
|
| Rate for Payer: Cofinity Commercial |
$134.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.21
|
| Rate for Payer: Healthscope Commercial |
$140.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.03
|
| Rate for Payer: PHP Commercial |
$133.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.56
|
| Rate for Payer: Priority Health SBD |
$98.60
|
| Rate for Payer: UMR Bronson Commercial |
$68.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.38
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$1,421.91
|
|
|
Service Code
|
NDC 0049-4900-30
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$625.64 |
| Max. Negotiated Rate |
$1,279.72 |
| Rate for Payer: Aetna American Axle |
$924.24
|
| Rate for Payer: Aetna Commercial |
$1,208.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.24
|
| Rate for Payer: Cash Price |
$1,137.53
|
| Rate for Payer: Cofinity Commercial |
$1,222.84
|
| Rate for Payer: Cofinity Commercial |
$995.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,137.53
|
| Rate for Payer: Healthscope Commercial |
$1,279.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$995.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,066.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,208.62
|
| Rate for Payer: PHP Commercial |
$1,208.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.34
|
| Rate for Payer: Priority Health SBD |
$895.80
|
| Rate for Payer: UMR Bronson Commercial |
$625.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,066.43
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$286.90
|
|
|
Service Code
|
NDC 60687-242-01
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$258.21 |
| Rate for Payer: Aetna American Axle |
$186.48
|
| Rate for Payer: Aetna Commercial |
$243.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.48
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Commercial |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$246.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$258.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.86
|
| Rate for Payer: PHP Commercial |
$243.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.83
|
| Rate for Payer: Priority Health SBD |
$180.75
|
| Rate for Payer: UMR Bronson Commercial |
$126.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.18
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$69.80
|
|
|
Service Code
|
NDC 68180-352-09
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna American Axle |
$45.37
|
| Rate for Payer: Aetna Commercial |
$59.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.37
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cofinity Commercial |
$48.86
|
| Rate for Payer: Cofinity Commercial |
$60.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$62.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.33
|
| Rate for Payer: PHP Commercial |
$59.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.86
|
| Rate for Payer: Priority Health SBD |
$43.97
|
| Rate for Payer: UMR Bronson Commercial |
$30.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.35
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 60687-242-11
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.01
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$210.90
|
|
|
Service Code
|
NDC 59762-4900-4
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$189.81 |
| Rate for Payer: Aetna American Axle |
$137.08
|
| Rate for Payer: Aetna Commercial |
$179.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.08
|
| Rate for Payer: Cash Price |
$168.72
|
| Rate for Payer: Cofinity Commercial |
$147.63
|
| Rate for Payer: Cofinity Commercial |
$181.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.72
|
| Rate for Payer: Healthscope Commercial |
$189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.26
|
| Rate for Payer: PHP Commercial |
$179.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.63
|
| Rate for Payer: Priority Health SBD |
$132.87
|
| Rate for Payer: UMR Bronson Commercial |
$92.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.18
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 59762-4900-3
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna American Axle |
$146.64
|
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.76
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.92
|
| Rate for Payer: Priority Health SBD |
$142.13
|
| Rate for Payer: UMR Bronson Commercial |
$99.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 0904-6925-61
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.94
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.19
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$119.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$323.19 |
| 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) |
$355.51
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$323.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
