|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$9.22
|
|
|
Service Code
|
NDC 51079021501
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna American Axle |
$5.99
|
| Rate for Payer: Aetna Commercial |
$7.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.99
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cofinity Advantage |
$6.45
|
| Rate for Payer: Cofinity Commercial |
$7.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.38
|
| Rate for Payer: Healthscope Commercial |
$8.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.92
|
| Rate for Payer: PHP Commercial |
$7.84
|
| Rate for Payer: Priority Health SBD |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.92
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$5,649.53
|
|
|
Service Code
|
NDC 58151008488
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,485.79 |
| Max. Negotiated Rate |
$5,084.58 |
| Rate for Payer: Aetna American Axle |
$3,672.19
|
| Rate for Payer: Aetna Commercial |
$4,802.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,672.19
|
| Rate for Payer: Cash Price |
$4,519.62
|
| Rate for Payer: Cofinity Advantage |
$3,954.67
|
| Rate for Payer: Cofinity Commercial |
$4,858.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,519.62
|
| Rate for Payer: Healthscope Commercial |
$5,084.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,954.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,237.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,802.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,237.15
|
| Rate for Payer: PHP Commercial |
$4,802.10
|
| Rate for Payer: Priority Health SBD |
$3,559.20
|
| Rate for Payer: UMR Bronson Commercial |
$2,485.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,237.15
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
NDC 60687044711
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: Aetna American Axle |
$4.96
|
| Rate for Payer: Aetna Commercial |
$6.49
|
| Rate for Payer: Aetna Medicare |
$3.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.96
|
| Rate for Payer: BCBS Complete |
$3.05
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cofinity Advantage |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$6.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.10
|
| Rate for Payer: Healthscope Commercial |
$6.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.72
|
| Rate for Payer: PHP Commercial |
$6.49
|
| Rate for Payer: Priority Health SBD |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.96
|
| Rate for Payer: UHC Core |
$3.98
|
| Rate for Payer: UHC Exchange |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.72
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$387.75
|
|
|
Service Code
|
NDC 69097042107
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.47 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna American Axle |
$252.04
|
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna Medicare |
$193.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: BCBS Complete |
$155.10
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Advantage |
$271.43
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.04
|
| Rate for Payer: UHC Core |
$202.02
|
| Rate for Payer: UHC Exchange |
$152.39
|
| Rate for Payer: UMR Bronson Commercial |
$143.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 69097042107
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna American Axle |
$252.04
|
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Advantage |
$271.43
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UMR Bronson Commercial |
$170.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 62332014231
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$56.50
|
|
|
Service Code
|
NDC 58151008432
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Aetna American Axle |
$36.73
|
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.73
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Cofinity Advantage |
$39.55
|
| Rate for Payer: Cofinity Commercial |
$48.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.20
|
| Rate for Payer: Healthscope Commercial |
$50.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.38
|
| Rate for Payer: PHP Commercial |
$48.02
|
| Rate for Payer: Priority Health SBD |
$35.59
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.38
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$921.30
|
|
|
Service Code
|
NDC 51079021520
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.88 |
| Max. Negotiated Rate |
$829.17 |
| Rate for Payer: Aetna American Axle |
$598.85
|
| Rate for Payer: Aetna Commercial |
$783.11
|
| Rate for Payer: Aetna Medicare |
$460.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.85
|
| Rate for Payer: BCBS Complete |
$368.52
|
| Rate for Payer: Cash Price |
$737.04
|
| Rate for Payer: Cofinity Advantage |
$644.91
|
| Rate for Payer: Cofinity Commercial |
$792.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.04
|
| Rate for Payer: Healthscope Commercial |
$829.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$690.98
|
| Rate for Payer: PHP Commercial |
$783.11
|
| Rate for Payer: Priority Health SBD |
$580.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.85
|
| Rate for Payer: UHC Core |
$480.00
|
| Rate for Payer: UHC Exchange |
$362.07
|
| Rate for Payer: UMR Bronson Commercial |
$340.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.98
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$233.76
|
|
|
Service Code
|
NDC 50268016915
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.49 |
| Max. Negotiated Rate |
$210.38 |
| Rate for Payer: Aetna American Axle |
$151.94
|
| Rate for Payer: Aetna Commercial |
$198.70
|
| Rate for Payer: Aetna Medicare |
$116.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.94
|
| Rate for Payer: BCBS Complete |
$93.50
|
| Rate for Payer: Cash Price |
$187.01
|
| Rate for Payer: Cofinity Advantage |
$163.63
|
| Rate for Payer: Cofinity Commercial |
$201.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.01
|
| Rate for Payer: Healthscope Commercial |
$210.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.32
|
| Rate for Payer: PHP Commercial |
$198.70
|
| Rate for Payer: Priority Health SBD |
$147.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.94
|
| Rate for Payer: UHC Core |
$121.79
|
| Rate for Payer: UHC Exchange |
$91.87
|
| Rate for Payer: UMR Bronson Commercial |
$86.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.32
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 42571014401
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 62332014231
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.10
|
| Rate for Payer: UHC Core |
$139.54
|
| Rate for Payer: UHC Exchange |
$105.26
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 42571014401
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 50268016911
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.04
|
| Rate for Payer: UHC Core |
$2.44
|
| Rate for Payer: UHC Exchange |
$1.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 72241002405
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.16 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna American Axle |
$142.06
|
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UMR Bronson Commercial |
$96.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
CELECOXIB 200 MG CAPSULE
|
Facility
|
OP
|
$5,649.53
|
|
|
Service Code
|
NDC 58151008488
|
| Hospital Charge Code |
24501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,090.33 |
| Max. Negotiated Rate |
$5,084.58 |
| Rate for Payer: Aetna American Axle |
$3,672.19
|
| Rate for Payer: Aetna Commercial |
$4,802.10
|
| Rate for Payer: Aetna Medicare |
$2,824.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,672.19
|
| Rate for Payer: BCBS Complete |
$2,259.81
|
| Rate for Payer: Cash Price |
$4,519.62
|
| Rate for Payer: Cofinity Advantage |
$3,954.67
|
| Rate for Payer: Cofinity Commercial |
$4,858.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,519.62
|
| Rate for Payer: Healthscope Commercial |
$5,084.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,954.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,237.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,519.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,802.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,237.15
|
| Rate for Payer: PHP Commercial |
$4,802.10
|
| Rate for Payer: Priority Health SBD |
$3,559.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,672.19
|
| Rate for Payer: UHC Core |
$2,943.41
|
| Rate for Payer: UHC Exchange |
$2,220.27
|
| Rate for Payer: UMR Bronson Commercial |
$2,090.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,237.15
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$3,443.69
|
|
|
Service Code
|
APR-DRG 3831
|
| Min. Negotiated Rate |
$3,279.71 |
| Max. Negotiated Rate |
$3,443.69 |
| Rate for Payer: BCBS Complete |
$3,443.69
|
| Rate for Payer: Mclaren Medicaid |
$3,279.71
|
| Rate for Payer: Meridian Medicaid |
$3,443.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,279.71
|
| Rate for Payer: UHC Medicaid |
$3,279.71
|
| Rate for Payer: UHCCP Medicaid |
$3,279.71
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$4,449.14
|
|
|
Service Code
|
APR-DRG 3832
|
| Min. Negotiated Rate |
$4,237.27 |
| Max. Negotiated Rate |
$4,449.14 |
| Rate for Payer: BCBS Complete |
$4,449.14
|
| Rate for Payer: Mclaren Medicaid |
$4,237.27
|
| Rate for Payer: Meridian Medicaid |
$4,449.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,237.27
|
| Rate for Payer: UHC Medicaid |
$4,237.27
|
| Rate for Payer: UHCCP Medicaid |
$4,237.27
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$10,063.53
|
|
|
Service Code
|
APR-DRG 3834
|
| Min. Negotiated Rate |
$9,584.31 |
| Max. Negotiated Rate |
$10,063.53 |
| Rate for Payer: BCBS Complete |
$10,063.53
|
| Rate for Payer: Mclaren Medicaid |
$9,584.31
|
| Rate for Payer: Meridian Medicaid |
$10,063.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,584.31
|
| Rate for Payer: UHC Medicaid |
$9,584.31
|
| Rate for Payer: UHCCP Medicaid |
$9,584.31
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$6,640.42
|
|
|
Service Code
|
APR-DRG 3833
|
| Min. Negotiated Rate |
$6,324.20 |
| Max. Negotiated Rate |
$6,640.42 |
| Rate for Payer: BCBS Complete |
$6,640.42
|
| Rate for Payer: Mclaren Medicaid |
$6,324.20
|
| Rate for Payer: Meridian Medicaid |
$6,640.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,324.20
|
| Rate for Payer: UHC Medicaid |
$6,324.20
|
| Rate for Payer: UHCCP Medicaid |
$6,324.20
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$29,103.55
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$11,854.93 |
| Max. Negotiated Rate |
$29,103.55 |
| Rate for Payer: Aetna Medicare |
$12,978.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,598.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,598.59
|
| Rate for Payer: BCBS MAPPO |
$12,478.87
|
| Rate for Payer: BCBS Trust/PPO |
$29,103.55
|
| Rate for Payer: BCN Commercial |
$29,103.55
|
| Rate for Payer: BCN Medicare Advantage |
$12,478.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,478.87
|
| Rate for Payer: Mclaren Medicare |
$12,478.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,102.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,350.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,726.76
|
| Rate for Payer: Nomi Health Commercial |
$18,334.77
|
| Rate for Payer: PACE Medicare |
$11,854.93
|
| Rate for Payer: PACE SWMI |
$12,478.87
|
| Rate for Payer: PHP Medicare Advantage |
$12,478.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,914.40
|
| Rate for Payer: Priority Health Medicare |
$12,478.87
|
| Rate for Payer: Priority Health Tiered Network |
$18,331.52
|
| Rate for Payer: Railroad Medicare Medicare |
$12,478.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,167.19
|
| Rate for Payer: UHC Core |
$19,382.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,478.87
|
| Rate for Payer: UHC Exchange |
$15,829.02
|
| Rate for Payer: VA VA |
$12,478.87
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$14,195.67
|
|
|
Service Code
|
MSDRG 603
|
| Min. Negotiated Rate |
$7,482.24 |
| Max. Negotiated Rate |
$14,195.67 |
| Rate for Payer: Aetna Medicare |
$8,191.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,845.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,845.05
|
| Rate for Payer: BCBS MAPPO |
$7,876.04
|
| Rate for Payer: BCBS Trust/PPO |
$13,879.23
|
| Rate for Payer: BCN Commercial |
$13,879.23
|
| Rate for Payer: BCN Medicare Advantage |
$7,876.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,876.04
|
| Rate for Payer: Mclaren Medicare |
$7,876.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,269.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,057.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,663.64
|
| Rate for Payer: Nomi Health Commercial |
$11,234.61
|
| Rate for Payer: PACE Medicare |
$7,482.24
|
| Rate for Payer: PACE SWMI |
$7,876.04
|
| Rate for Payer: PHP Medicare Advantage |
$7,876.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,040.77
|
| Rate for Payer: Priority Health Medicare |
$7,876.04
|
| Rate for Payer: Priority Health Tiered Network |
$11,232.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7,876.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,195.67
|
| Rate for Payer: UHC Core |
$11,876.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,876.04
|
| Rate for Payer: UHC Exchange |
$9,699.21
|
| Rate for Payer: VA VA |
$7,876.04
|
|
|
CELLULOSE, OXIDIZED 2" X 14" PADS
|
Facility
|
IP
|
$250.27
|
|
|
Service Code
|
NDC 09900000602
|
| Hospital Charge Code |
169202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$225.24 |
| Rate for Payer: Aetna American Axle |
$162.68
|
| Rate for Payer: Aetna Commercial |
$212.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.68
|
| Rate for Payer: Cash Price |
$200.22
|
| Rate for Payer: Cofinity Advantage |
$175.19
|
| Rate for Payer: Cofinity Commercial |
$215.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.22
|
| Rate for Payer: Healthscope Commercial |
$225.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.70
|
| Rate for Payer: PHP Commercial |
$212.73
|
| Rate for Payer: Priority Health SBD |
$157.67
|
| Rate for Payer: UMR Bronson Commercial |
$110.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.70
|
|
|
CELLULOSE, OXIDIZED 2" X 14" PADS
|
Facility
|
OP
|
$250.27
|
|
|
Service Code
|
NDC 09900000602
|
| Hospital Charge Code |
169202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$225.24 |
| Rate for Payer: Aetna American Axle |
$162.68
|
| Rate for Payer: Aetna Commercial |
$212.73
|
| Rate for Payer: Aetna Medicare |
$125.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.68
|
| Rate for Payer: BCBS Complete |
$100.11
|
| Rate for Payer: Cash Price |
$200.22
|
| Rate for Payer: Cofinity Advantage |
$175.19
|
| Rate for Payer: Cofinity Commercial |
$215.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.22
|
| Rate for Payer: Healthscope Commercial |
$225.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.70
|
| Rate for Payer: PHP Commercial |
$212.73
|
| Rate for Payer: Priority Health SBD |
$157.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.68
|
| Rate for Payer: UHC Core |
$130.39
|
| Rate for Payer: UHC Exchange |
$98.36
|
| Rate for Payer: UMR Bronson Commercial |
$92.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.70
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
IP
|
$159.91
|
|
|
Service Code
|
NDC 09900000603
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.36 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna American Axle |
$103.94
|
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.94
|
| Rate for Payer: Cash Price |
$127.93
|
| Rate for Payer: Cofinity Advantage |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.93
|
| Rate for Payer: Healthscope Commercial |
$143.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.93
|
| Rate for Payer: PHP Commercial |
$135.92
|
| Rate for Payer: Priority Health SBD |
$100.74
|
| Rate for Payer: UMR Bronson Commercial |
$70.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.93
|
|
|
CELLULOSE, OXIDIZED 2" X 3" MISC
|
Facility
|
IP
|
$245.24
|
|
|
Service Code
|
NDC 63713091953
|
| Hospital Charge Code |
169203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.91 |
| Max. Negotiated Rate |
$220.72 |
| Rate for Payer: Aetna American Axle |
$159.41
|
| Rate for Payer: Aetna Commercial |
$208.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.41
|
| Rate for Payer: Cash Price |
$196.19
|
| Rate for Payer: Cofinity Advantage |
$171.67
|
| Rate for Payer: Cofinity Commercial |
$210.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.19
|
| Rate for Payer: Healthscope Commercial |
$220.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.93
|
| Rate for Payer: PHP Commercial |
$208.45
|
| Rate for Payer: Priority Health SBD |
$154.50
|
| Rate for Payer: UMR Bronson Commercial |
$107.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.93
|
|
