|
SOFT TISSUE PROCEDURES WITH CC
|
Facility
|
IP
|
$35,630.41
|
|
|
Service Code
|
MS-DRG 501
|
| Min. Negotiated Rate |
$13,193.33 |
| Max. Negotiated Rate |
$35,630.41 |
| Rate for Payer: Aetna Medicare |
$14,443.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,359.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,359.65
|
| Rate for Payer: BCBS MAPPO |
$13,887.72
|
| Rate for Payer: BCBS Trust/PPO |
$35,630.41
|
| Rate for Payer: BCN Medicare Advantage |
$13,887.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,887.72
|
| Rate for Payer: Mclaren Medicare |
$13,887.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,582.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,970.88
|
| Rate for Payer: PACE Medicare |
$13,193.33
|
| Rate for Payer: PACE SWMI |
$13,887.72
|
| Rate for Payer: PHP Medicare Advantage |
$13,887.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,907.16
|
| Rate for Payer: Priority Health Medicare |
$13,887.72
|
| Rate for Payer: Priority Health Narrow Network |
$19,925.73
|
| Rate for Payer: Railroad Medicare Medicare |
$13,887.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,476.37
|
| Rate for Payer: UHC Core |
$21,710.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,887.72
|
| Rate for Payer: UHC Exchange |
$17,259.80
|
| Rate for Payer: UHC Medicare Advantage |
$14,304.35
|
| Rate for Payer: VA VA |
$13,887.72
|
|
|
SOFT TISSUE PROCEDURES WITH MCC
|
Facility
|
IP
|
$73,555.10
|
|
|
Service Code
|
MS-DRG 500
|
| Min. Negotiated Rate |
$24,226.41 |
| Max. Negotiated Rate |
$73,555.10 |
| Rate for Payer: Aetna Medicare |
$26,521.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,876.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,876.85
|
| Rate for Payer: BCBS MAPPO |
$25,501.48
|
| Rate for Payer: BCBS Trust/PPO |
$73,555.10
|
| Rate for Payer: BCN Medicare Advantage |
$25,501.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,501.48
|
| Rate for Payer: Mclaren Medicare |
$25,501.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,776.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,326.70
|
| Rate for Payer: PACE Medicare |
$24,226.41
|
| Rate for Payer: PACE SWMI |
$25,501.48
|
| Rate for Payer: PHP Medicare Advantage |
$25,501.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,533.92
|
| Rate for Payer: Priority Health Medicare |
$25,501.48
|
| Rate for Payer: Priority Health Narrow Network |
$37,227.14
|
| Rate for Payer: Railroad Medicare Medicare |
$25,501.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,465.67
|
| Rate for Payer: UHC Core |
$40,560.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,501.48
|
| Rate for Payer: UHC Exchange |
$32,246.40
|
| Rate for Payer: UHC Medicare Advantage |
$26,266.52
|
| Rate for Payer: VA VA |
$25,501.48
|
|
|
SOFT TISSUE PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,810.67
|
|
|
Service Code
|
MS-DRG 502
|
| Min. Negotiated Rate |
$10,609.12 |
| Max. Negotiated Rate |
$30,810.67 |
| Rate for Payer: Aetna Medicare |
$11,614.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,959.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,959.36
|
| Rate for Payer: BCBS MAPPO |
$11,167.49
|
| Rate for Payer: BCBS Trust/PPO |
$30,810.67
|
| Rate for Payer: BCN Medicare Advantage |
$11,167.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,167.49
|
| Rate for Payer: Mclaren Medicare |
$11,167.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,725.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,842.61
|
| Rate for Payer: PACE Medicare |
$10,609.12
|
| Rate for Payer: PACE SWMI |
$11,167.49
|
| Rate for Payer: PHP Medicare Advantage |
$11,167.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,841.63
|
| Rate for Payer: Priority Health Medicare |
$11,167.49
|
| Rate for Payer: Priority Health Narrow Network |
$15,873.30
|
| Rate for Payer: Railroad Medicare Medicare |
$11,167.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,091.71
|
| Rate for Payer: UHC Core |
$17,294.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,167.49
|
| Rate for Payer: UHC Exchange |
$13,749.57
|
| Rate for Payer: UHC Medicare Advantage |
$11,502.51
|
| Rate for Payer: VA VA |
$11,167.49
|
|
|
SOMATROPIN 0.2 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$731.24
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$658.12 |
| Rate for Payer: Aetna American Axle |
$475.31
|
| Rate for Payer: Aetna American Axle |
$67.91
|
| Rate for Payer: Aetna Commercial |
$88.80
|
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.31
|
| Rate for Payer: Cash Price |
$83.58
|
| Rate for Payer: Cash Price |
$584.99
|
| Rate for Payer: Cofinity Commercial |
$628.87
|
| Rate for Payer: Cofinity Commercial |
$73.13
|
| Rate for Payer: Cofinity Commercial |
$89.84
|
| Rate for Payer: Cofinity Commercial |
$511.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.99
|
| Rate for Payer: Healthscope Commercial |
$658.12
|
| Rate for Payer: Healthscope Commercial |
$94.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$621.55
|
| Rate for Payer: PHP Commercial |
$621.55
|
| Rate for Payer: PHP Commercial |
$88.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.87
|
| Rate for Payer: Priority Health SBD |
$65.82
|
| Rate for Payer: Priority Health SBD |
$460.68
|
| Rate for Payer: UMR Bronson Commercial |
$321.75
|
| Rate for Payer: UMR Bronson Commercial |
$45.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.43
|
|
|
SOMATROPIN 0.4 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$1,462.66
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$643.57 |
| Max. Negotiated Rate |
$1,316.39 |
| Rate for Payer: Aetna American Axle |
$950.73
|
| Rate for Payer: Aetna Commercial |
$1,243.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$950.73
|
| Rate for Payer: Cash Price |
$1,170.13
|
| Rate for Payer: Cofinity Commercial |
$1,023.86
|
| Rate for Payer: Cofinity Commercial |
$1,257.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,170.13
|
| Rate for Payer: Healthscope Commercial |
$1,316.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,023.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,097.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,243.26
|
| Rate for Payer: PHP Commercial |
$1,243.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.86
|
| Rate for Payer: Priority Health SBD |
$921.48
|
| Rate for Payer: UMR Bronson Commercial |
$643.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,097.00
|
|
|
SORAFENIB 200 MG TABLET
|
Facility
|
IP
|
$69,645.40
|
|
|
Service Code
|
NDC 0378-1201-78
|
| Hospital Charge Code |
43675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30,643.98 |
| Max. Negotiated Rate |
$62,680.86 |
| Rate for Payer: Aetna American Axle |
$45,269.51
|
| Rate for Payer: Aetna Commercial |
$59,198.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45,269.51
|
| Rate for Payer: Cash Price |
$55,716.32
|
| Rate for Payer: Cofinity Commercial |
$48,751.78
|
| Rate for Payer: Cofinity Commercial |
$59,895.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55,716.32
|
| Rate for Payer: Healthscope Commercial |
$62,680.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48,751.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52,234.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59,198.59
|
| Rate for Payer: PHP Commercial |
$59,198.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48,751.78
|
| Rate for Payer: Priority Health SBD |
$43,876.60
|
| Rate for Payer: UMR Bronson Commercial |
$30,643.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52,234.05
|
|
|
SORAFENIB 200 MG TABLET
|
Facility
|
OP
|
$94,398.84
|
|
|
Service Code
|
NDC 50419-488-58
|
| Hospital Charge Code |
43675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34,927.57 |
| Max. Negotiated Rate |
$84,958.96 |
| Rate for Payer: Aetna American Axle |
$61,359.25
|
| Rate for Payer: Aetna Commercial |
$80,239.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61,359.25
|
| Rate for Payer: BCBS Complete |
$37,759.54
|
| Rate for Payer: Cash Price |
$75,519.07
|
| Rate for Payer: Cofinity Commercial |
$66,079.19
|
| Rate for Payer: Cofinity Commercial |
$81,183.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75,519.07
|
| Rate for Payer: Healthscope Commercial |
$84,958.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66,079.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70,799.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80,239.01
|
| Rate for Payer: PHP Commercial |
$80,239.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66,079.19
|
| Rate for Payer: Priority Health SBD |
$59,471.27
|
| Rate for Payer: UMR Bronson Commercial |
$34,927.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70,799.13
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
IP
|
$10.51
|
|
|
Service Code
|
NDC 57896-435-16
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Aetna American Axle |
$6.83
|
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.83
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$9.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.93
|
| Rate for Payer: PHP Commercial |
$8.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.36
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: UMR Bronson Commercial |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
IP
|
$52.51
|
|
|
Service Code
|
NDC 4628750001
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$47.26 |
| Rate for Payer: Aetna American Axle |
$34.13
|
| Rate for Payer: Aetna Commercial |
$44.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.13
|
| Rate for Payer: Cash Price |
$42.01
|
| Rate for Payer: Cofinity Commercial |
$36.76
|
| Rate for Payer: Cofinity Commercial |
$45.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.01
|
| Rate for Payer: Healthscope Commercial |
$47.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.63
|
| Rate for Payer: PHP Commercial |
$44.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.76
|
| Rate for Payer: Priority Health SBD |
$33.08
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.38
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
IP
|
$29.76
|
|
|
Service Code
|
NDC 802391316
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna American Axle |
$19.34
|
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.34
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Healthscope Commercial |
$26.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.30
|
| Rate for Payer: PHP Commercial |
$25.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.83
|
| Rate for Payer: Priority Health SBD |
$18.75
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.32
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
IP
|
$341.05
|
|
|
Service Code
|
NDC 0185-0170-01
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.06 |
| Max. Negotiated Rate |
$306.94 |
| Rate for Payer: Aetna American Axle |
$221.68
|
| Rate for Payer: Aetna Commercial |
$289.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.68
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$238.74
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$306.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.89
|
| Rate for Payer: PHP Commercial |
$289.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.74
|
| Rate for Payer: Priority Health SBD |
$214.86
|
| Rate for Payer: UMR Bronson Commercial |
$150.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.79
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
IP
|
$213.85
|
|
|
Service Code
|
NDC 60505-0159-0
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$192.46 |
| Rate for Payer: Aetna American Axle |
$139.00
|
| Rate for Payer: Aetna Commercial |
$181.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.00
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$149.70
|
| Rate for Payer: Cofinity Commercial |
$183.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$192.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.77
|
| Rate for Payer: PHP Commercial |
$181.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.70
|
| Rate for Payer: Priority Health SBD |
$134.73
|
| Rate for Payer: UMR Bronson Commercial |
$94.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.39
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
IP
|
$338.20
|
|
|
Service Code
|
NDC 0093-1060-01
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.81 |
| Max. Negotiated Rate |
$304.38 |
| Rate for Payer: Aetna American Axle |
$219.83
|
| Rate for Payer: Aetna Commercial |
$287.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.83
|
| Rate for Payer: Cash Price |
$270.56
|
| Rate for Payer: Cofinity Commercial |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$290.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.56
|
| Rate for Payer: Healthscope Commercial |
$304.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.47
|
| Rate for Payer: PHP Commercial |
$287.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.74
|
| Rate for Payer: Priority Health SBD |
$213.07
|
| Rate for Payer: UMR Bronson Commercial |
$148.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.65
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 60505-0080-0
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.25
|
| Rate for Payer: Priority Health SBD |
$74.02
|
| Rate for Payer: UMR Bronson Commercial |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$462.24
|
|
|
Service Code
|
NDC 0245-0012-01
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.39 |
| Max. Negotiated Rate |
$416.02 |
| Rate for Payer: Aetna American Axle |
$300.46
|
| Rate for Payer: Aetna Commercial |
$392.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.46
|
| Rate for Payer: Cash Price |
$369.79
|
| Rate for Payer: Cofinity Commercial |
$323.57
|
| Rate for Payer: Cofinity Commercial |
$397.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.79
|
| Rate for Payer: Healthscope Commercial |
$416.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$392.90
|
| Rate for Payer: PHP Commercial |
$392.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.57
|
| Rate for Payer: Priority Health SBD |
$291.21
|
| Rate for Payer: UMR Bronson Commercial |
$203.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.68
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$397.44
|
|
|
Service Code
|
NDC 0904-7143-61
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.87 |
| Max. Negotiated Rate |
$357.70 |
| Rate for Payer: Aetna American Axle |
$258.34
|
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.34
|
| Rate for Payer: Cash Price |
$317.95
|
| Rate for Payer: Cofinity Commercial |
$278.21
|
| Rate for Payer: Cofinity Commercial |
$341.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.95
|
| Rate for Payer: Healthscope Commercial |
$357.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.82
|
| Rate for Payer: PHP Commercial |
$337.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.21
|
| Rate for Payer: Priority Health SBD |
$250.39
|
| Rate for Payer: UMR Bronson Commercial |
$174.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.08
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 0245-0012-89
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna American Axle |
$3.01
|
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.01
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$4.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.94
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.24
|
| Rate for Payer: Priority Health SBD |
$2.92
|
| Rate for Payer: UMR Bronson Commercial |
$2.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.47
|
|
|
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT
|
Facility
|
OP
|
$7,856.86
|
|
|
Service Code
|
CPT 46750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$736.42 |
| Max. Negotiated Rate |
$7,856.86 |
| Rate for Payer: Aetna Medicare |
$2,595.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,136.95
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,856.86
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$6,285.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.06
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,495.78
|
| Rate for Payer: UHC Exchange |
$736.42
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: VA VA |
$2,495.78
|
|
|
SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$7,856.86
|
|
|
Service Code
|
CPT 46080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.53 |
| Max. Negotiated Rate |
$7,856.86 |
| Rate for Payer: Aetna Medicare |
$2,595.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,134.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,856.86
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$6,285.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.08
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,495.78
|
| Rate for Payer: UHC Exchange |
$155.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: VA VA |
$2,495.78
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
|
IP
|
$30,363.37
|
|
|
Service Code
|
MS-DRG 052
|
| Min. Negotiated Rate |
$14,721.91 |
| Max. Negotiated Rate |
$30,363.37 |
| Rate for Payer: Aetna Medicare |
$16,116.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,370.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,370.94
|
| Rate for Payer: BCBS MAPPO |
$15,496.75
|
| Rate for Payer: BCBS Trust/PPO |
$30,363.37
|
| Rate for Payer: BCN Medicare Advantage |
$15,496.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,496.75
|
| Rate for Payer: Mclaren Medicare |
$15,496.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,271.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,821.26
|
| Rate for Payer: PACE Medicare |
$14,721.91
|
| Rate for Payer: PACE SWMI |
$15,496.75
|
| Rate for Payer: PHP Medicare Advantage |
$15,496.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,903.42
|
| Rate for Payer: Priority Health Medicare |
$15,496.75
|
| Rate for Payer: Priority Health Narrow Network |
$22,322.74
|
| Rate for Payer: Railroad Medicare Medicare |
$15,496.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,661.40
|
| Rate for Payer: UHC Core |
$24,321.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,496.75
|
| Rate for Payer: UHC Exchange |
$19,336.11
|
| Rate for Payer: UHC Medicare Advantage |
$15,961.65
|
| Rate for Payer: VA VA |
$15,496.75
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,902.44
|
|
|
Service Code
|
MS-DRG 053
|
| Min. Negotiated Rate |
$7,688.86 |
| Max. Negotiated Rate |
$21,902.44 |
| Rate for Payer: Aetna Medicare |
$8,417.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,116.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,116.92
|
| Rate for Payer: BCBS MAPPO |
$8,093.54
|
| Rate for Payer: BCBS Trust/PPO |
$21,902.44
|
| Rate for Payer: BCN Medicare Advantage |
$8,093.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,093.54
|
| Rate for Payer: Mclaren Medicare |
$8,093.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,498.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,307.57
|
| Rate for Payer: PACE Medicare |
$7,688.86
|
| Rate for Payer: PACE SWMI |
$8,093.54
|
| Rate for Payer: PHP Medicare Advantage |
$8,093.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,117.45
|
| Rate for Payer: Priority Health Medicare |
$8,093.54
|
| Rate for Payer: Priority Health Narrow Network |
$11,293.96
|
| Rate for Payer: Railroad Medicare Medicare |
$8,093.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,006.89
|
| Rate for Payer: UHC Core |
$12,305.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,093.54
|
| Rate for Payer: UHC Exchange |
$9,782.91
|
| Rate for Payer: UHC Medicare Advantage |
$8,336.35
|
| Rate for Payer: VA VA |
$8,093.54
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH MCC
|
Facility
|
IP
|
$101,169.10
|
|
|
Service Code
|
MS-DRG 459
|
| Min. Negotiated Rate |
$49,040.03 |
| Max. Negotiated Rate |
$101,169.10 |
| Rate for Payer: Aetna Medicare |
$53,685.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64,526.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64,526.35
|
| Rate for Payer: BCBS MAPPO |
$51,621.08
|
| Rate for Payer: BCBS Trust/PPO |
$95,565.59
|
| Rate for Payer: BCN Medicare Advantage |
$51,621.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51,621.08
|
| Rate for Payer: Mclaren Medicare |
$51,621.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54,202.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59,364.24
|
| Rate for Payer: PACE Medicare |
$49,040.03
|
| Rate for Payer: PACE SWMI |
$51,621.08
|
| Rate for Payer: PHP Medicare Advantage |
$51,621.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95,172.97
|
| Rate for Payer: Priority Health Medicare |
$51,621.08
|
| Rate for Payer: Priority Health Narrow Network |
$76,138.38
|
| Rate for Payer: Railroad Medicare Medicare |
$51,621.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101,169.10
|
| Rate for Payer: UHC Core |
$82,956.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$51,621.08
|
| Rate for Payer: UHC Exchange |
$65,951.59
|
| Rate for Payer: UHC Medicare Advantage |
$53,169.71
|
| Rate for Payer: VA VA |
$51,621.08
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$61,372.56
|
|
|
Service Code
|
MS-DRG 460
|
| Min. Negotiated Rate |
$27,265.24 |
| Max. Negotiated Rate |
$61,372.56 |
| Rate for Payer: Aetna Medicare |
$29,848.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,875.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,875.31
|
| Rate for Payer: BCBS MAPPO |
$28,700.25
|
| Rate for Payer: BCBS Trust/PPO |
$61,372.56
|
| Rate for Payer: BCN Medicare Advantage |
$28,700.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,700.25
|
| Rate for Payer: Mclaren Medicare |
$28,700.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,135.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,005.29
|
| Rate for Payer: PACE Medicare |
$27,265.24
|
| Rate for Payer: PACE SWMI |
$28,700.25
|
| Rate for Payer: PHP Medicare Advantage |
$28,700.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,490.57
|
| Rate for Payer: Priority Health Medicare |
$28,700.25
|
| Rate for Payer: Priority Health Narrow Network |
$41,992.46
|
| Rate for Payer: Railroad Medicare Medicare |
$28,700.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,797.61
|
| Rate for Payer: UHC Core |
$45,753.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,700.25
|
| Rate for Payer: UHC Exchange |
$36,374.16
|
| Rate for Payer: UHC Medicare Advantage |
$29,561.26
|
| Rate for Payer: VA VA |
$28,700.25
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC
|
Facility
|
IP
|
$110,542.47
|
|
|
Service Code
|
MS-DRG 457
|
| Min. Negotiated Rate |
$44,962.39 |
| Max. Negotiated Rate |
$110,542.47 |
| Rate for Payer: Aetna Medicare |
$49,221.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59,161.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59,161.04
|
| Rate for Payer: BCBS MAPPO |
$47,328.83
|
| Rate for Payer: BCBS Trust/PPO |
$110,542.47
|
| Rate for Payer: BCN Medicare Advantage |
$47,328.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,328.83
|
| Rate for Payer: Mclaren Medicare |
$47,328.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49,695.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54,428.15
|
| Rate for Payer: PACE Medicare |
$44,962.39
|
| Rate for Payer: PACE SWMI |
$47,328.83
|
| Rate for Payer: PHP Medicare Advantage |
$47,328.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87,180.07
|
| Rate for Payer: Priority Health Medicare |
$47,328.83
|
| Rate for Payer: Priority Health Narrow Network |
$69,744.06
|
| Rate for Payer: Railroad Medicare Medicare |
$47,328.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92,672.63
|
| Rate for Payer: UHC Core |
$75,989.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$47,328.83
|
| Rate for Payer: UHC Exchange |
$60,412.78
|
| Rate for Payer: UHC Medicare Advantage |
$48,748.69
|
| Rate for Payer: VA VA |
$47,328.83
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
|
IP
|
$134,377.33
|
|
|
Service Code
|
MS-DRG 456
|
| Min. Negotiated Rate |
$62,196.11 |
| Max. Negotiated Rate |
$134,377.33 |
| Rate for Payer: Aetna Medicare |
$68,088.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81,836.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81,836.99
|
| Rate for Payer: BCBS MAPPO |
$65,469.59
|
| Rate for Payer: BCBS Trust/PPO |
$134,377.33
|
| Rate for Payer: BCN Medicare Advantage |
$65,469.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65,469.59
|
| Rate for Payer: Mclaren Medicare |
$65,469.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68,743.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75,290.03
|
| Rate for Payer: PACE Medicare |
$62,196.11
|
| Rate for Payer: PACE SWMI |
$65,469.59
|
| Rate for Payer: PHP Medicare Advantage |
$65,469.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120,961.22
|
| Rate for Payer: Priority Health Medicare |
$65,469.59
|
| Rate for Payer: Priority Health Narrow Network |
$96,768.98
|
| Rate for Payer: Railroad Medicare Medicare |
$65,469.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128,582.07
|
| Rate for Payer: UHC Core |
$105,434.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$65,469.59
|
| Rate for Payer: UHC Exchange |
$83,821.95
|
| Rate for Payer: UHC Medicare Advantage |
$67,433.68
|
| Rate for Payer: VA VA |
$65,469.59
|
|
