|
TORSEMIDE 100 MG TABLET
|
Facility
|
IP
|
$868.32
|
|
|
Service Code
|
NDC 50111-918-01
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$382.06 |
| Max. Negotiated Rate |
$781.49 |
| Rate for Payer: Aetna American Axle |
$564.41
|
| Rate for Payer: Aetna Commercial |
$738.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.41
|
| Rate for Payer: Cash Price |
$694.66
|
| Rate for Payer: Cofinity Commercial |
$607.82
|
| Rate for Payer: Cofinity Commercial |
$746.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.66
|
| Rate for Payer: Healthscope Commercial |
$781.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$607.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$738.07
|
| Rate for Payer: PHP Commercial |
$738.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.82
|
| Rate for Payer: Priority Health SBD |
$547.04
|
| Rate for Payer: UMR Bronson Commercial |
$382.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.24
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 0054-0077-25
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.77 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Commercial |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.50
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.36
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UMR Bronson Commercial |
$205.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$216.20
|
|
|
Service Code
|
NDC 31722-531-01
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.13 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna American Axle |
$140.53
|
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.53
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Commercial |
$151.34
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.77
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.34
|
| Rate for Payer: Priority Health SBD |
$136.21
|
| Rate for Payer: UMR Bronson Commercial |
$95.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.15
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 50111-917-01
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.34 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna American Axle |
$182.21
|
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.27
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.22
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UMR Bronson Commercial |
$123.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$308.75
|
|
|
Service Code
|
NDC 68084-539-01
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna American Axle |
$200.69
|
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.69
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$216.12
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.44
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.12
|
| Rate for Payer: Priority Health SBD |
$194.51
|
| Rate for Payer: UMR Bronson Commercial |
$135.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$111.63
|
|
|
Service Code
|
NDC 50268-754-15
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$100.47 |
| Rate for Payer: Aetna American Axle |
$72.56
|
| Rate for Payer: Aetna Commercial |
$94.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.56
|
| Rate for Payer: Cash Price |
$89.30
|
| Rate for Payer: Cofinity Commercial |
$78.14
|
| Rate for Payer: Cofinity Commercial |
$96.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.30
|
| Rate for Payer: Healthscope Commercial |
$100.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.89
|
| Rate for Payer: PHP Commercial |
$94.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.14
|
| Rate for Payer: Priority Health SBD |
$70.33
|
| Rate for Payer: UMR Bronson Commercial |
$49.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.72
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 50111-915-01
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.52 |
| Max. Negotiated Rate |
$385.60 |
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.92
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$188.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 31722-529-01
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.02
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$2.24
|
|
|
Service Code
|
NDC 50268-754-11
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.90
|
| Rate for Payer: PHP Commercial |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.41
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.68
|
|
|
TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S);
|
Facility
|
OP
|
$7,568.61
|
|
|
Service Code
|
CPT 58150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,002.63 |
| Max. Negotiated Rate |
$7,568.61 |
| Rate for Payer: BCBS Trust/PPO |
$7,568.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,102.89
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Exchange |
$1,002.63
|
|
|
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SECOND LEVEL, CERVICAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$24,304.16
|
|
|
Service Code
|
CPT 22858
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$494.76 |
| Max. Negotiated Rate |
$24,304.16 |
| Rate for Payer: BCBS Trust/PPO |
$24,304.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$544.24
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$494.76
|
|
|
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SINGLE INTERSPACE, CERVICAL
|
Facility
|
OP
|
$52,147.99
|
|
|
Service Code
|
CPT 22856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,608.40 |
| Max. Negotiated Rate |
$52,147.99 |
| Rate for Payer: Aetna Medicare |
$17,227.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,706.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,706.49
|
| Rate for Payer: BCBS Complete |
$9,515.05
|
| Rate for Payer: BCBS MAPPO |
$16,565.19
|
| Rate for Payer: BCBS Trust/PPO |
$16,497.54
|
| Rate for Payer: BCN Medicare Advantage |
$16,565.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,565.19
|
| Rate for Payer: Mclaren Medicaid |
$9,061.16
|
| Rate for Payer: Mclaren Medicare |
$16,565.19
|
| Rate for Payer: Meridian Medicaid |
$9,515.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,393.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,049.97
|
| Rate for Payer: PACE Medicare |
$15,736.93
|
| Rate for Payer: PACE SWMI |
$16,565.19
|
| Rate for Payer: PHP Medicare Advantage |
$16,565.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,061.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,147.99
|
| Rate for Payer: Priority Health Medicare |
$16,565.19
|
| Rate for Payer: Priority Health Narrow Network |
$41,718.39
|
| Rate for Payer: Railroad Medicare Medicare |
$16,565.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,769.24
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,565.19
|
| Rate for Payer: UHC Exchange |
$1,608.40
|
| Rate for Payer: UHC Medicare Advantage |
$17,062.15
|
| Rate for Payer: VA VA |
$16,565.19
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 60220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$697.78 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$5,780.16
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$767.56
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$697.78
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,468.63
|
|
|
Service Code
|
HCPCS J9352
|
| Hospital Charge Code |
175966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.10 |
| Max. Negotiated Rate |
$13,021.77 |
| Rate for Payer: Aetna American Axle |
$9,404.61
|
| Rate for Payer: Aetna Commercial |
$12,298.34
|
| Rate for Payer: Aetna Medicare |
$351.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,404.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$423.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$423.00
|
| Rate for Payer: BCBS Complete |
$194.38
|
| Rate for Payer: BCBS MAPPO |
$338.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.54
|
| Rate for Payer: BCN Medicare Advantage |
$338.40
|
| Rate for Payer: Cash Price |
$11,574.90
|
| Rate for Payer: Cash Price |
$11,574.90
|
| Rate for Payer: Cofinity Commercial |
$12,443.02
|
| Rate for Payer: Cofinity Commercial |
$10,128.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,574.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.40
|
| Rate for Payer: Healthscope Commercial |
$13,021.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,128.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,851.47
|
| Rate for Payer: Mclaren Medicaid |
$185.10
|
| Rate for Payer: Mclaren Medicare |
$338.40
|
| Rate for Payer: Meridian Medicaid |
$194.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$355.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$389.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,298.34
|
| Rate for Payer: PACE Medicare |
$321.48
|
| Rate for Payer: PACE SWMI |
$338.40
|
| Rate for Payer: PHP Commercial |
$12,298.34
|
| Rate for Payer: PHP Medicare Advantage |
$338.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,128.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$993.88
|
| Rate for Payer: Priority Health Medicare |
$338.40
|
| Rate for Payer: Priority Health Narrow Network |
$795.10
|
| Rate for Payer: Priority Health SBD |
$9,115.24
|
| Rate for Payer: Railroad Medicare Medicare |
$338.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.40
|
| Rate for Payer: UHC Medicare Advantage |
$348.55
|
| Rate for Payer: UMR Bronson Commercial |
$5,353.39
|
| Rate for Payer: VA VA |
$338.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,851.47
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,468.63
|
|
|
Service Code
|
HCPCS J9352
|
| Hospital Charge Code |
175966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,366.20 |
| Max. Negotiated Rate |
$13,021.77 |
| Rate for Payer: Aetna American Axle |
$9,404.61
|
| Rate for Payer: Aetna Commercial |
$12,298.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,404.61
|
| Rate for Payer: Cash Price |
$11,574.90
|
| Rate for Payer: Cofinity Commercial |
$10,128.04
|
| Rate for Payer: Cofinity Commercial |
$12,443.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,574.90
|
| Rate for Payer: Healthscope Commercial |
$13,021.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,128.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,851.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,298.34
|
| Rate for Payer: PHP Commercial |
$12,298.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,128.04
|
| Rate for Payer: Priority Health SBD |
$9,115.24
|
| Rate for Payer: UMR Bronson Commercial |
$6,366.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,851.47
|
|
|
TRABECULOTOMY AB EXTERNO
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 65850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$819.91 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$901.90
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$819.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS
|
Facility
|
IP
|
$74.18
|
|
|
Service Code
|
NDC 0517-9203-25
|
| Hospital Charge Code |
18266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$66.76 |
| Rate for Payer: Aetna American Axle |
$48.22
|
| Rate for Payer: Aetna Commercial |
$63.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.22
|
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Cofinity Commercial |
$51.93
|
| Rate for Payer: Cofinity Commercial |
$63.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.34
|
| Rate for Payer: Healthscope Commercial |
$66.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.05
|
| Rate for Payer: PHP Commercial |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.93
|
| Rate for Payer: Priority Health SBD |
$46.73
|
| Rate for Payer: UMR Bronson Commercial |
$32.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.64
|
|
|
TRACE ELEMENTS ADULT INJECTION (NORWAY)
|
Facility
|
IP
|
$90.92
|
|
|
Service Code
|
NDC 9900-0005-58
|
| Hospital Charge Code |
168908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$81.83 |
| Rate for Payer: Aetna American Axle |
$59.10
|
| Rate for Payer: Aetna Commercial |
$77.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.10
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cofinity Commercial |
$78.19
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.74
|
| Rate for Payer: Healthscope Commercial |
$81.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.28
|
| Rate for Payer: PHP Commercial |
$77.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.64
|
| Rate for Payer: Priority Health SBD |
$57.28
|
| Rate for Payer: UMR Bronson Commercial |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.19
|
|
|
TRACE ELEMENTS ADULT INJECTION (NORWAY)
|
Facility
|
IP
|
$97.48
|
|
|
Service Code
|
NDC 0517-7201-25
|
| Hospital Charge Code |
168908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.89 |
| Max. Negotiated Rate |
$87.73 |
| Rate for Payer: Aetna American Axle |
$63.36
|
| Rate for Payer: Aetna Commercial |
$82.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.36
|
| Rate for Payer: Cash Price |
$77.98
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$83.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.98
|
| Rate for Payer: Healthscope Commercial |
$87.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.86
|
| Rate for Payer: PHP Commercial |
$82.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health SBD |
$61.41
|
| Rate for Payer: UMR Bronson Commercial |
$42.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.11
|
|
|
TRACE ELEMENTS CR-CU-MN-ZN 0.85 MCG-0.1 MG-25 MCG-1.5MG/ML INTRAVENOUS
|
Facility
|
IP
|
$14.12
|
|
|
Service Code
|
NDC 0517-6202-25
|
| Hospital Charge Code |
18267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$12.71 |
| Rate for Payer: Aetna American Axle |
$9.18
|
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.18
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cofinity Commercial |
$12.14
|
| Rate for Payer: Cofinity Commercial |
$9.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.30
|
| Rate for Payer: Healthscope Commercial |
$12.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.00
|
| Rate for Payer: PHP Commercial |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.88
|
| Rate for Payer: Priority Health SBD |
$8.90
|
| Rate for Payer: UMR Bronson Commercial |
$6.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.59
|
|
|
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG-0.5 MG-5 MG/ML INTRAVENOUS SOLN
|
Facility
|
OP
|
$47.26
|
|
|
Service Code
|
NDC 0517-7201-25
|
| Hospital Charge Code |
18262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Aetna American Axle |
$30.72
|
| Rate for Payer: Aetna Commercial |
$40.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.72
|
| Rate for Payer: BCBS Complete |
$18.90
|
| Rate for Payer: Cash Price |
$37.81
|
| Rate for Payer: Cofinity Commercial |
$33.08
|
| Rate for Payer: Cofinity Commercial |
$40.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.81
|
| Rate for Payer: Healthscope Commercial |
$42.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.17
|
| Rate for Payer: PHP Commercial |
$40.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.08
|
| Rate for Payer: Priority Health SBD |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.44
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$87.93
|
|
|
Service Code
|
NDC 0517-9305-25
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$79.14 |
| Rate for Payer: Aetna American Axle |
$57.15
|
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.15
|
| Rate for Payer: Cash Price |
$70.34
|
| Rate for Payer: Cofinity Commercial |
$61.55
|
| Rate for Payer: Cofinity Commercial |
$75.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.34
|
| Rate for Payer: Healthscope Commercial |
$79.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.74
|
| Rate for Payer: PHP Commercial |
$74.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.55
|
| Rate for Payer: Priority Health SBD |
$55.40
|
| Rate for Payer: UMR Bronson Commercial |
$38.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.95
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$87.93
|
|
|
Service Code
|
NDC 0517-9305-01
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$79.14 |
| Rate for Payer: Aetna American Axle |
$57.15
|
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.15
|
| Rate for Payer: Cash Price |
$70.34
|
| Rate for Payer: Cofinity Commercial |
$61.55
|
| Rate for Payer: Cofinity Commercial |
$75.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.34
|
| Rate for Payer: Healthscope Commercial |
$79.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.74
|
| Rate for Payer: PHP Commercial |
$74.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.55
|
| Rate for Payer: Priority Health SBD |
$55.40
|
| Rate for Payer: UMR Bronson Commercial |
$38.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.95
|
|
|
TRACHELORRHAPHY, PLASTIC REPAIR OF UTERINE CERVIX, VAGINAL APPROACH
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 57720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.03 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.22
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.23
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$332.03
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
|
IP
|
$103,875.75
|
|
|
Service Code
|
MS-DRG 012
|
| Min. Negotiated Rate |
$29,805.55 |
| Max. Negotiated Rate |
$103,875.75 |
| Rate for Payer: Aetna Medicare |
$32,629.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,217.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,217.82
|
| Rate for Payer: BCBS MAPPO |
$31,374.26
|
| Rate for Payer: BCBS Trust/PPO |
$103,875.75
|
| Rate for Payer: BCN Medicare Advantage |
$31,374.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,374.26
|
| Rate for Payer: Mclaren Medicare |
$31,374.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,942.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,080.40
|
| Rate for Payer: PACE Medicare |
$29,805.55
|
| Rate for Payer: PACE SWMI |
$31,374.26
|
| Rate for Payer: PHP Medicare Advantage |
$31,374.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57,469.99
|
| Rate for Payer: Priority Health Medicare |
$31,374.26
|
| Rate for Payer: Priority Health Narrow Network |
$45,975.99
|
| Rate for Payer: Railroad Medicare Medicare |
$31,374.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61,090.74
|
| Rate for Payer: UHC Core |
$50,093.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$31,374.26
|
| Rate for Payer: UHC Exchange |
$39,824.73
|
| Rate for Payer: UHC Medicare Advantage |
$32,315.49
|
| Rate for Payer: VA VA |
$31,374.26
|
|
