|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$23,651.41
|
|
|
Service Code
|
MS-DRG 743
|
| Min. Negotiated Rate |
$8,993.42 |
| Max. Negotiated Rate |
$23,651.41 |
| Rate for Payer: Aetna Medicare |
$9,845.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,833.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,833.45
|
| Rate for Payer: BCBS MAPPO |
$9,466.76
|
| Rate for Payer: BCBS Trust/PPO |
$23,651.41
|
| Rate for Payer: BCN Medicare Advantage |
$9,466.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,466.76
|
| Rate for Payer: Mclaren Medicare |
$9,466.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,940.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,886.77
|
| Rate for Payer: PACE Medicare |
$8,993.42
|
| Rate for Payer: PACE SWMI |
$9,466.76
|
| Rate for Payer: PHP Medicare Advantage |
$9,466.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,674.61
|
| Rate for Payer: Priority Health Medicare |
$9,466.76
|
| Rate for Payer: Priority Health Narrow Network |
$13,339.69
|
| Rate for Payer: Railroad Medicare Medicare |
$9,466.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,725.15
|
| Rate for Payer: UHC Core |
$14,534.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,466.76
|
| Rate for Payer: UHC Exchange |
$11,554.93
|
| Rate for Payer: UHC Medicare Advantage |
$9,750.76
|
| Rate for Payer: VA VA |
$9,466.76
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
IP
|
$39,945.06
|
|
|
Service Code
|
MS-DRG 740
|
| Min. Negotiated Rate |
$13,568.89 |
| Max. Negotiated Rate |
$39,945.06 |
| Rate for Payer: Aetna Medicare |
$14,854.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,853.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,853.80
|
| Rate for Payer: BCBS MAPPO |
$14,283.04
|
| Rate for Payer: BCBS Trust/PPO |
$39,945.06
|
| Rate for Payer: BCN Medicare Advantage |
$14,283.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,283.04
|
| Rate for Payer: Mclaren Medicare |
$14,283.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,997.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,425.50
|
| Rate for Payer: PACE Medicare |
$13,568.89
|
| Rate for Payer: PACE SWMI |
$14,283.04
|
| Rate for Payer: PHP Medicare Advantage |
$14,283.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,643.31
|
| Rate for Payer: Priority Health Medicare |
$14,283.04
|
| Rate for Payer: Priority Health Narrow Network |
$20,514.65
|
| Rate for Payer: Railroad Medicare Medicare |
$14,283.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,258.90
|
| Rate for Payer: UHC Core |
$22,351.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,283.04
|
| Rate for Payer: UHC Exchange |
$17,769.93
|
| Rate for Payer: UHC Medicare Advantage |
$14,711.53
|
| Rate for Payer: VA VA |
$14,283.04
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
IP
|
$63,196.92
|
|
|
Service Code
|
MS-DRG 739
|
| Min. Negotiated Rate |
$26,960.70 |
| Max. Negotiated Rate |
$63,196.92 |
| Rate for Payer: Aetna Medicare |
$29,514.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,474.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,474.60
|
| Rate for Payer: BCBS MAPPO |
$28,379.68
|
| Rate for Payer: BCBS Trust/PPO |
$63,196.92
|
| Rate for Payer: BCN Medicare Advantage |
$28,379.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,379.68
|
| Rate for Payer: Mclaren Medicare |
$28,379.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,798.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,636.63
|
| Rate for Payer: PACE Medicare |
$26,960.70
|
| Rate for Payer: PACE SWMI |
$28,379.68
|
| Rate for Payer: PHP Medicare Advantage |
$28,379.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,893.62
|
| Rate for Payer: Priority Health Medicare |
$28,379.68
|
| Rate for Payer: Priority Health Narrow Network |
$41,514.90
|
| Rate for Payer: Railroad Medicare Medicare |
$28,379.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,163.04
|
| Rate for Payer: UHC Core |
$45,232.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,379.68
|
| Rate for Payer: UHC Exchange |
$35,960.49
|
| Rate for Payer: UHC Medicare Advantage |
$29,231.07
|
| Rate for Payer: VA VA |
$28,379.68
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$29,770.33
|
|
|
Service Code
|
MS-DRG 741
|
| Min. Negotiated Rate |
$9,998.56 |
| Max. Negotiated Rate |
$29,770.33 |
| Rate for Payer: Aetna Medicare |
$10,945.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,156.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,156.00
|
| Rate for Payer: BCBS MAPPO |
$10,524.80
|
| Rate for Payer: BCBS Trust/PPO |
$29,770.33
|
| Rate for Payer: BCN Medicare Advantage |
$10,524.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,524.80
|
| Rate for Payer: Mclaren Medicare |
$10,524.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,051.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,103.52
|
| Rate for Payer: PACE Medicare |
$9,998.56
|
| Rate for Payer: PACE SWMI |
$10,524.80
|
| Rate for Payer: PHP Medicare Advantage |
$10,524.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,644.85
|
| Rate for Payer: Priority Health Medicare |
$10,524.80
|
| Rate for Payer: Priority Health Narrow Network |
$14,915.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10,524.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,819.52
|
| Rate for Payer: UHC Core |
$16,251.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,524.80
|
| Rate for Payer: UHC Exchange |
$12,920.24
|
| Rate for Payer: UHC Medicare Advantage |
$10,840.54
|
| Rate for Payer: VA VA |
$10,524.80
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
IP
|
$39,774.18
|
|
|
Service Code
|
MS-DRG 737
|
| Min. Negotiated Rate |
$14,936.38 |
| Max. Negotiated Rate |
$39,774.18 |
| Rate for Payer: Aetna Medicare |
$16,351.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,653.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,653.14
|
| Rate for Payer: BCBS MAPPO |
$15,722.51
|
| Rate for Payer: BCBS Trust/PPO |
$39,774.18
|
| Rate for Payer: BCN Medicare Advantage |
$15,722.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,722.51
|
| Rate for Payer: Mclaren Medicare |
$15,722.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,508.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,080.89
|
| Rate for Payer: PACE Medicare |
$14,936.38
|
| Rate for Payer: PACE SWMI |
$15,722.51
|
| Rate for Payer: PHP Medicare Advantage |
$15,722.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,323.87
|
| Rate for Payer: Priority Health Medicare |
$15,722.51
|
| Rate for Payer: Priority Health Narrow Network |
$22,659.10
|
| Rate for Payer: Railroad Medicare Medicare |
$15,722.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,108.35
|
| Rate for Payer: UHC Core |
$24,688.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,722.51
|
| Rate for Payer: UHC Exchange |
$19,627.47
|
| Rate for Payer: UHC Medicare Advantage |
$16,194.19
|
| Rate for Payer: VA VA |
$15,722.51
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
IP
|
$75,522.70
|
|
|
Service Code
|
MS-DRG 736
|
| Min. Negotiated Rate |
$28,943.89 |
| Max. Negotiated Rate |
$75,522.70 |
| Rate for Payer: Aetna Medicare |
$31,685.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,084.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,084.06
|
| Rate for Payer: BCBS MAPPO |
$30,467.25
|
| Rate for Payer: BCBS Trust/PPO |
$75,522.70
|
| Rate for Payer: BCN Medicare Advantage |
$30,467.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,467.25
|
| Rate for Payer: Mclaren Medicare |
$30,467.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,990.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,037.34
|
| Rate for Payer: PACE Medicare |
$28,943.89
|
| Rate for Payer: PACE SWMI |
$30,467.25
|
| Rate for Payer: PHP Medicare Advantage |
$30,467.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,781.01
|
| Rate for Payer: Priority Health Medicare |
$30,467.25
|
| Rate for Payer: Priority Health Narrow Network |
$44,624.81
|
| Rate for Payer: Railroad Medicare Medicare |
$30,467.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,295.35
|
| Rate for Payer: UHC Core |
$48,621.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$30,467.25
|
| Rate for Payer: UHC Exchange |
$38,654.32
|
| Rate for Payer: UHC Medicare Advantage |
$31,381.27
|
| Rate for Payer: VA VA |
$30,467.25
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$28,719.93
|
|
|
Service Code
|
MS-DRG 738
|
| Min. Negotiated Rate |
$10,476.60 |
| Max. Negotiated Rate |
$28,719.93 |
| Rate for Payer: Aetna Medicare |
$11,469.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,785.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,785.00
|
| Rate for Payer: BCBS MAPPO |
$11,028.00
|
| Rate for Payer: BCBS Trust/PPO |
$28,719.93
|
| Rate for Payer: BCN Medicare Advantage |
$11,028.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,028.00
|
| Rate for Payer: Mclaren Medicare |
$11,028.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,579.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,682.20
|
| Rate for Payer: PACE Medicare |
$10,476.60
|
| Rate for Payer: PACE SWMI |
$11,028.00
|
| Rate for Payer: PHP Medicare Advantage |
$11,028.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,581.90
|
| Rate for Payer: Priority Health Medicare |
$11,028.00
|
| Rate for Payer: Priority Health Narrow Network |
$15,665.52
|
| Rate for Payer: Railroad Medicare Medicare |
$11,028.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,815.61
|
| Rate for Payer: UHC Core |
$17,068.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,028.00
|
| Rate for Payer: UHC Exchange |
$13,569.58
|
| Rate for Payer: UHC Medicare Advantage |
$11,358.84
|
| Rate for Payer: VA VA |
$11,028.00
|
|
|
UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE
|
Facility
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 59870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$534.39 |
| 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 |
$1,583.45
|
| 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) |
$587.83
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$534.39
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
UVULECTOMY, EXCISION OF UVULA
|
Facility
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 42140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$162.08 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,629.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.29
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$162.08
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
IP
|
$29,956.28
|
|
|
Service Code
|
MS-DRG 746
|
| Min. Negotiated Rate |
$12,757.00 |
| Max. Negotiated Rate |
$29,956.28 |
| Rate for Payer: Aetna Medicare |
$13,965.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,785.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,785.52
|
| Rate for Payer: BCBS MAPPO |
$13,428.42
|
| Rate for Payer: BCBS Trust/PPO |
$29,956.28
|
| Rate for Payer: BCN Medicare Advantage |
$13,428.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,428.42
|
| Rate for Payer: Mclaren Medicare |
$13,428.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,099.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,442.68
|
| Rate for Payer: PACE Medicare |
$12,757.00
|
| Rate for Payer: PACE SWMI |
$13,428.42
|
| Rate for Payer: PHP Medicare Advantage |
$13,428.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,051.90
|
| Rate for Payer: Priority Health Medicare |
$13,428.42
|
| Rate for Payer: Priority Health Narrow Network |
$19,241.52
|
| Rate for Payer: Railroad Medicare Medicare |
$13,428.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,567.23
|
| Rate for Payer: UHC Core |
$20,964.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,428.42
|
| Rate for Payer: UHC Exchange |
$16,667.14
|
| Rate for Payer: UHC Medicare Advantage |
$13,831.27
|
| Rate for Payer: VA VA |
$13,428.42
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$24,827.45
|
|
|
Service Code
|
MS-DRG 747
|
| Min. Negotiated Rate |
$6,981.67 |
| Max. Negotiated Rate |
$24,827.45 |
| Rate for Payer: Aetna Medicare |
$7,643.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,186.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,186.41
|
| Rate for Payer: BCBS MAPPO |
$7,349.13
|
| Rate for Payer: BCBS Trust/PPO |
$24,827.45
|
| Rate for Payer: BCN Medicare Advantage |
$7,349.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,349.13
|
| Rate for Payer: Mclaren Medicare |
$7,349.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,716.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,451.50
|
| Rate for Payer: PACE Medicare |
$6,981.67
|
| Rate for Payer: PACE SWMI |
$7,349.13
|
| Rate for Payer: PHP Medicare Advantage |
$7,349.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,731.25
|
| Rate for Payer: Priority Health Medicare |
$7,349.13
|
| Rate for Payer: Priority Health Narrow Network |
$10,185.00
|
| Rate for Payer: Railroad Medicare Medicare |
$7,349.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,533.35
|
| Rate for Payer: UHC Core |
$11,097.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,349.13
|
| Rate for Payer: UHC Exchange |
$8,822.32
|
| Rate for Payer: UHC Medicare Advantage |
$7,569.60
|
| Rate for Payer: VA VA |
$7,349.13
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
IP
|
$18,580.90
|
|
|
Service Code
|
MS-DRG 768
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$18,580.90 |
| Rate for Payer: Aetna Medicare |
$10,295.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,373.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,373.84
|
| Rate for Payer: BCBS MAPPO |
$9,899.07
|
| Rate for Payer: BCBS Trust/PPO |
$11,740.27
|
| Rate for Payer: BCN Medicare Advantage |
$9,899.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,899.07
|
| Rate for Payer: Mclaren Medicare |
$9,899.07
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,394.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,383.93
|
| Rate for Payer: PACE Medicare |
$9,404.12
|
| Rate for Payer: PACE SWMI |
$9,899.07
|
| Rate for Payer: PHP Medicare Advantage |
$9,899.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,479.64
|
| Rate for Payer: Priority Health Medicare |
$9,899.07
|
| Rate for Payer: Priority Health Narrow Network |
$13,983.71
|
| Rate for Payer: Railroad Medicare Medicare |
$9,899.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,580.90
|
| Rate for Payer: UHC Core |
$15,235.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,899.07
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$10,196.04
|
| Rate for Payer: VA VA |
$9,899.07
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
IP
|
$11,390.16
|
|
|
Service Code
|
MS-DRG 806
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$11,390.16 |
| Rate for Payer: Aetna Medicare |
$6,517.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,833.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,833.06
|
| Rate for Payer: BCBS MAPPO |
$6,266.45
|
| Rate for Payer: BCBS Trust/PPO |
$9,878.21
|
| Rate for Payer: BCN Medicare Advantage |
$6,266.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,266.45
|
| Rate for Payer: Mclaren Medicare |
$6,266.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,579.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,206.42
|
| Rate for Payer: PACE Medicare |
$5,953.13
|
| Rate for Payer: PACE SWMI |
$6,266.45
|
| Rate for Payer: PHP Medicare Advantage |
$6,266.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,715.09
|
| Rate for Payer: Priority Health Medicare |
$6,266.45
|
| Rate for Payer: Priority Health Narrow Network |
$8,572.07
|
| Rate for Payer: Railroad Medicare Medicare |
$6,266.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,390.16
|
| Rate for Payer: UHC Core |
$9,339.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,266.45
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,454.44
|
| Rate for Payer: VA VA |
$6,266.45
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
IP
|
$15,379.08
|
|
|
Service Code
|
MS-DRG 805
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$15,379.08 |
| Rate for Payer: Aetna Medicare |
$8,612.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,351.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,351.96
|
| Rate for Payer: BCBS MAPPO |
$8,281.57
|
| Rate for Payer: BCBS Trust/PPO |
$11,818.17
|
| Rate for Payer: BCN Medicare Advantage |
$8,281.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,281.57
|
| Rate for Payer: Mclaren Medicare |
$8,281.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,695.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,523.81
|
| Rate for Payer: PACE Medicare |
$7,867.49
|
| Rate for Payer: PACE SWMI |
$8,281.57
|
| Rate for Payer: PHP Medicare Advantage |
$8,281.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,467.59
|
| Rate for Payer: Priority Health Medicare |
$8,281.57
|
| Rate for Payer: Priority Health Narrow Network |
$11,574.07
|
| Rate for Payer: Railroad Medicare Medicare |
$8,281.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,379.08
|
| Rate for Payer: UHC Core |
$12,610.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,281.57
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$8,530.02
|
| Rate for Payer: VA VA |
$8,281.57
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
IP
|
$9,980.69
|
|
|
Service Code
|
MS-DRG 807
|
| Min. Negotiated Rate |
$5,276.69 |
| Max. Negotiated Rate |
$9,980.69 |
| Rate for Payer: Aetna Medicare |
$5,776.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,943.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,943.01
|
| Rate for Payer: BCBS MAPPO |
$5,554.41
|
| Rate for Payer: BCBS Trust/PPO |
$8,780.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,554.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,554.41
|
| Rate for Payer: Mclaren Medicare |
$5,554.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,832.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,387.57
|
| Rate for Payer: PACE Medicare |
$5,276.69
|
| Rate for Payer: PACE SWMI |
$5,554.41
|
| Rate for Payer: PHP Medicare Advantage |
$5,554.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,389.15
|
| Rate for Payer: Priority Health Medicare |
$5,554.41
|
| Rate for Payer: Priority Health Narrow Network |
$7,511.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5,554.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,980.69
|
| Rate for Payer: UHC Core |
$8,183.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,554.41
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,721.04
|
| Rate for Payer: VA VA |
$5,554.41
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
IP
|
$15,547.31
|
|
|
Service Code
|
MS-DRG 797
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$15,547.31 |
| Rate for Payer: Aetna Medicare |
$8,514.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,233.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,233.50
|
| Rate for Payer: BCBS MAPPO |
$8,186.80
|
| Rate for Payer: BCBS Trust/PPO |
$15,547.31
|
| Rate for Payer: BCN Medicare Advantage |
$8,186.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,186.80
|
| Rate for Payer: Mclaren Medicare |
$8,186.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,596.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,414.82
|
| Rate for Payer: PACE Medicare |
$7,777.46
|
| Rate for Payer: PACE SWMI |
$8,186.80
|
| Rate for Payer: PHP Medicare Advantage |
$8,186.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,291.09
|
| Rate for Payer: Priority Health Medicare |
$8,186.80
|
| Rate for Payer: Priority Health Narrow Network |
$11,432.87
|
| Rate for Payer: Railroad Medicare Medicare |
$8,186.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,191.46
|
| Rate for Payer: UHC Core |
$12,456.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,186.80
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$8,432.40
|
| Rate for Payer: VA VA |
$8,186.80
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
IP
|
$21,636.27
|
|
|
Service Code
|
MS-DRG 796
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$21,636.27 |
| Rate for Payer: Aetna Medicare |
$11,900.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,303.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,303.24
|
| Rate for Payer: BCBS MAPPO |
$11,442.59
|
| Rate for Payer: BCBS Trust/PPO |
$18,776.39
|
| Rate for Payer: BCN Medicare Advantage |
$11,442.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,442.59
|
| Rate for Payer: Mclaren Medicare |
$11,442.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,014.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,158.98
|
| Rate for Payer: PACE Medicare |
$10,870.46
|
| Rate for Payer: PACE SWMI |
$11,442.59
|
| Rate for Payer: PHP Medicare Advantage |
$11,442.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,353.93
|
| Rate for Payer: Priority Health Medicare |
$11,442.59
|
| Rate for Payer: Priority Health Narrow Network |
$16,283.14
|
| Rate for Payer: Railroad Medicare Medicare |
$11,442.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,636.27
|
| Rate for Payer: UHC Core |
$17,741.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,442.59
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,785.87
|
| Rate for Payer: VA VA |
$11,442.59
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
IP
|
$13,949.11
|
|
|
Service Code
|
MS-DRG 798
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$13,949.11 |
| Rate for Payer: Aetna Medicare |
$7,225.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,684.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,684.58
|
| Rate for Payer: BCBS MAPPO |
$6,947.66
|
| Rate for Payer: BCBS Trust/PPO |
$13,949.11
|
| Rate for Payer: BCN Medicare Advantage |
$6,947.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,947.66
|
| Rate for Payer: Mclaren Medicare |
$6,947.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,295.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,989.81
|
| Rate for Payer: PACE Medicare |
$6,600.28
|
| Rate for Payer: PACE SWMI |
$6,947.66
|
| Rate for Payer: PHP Medicare Advantage |
$6,947.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,640.66
|
| Rate for Payer: Priority Health Medicare |
$6,947.66
|
| Rate for Payer: Priority Health Narrow Network |
$9,312.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,947.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,374.04
|
| Rate for Payer: UHC Core |
$10,146.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,947.66
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,156.09
|
| Rate for Payer: VA VA |
$6,947.66
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 58260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$828.76 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,661.05
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.64
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$828.76
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)
|
Facility
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 58262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$915.53 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,423.93
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.08
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$915.53
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REPAIR OF ENTEROCELE
|
Facility
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 58270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$882.46 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,393.63
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$970.71
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$882.46
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 58291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,224.96 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,393.63
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,347.46
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$1,224.96
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
VALACYCLOVIR 1 GRAM TABLET
|
Facility
IP
|
$127.40
|
|
|
Service Code
|
NDC 57237-043-30
|
| Hospital Charge Code |
13132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$114.66 |
| Rate for Payer: Aetna American Axle |
$82.81
|
| Rate for Payer: Aetna Commercial |
$108.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.81
|
| Rate for Payer: Cash Price |
$101.92
|
| Rate for Payer: Cofinity Commercial |
$109.56
|
| Rate for Payer: Cofinity Commercial |
$89.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.92
|
| Rate for Payer: Healthscope Commercial |
$114.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.29
|
| Rate for Payer: PHP Commercial |
$108.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.18
|
| Rate for Payer: Priority Health SBD |
$80.26
|
| Rate for Payer: UMR Bronson Commercial |
$56.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.55
|
|
|
VALACYCLOVIR 1 GRAM TABLET
|
Facility
IP
|
$84.82
|
|
|
Service Code
|
NDC 0378-4276-93
|
| Hospital Charge Code |
13132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna American Axle |
$55.13
|
| Rate for Payer: Aetna Commercial |
$72.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.13
|
| Rate for Payer: Cash Price |
$67.86
|
| Rate for Payer: Cofinity Commercial |
$59.37
|
| Rate for Payer: Cofinity Commercial |
$72.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.86
|
| Rate for Payer: Healthscope Commercial |
$76.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.10
|
| Rate for Payer: PHP Commercial |
$72.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$53.44
|
| Rate for Payer: UMR Bronson Commercial |
$37.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.62
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$309.51
|
|
|
Service Code
|
NDC 57237-042-90
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.18 |
| Max. Negotiated Rate |
$278.56 |
| Rate for Payer: Aetna American Axle |
$201.18
|
| Rate for Payer: Aetna Commercial |
$263.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.18
|
| Rate for Payer: Cash Price |
$247.61
|
| Rate for Payer: Cofinity Commercial |
$216.66
|
| Rate for Payer: Cofinity Commercial |
$266.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.61
|
| Rate for Payer: Healthscope Commercial |
$278.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.08
|
| Rate for Payer: PHP Commercial |
$263.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.66
|
| Rate for Payer: Priority Health SBD |
$194.99
|
| Rate for Payer: UMR Bronson Commercial |
$136.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.13
|
|
