|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 0378-1610-01
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.81
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.02
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$78.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 0591-0794-01
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.97
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 51079-118-20
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.04 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna American Axle |
$248.24
|
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$267.33
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$324.62
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.33
|
| Rate for Payer: Priority Health SBD |
$240.60
|
| Rate for Payer: UMR Bronson Commercial |
$168.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.42
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 60687-369-11
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.37
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 0527-0586-01
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.46 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.55
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$196.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$395.20
|
|
|
Service Code
|
NDC 60687-369-01
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$355.68 |
| Rate for Payer: Aetna American Axle |
$256.88
|
| Rate for Payer: Aetna Commercial |
$335.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.88
|
| Rate for Payer: Cash Price |
$316.16
|
| Rate for Payer: Cofinity Commercial |
$276.64
|
| Rate for Payer: Cofinity Commercial |
$339.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.16
|
| Rate for Payer: Healthscope Commercial |
$355.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.92
|
| Rate for Payer: PHP Commercial |
$335.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health SBD |
$248.98
|
| Rate for Payer: UMR Bronson Commercial |
$173.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.40
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 0143-3126-01
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.97
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$388.55
|
|
|
Service Code
|
NDC 0904-6987-61
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.96 |
| Max. Negotiated Rate |
$349.70 |
| Rate for Payer: Aetna American Axle |
$252.56
|
| Rate for Payer: Aetna Commercial |
$330.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.56
|
| Rate for Payer: Cash Price |
$310.84
|
| Rate for Payer: Cofinity Commercial |
$271.98
|
| Rate for Payer: Cofinity Commercial |
$334.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.84
|
| Rate for Payer: Healthscope Commercial |
$349.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.27
|
| Rate for Payer: PHP Commercial |
$330.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.98
|
| Rate for Payer: Priority Health SBD |
$244.79
|
| Rate for Payer: UMR Bronson Commercial |
$170.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.41
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$27.52
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna American Axle |
$58.69
|
| Rate for Payer: Aetna American Axle |
$180.39
|
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.69
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$72.23
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cofinity Commercial |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Cofinity Commercial |
$194.26
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Healthscope Commercial |
$81.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.39
|
| Rate for Payer: PHP Commercial |
$76.75
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.26
|
| Rate for Payer: Priority Health SBD |
$174.84
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$56.88
|
| Rate for Payer: UMR Bronson Commercial |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$122.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
IP
|
$3,948.00
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,737.12 |
| Max. Negotiated Rate |
$3,553.20 |
| Rate for Payer: Aetna American Axle |
$2,566.20
|
| Rate for Payer: Aetna American Axle |
$255.64
|
| Rate for Payer: Aetna American Axle |
$163.02
|
| Rate for Payer: Aetna American Axle |
$2.56
|
| Rate for Payer: Aetna American Axle |
$248.24
|
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna Commercial |
$3,355.80
|
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,566.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.64
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cash Price |
$3,158.40
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cash Price |
$314.64
|
| Rate for Payer: Cofinity Commercial |
$267.33
|
| Rate for Payer: Cofinity Commercial |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Cofinity Commercial |
$2,763.60
|
| Rate for Payer: Cofinity Commercial |
$275.31
|
| Rate for Payer: Cofinity Commercial |
$338.24
|
| Rate for Payer: Cofinity Commercial |
$2.76
|
| Rate for Payer: Cofinity Commercial |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3,395.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,158.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$353.97
|
| Rate for Payer: Healthscope Commercial |
$3.55
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Healthscope Commercial |
$3,553.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,763.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,961.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,355.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$324.62
|
| Rate for Payer: PHP Commercial |
$3,355.80
|
| Rate for Payer: PHP Commercial |
$3.35
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: PHP Commercial |
$334.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,763.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.31
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: Priority Health SBD |
$158.00
|
| Rate for Payer: Priority Health SBD |
$240.60
|
| Rate for Payer: Priority Health SBD |
$247.78
|
| Rate for Payer: Priority Health SBD |
$2,487.24
|
| Rate for Payer: UMR Bronson Commercial |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$173.05
|
| Rate for Payer: UMR Bronson Commercial |
$168.04
|
| Rate for Payer: UMR Bronson Commercial |
$110.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,737.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,961.00
|
|
|
DIGESTIVE MALIGNANCY WITH CC
|
Facility
|
IP
|
$20,316.80
|
|
|
Service Code
|
MS-DRG 375
|
| Min. Negotiated Rate |
$9,259.18 |
| Max. Negotiated Rate |
$20,316.80 |
| Rate for Payer: Aetna Medicare |
$10,136.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,183.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,183.12
|
| Rate for Payer: BCBS MAPPO |
$9,746.50
|
| Rate for Payer: BCBS Trust/PPO |
$20,316.80
|
| Rate for Payer: BCN Medicare Advantage |
$9,746.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,746.50
|
| Rate for Payer: Mclaren Medicare |
$9,746.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,233.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,208.48
|
| Rate for Payer: PACE Medicare |
$9,259.18
|
| Rate for Payer: PACE SWMI |
$9,746.50
|
| Rate for Payer: PHP Medicare Advantage |
$9,746.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,195.51
|
| Rate for Payer: Priority Health Medicare |
$9,746.50
|
| Rate for Payer: Priority Health Narrow Network |
$13,756.41
|
| Rate for Payer: Railroad Medicare Medicare |
$9,746.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,278.87
|
| Rate for Payer: UHC Core |
$14,988.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,746.50
|
| Rate for Payer: UHC Exchange |
$11,915.90
|
| Rate for Payer: UHC Medicare Advantage |
$10,038.90
|
| Rate for Payer: VA VA |
$9,746.50
|
|
|
DIGESTIVE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$34,987.11
|
|
|
Service Code
|
MS-DRG 374
|
| Min. Negotiated Rate |
$15,852.95 |
| Max. Negotiated Rate |
$34,987.11 |
| Rate for Payer: Aetna Medicare |
$17,354.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,859.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,859.15
|
| Rate for Payer: BCBS MAPPO |
$16,687.32
|
| Rate for Payer: BCBS Trust/PPO |
$34,987.11
|
| Rate for Payer: BCN Medicare Advantage |
$16,687.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,687.32
|
| Rate for Payer: Mclaren Medicare |
$16,687.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,521.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,190.42
|
| Rate for Payer: PACE Medicare |
$15,852.95
|
| Rate for Payer: PACE SWMI |
$16,687.32
|
| Rate for Payer: PHP Medicare Advantage |
$16,687.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,120.48
|
| Rate for Payer: Priority Health Medicare |
$16,687.32
|
| Rate for Payer: Priority Health Narrow Network |
$24,096.38
|
| Rate for Payer: Railroad Medicare Medicare |
$16,687.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,018.15
|
| Rate for Payer: UHC Core |
$26,254.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,687.32
|
| Rate for Payer: UHC Exchange |
$20,872.46
|
| Rate for Payer: UHC Medicare Advantage |
$17,187.94
|
| Rate for Payer: VA VA |
$16,687.32
|
|
|
DIGESTIVE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$15,115.09
|
|
|
Service Code
|
MS-DRG 376
|
| Min. Negotiated Rate |
$7,012.43 |
| Max. Negotiated Rate |
$15,115.09 |
| Rate for Payer: Aetna Medicare |
$7,676.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,226.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,226.89
|
| Rate for Payer: BCBS MAPPO |
$7,381.51
|
| Rate for Payer: BCBS Trust/PPO |
$15,115.09
|
| Rate for Payer: BCN Medicare Advantage |
$7,381.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,381.51
|
| Rate for Payer: Mclaren Medicare |
$7,381.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,750.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,488.74
|
| Rate for Payer: PACE Medicare |
$7,012.43
|
| Rate for Payer: PACE SWMI |
$7,381.51
|
| Rate for Payer: PHP Medicare Advantage |
$7,381.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,791.52
|
| Rate for Payer: Priority Health Medicare |
$7,381.51
|
| Rate for Payer: Priority Health Narrow Network |
$10,233.22
|
| Rate for Payer: Railroad Medicare Medicare |
$7,381.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,597.42
|
| Rate for Payer: UHC Core |
$11,149.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,381.51
|
| Rate for Payer: UHC Exchange |
$8,864.08
|
| Rate for Payer: UHC Medicare Advantage |
$7,602.96
|
| Rate for Payer: VA VA |
$7,381.51
|
|
|
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$417.18
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
9853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$375.46 |
| Rate for Payer: Aetna American Axle |
$271.17
|
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.17
|
| Rate for Payer: Cash Price |
$333.74
|
| Rate for Payer: Cofinity Commercial |
$292.03
|
| Rate for Payer: Cofinity Commercial |
$358.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.74
|
| Rate for Payer: Healthscope Commercial |
$375.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$354.60
|
| Rate for Payer: PHP Commercial |
$354.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.03
|
| Rate for Payer: Priority Health SBD |
$262.82
|
| Rate for Payer: UMR Bronson Commercial |
$183.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.88
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$528.96
|
|
|
Service Code
|
NDC 0143-1240-01
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.74 |
| Max. Negotiated Rate |
$476.06 |
| Rate for Payer: Aetna American Axle |
$343.82
|
| Rate for Payer: Aetna Commercial |
$449.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.82
|
| Rate for Payer: Cash Price |
$423.17
|
| Rate for Payer: Cofinity Commercial |
$370.27
|
| Rate for Payer: Cofinity Commercial |
$454.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.17
|
| Rate for Payer: Healthscope Commercial |
$476.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$449.62
|
| Rate for Payer: PHP Commercial |
$449.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$370.27
|
| Rate for Payer: Priority Health SBD |
$333.24
|
| Rate for Payer: UMR Bronson Commercial |
$232.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.72
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$403.20
|
|
|
Service Code
|
NDC 0904-5921-61
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.41 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna American Axle |
$262.08
|
| Rate for Payer: Aetna Commercial |
$342.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.08
|
| Rate for Payer: Cash Price |
$322.56
|
| Rate for Payer: Cofinity Commercial |
$282.24
|
| Rate for Payer: Cofinity Commercial |
$346.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.56
|
| Rate for Payer: Healthscope Commercial |
$362.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$342.72
|
| Rate for Payer: PHP Commercial |
$342.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.24
|
| Rate for Payer: Priority Health SBD |
$254.02
|
| Rate for Payer: UMR Bronson Commercial |
$177.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.40
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
NDC 0904-5922-61
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna American Axle |
$26.65
|
| Rate for Payer: Aetna Commercial |
$34.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.65
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$35.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.80
|
| Rate for Payer: Healthscope Commercial |
$36.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.85
|
| Rate for Payer: PHP Commercial |
$34.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.70
|
| Rate for Payer: Priority Health SBD |
$25.83
|
| Rate for Payer: UMR Bronson Commercial |
$18.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.75
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
IP
|
$528.96
|
|
|
Service Code
|
NDC 0143-1241-01
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.74 |
| Max. Negotiated Rate |
$476.06 |
| Rate for Payer: Aetna American Axle |
$343.82
|
| Rate for Payer: Aetna Commercial |
$449.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.82
|
| Rate for Payer: Cash Price |
$423.17
|
| Rate for Payer: Cofinity Commercial |
$370.27
|
| Rate for Payer: Cofinity Commercial |
$454.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.17
|
| Rate for Payer: Healthscope Commercial |
$476.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$449.62
|
| Rate for Payer: PHP Commercial |
$449.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$370.27
|
| Rate for Payer: Priority Health SBD |
$333.24
|
| Rate for Payer: UMR Bronson Commercial |
$232.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.72
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$23.05
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$20.74 |
| Rate for Payer: Aetna American Axle |
$14.98
|
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna Commercial |
$19.59
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.44
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Healthscope Commercial |
$20.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.59
|
| Rate for Payer: PHP Commercial |
$19.59
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health SBD |
$14.52
|
| Rate for Payer: UMR Bronson Commercial |
$9.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.29
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$537.12
|
|
|
Service Code
|
NDC 0054-0057-46
|
| Hospital Charge Code |
43556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.33 |
| Max. Negotiated Rate |
$483.41 |
| Rate for Payer: Aetna American Axle |
$349.13
|
| Rate for Payer: Aetna Commercial |
$456.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.13
|
| Rate for Payer: Cash Price |
$429.70
|
| Rate for Payer: Cofinity Commercial |
$375.98
|
| Rate for Payer: Cofinity Commercial |
$461.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.70
|
| Rate for Payer: Healthscope Commercial |
$483.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$375.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$402.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$456.55
|
| Rate for Payer: PHP Commercial |
$456.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.98
|
| Rate for Payer: Priority Health SBD |
$338.39
|
| Rate for Payer: UMR Bronson Commercial |
$236.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.84
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,120.39
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,892.97 |
| Max. Negotiated Rate |
$10,008.35 |
| Rate for Payer: Aetna American Axle |
$7,228.25
|
| Rate for Payer: Aetna Commercial |
$9,452.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,228.25
|
| Rate for Payer: Cash Price |
$8,896.31
|
| Rate for Payer: Cofinity Commercial |
$7,784.27
|
| Rate for Payer: Cofinity Commercial |
$9,563.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,896.31
|
| Rate for Payer: Healthscope Commercial |
$10,008.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,784.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,340.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,452.33
|
| Rate for Payer: PHP Commercial |
$9,452.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,784.27
|
| Rate for Payer: Priority Health SBD |
$7,005.85
|
| Rate for Payer: UMR Bronson Commercial |
$4,892.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,340.29
|
|
|
DIGOXIN IV NEONATE 10 MCG/ML INJECTION
|
Facility
|
IP
|
$323.12
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
163536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.17 |
| Max. Negotiated Rate |
$290.81 |
| Rate for Payer: Aetna American Axle |
$210.03
|
| Rate for Payer: Aetna Commercial |
$274.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.03
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cofinity Commercial |
$226.18
|
| Rate for Payer: Cofinity Commercial |
$277.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.50
|
| Rate for Payer: Healthscope Commercial |
$290.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.65
|
| Rate for Payer: PHP Commercial |
$274.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.18
|
| Rate for Payer: Priority Health SBD |
$203.57
|
| Rate for Payer: UMR Bronson Commercial |
$142.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.34
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$181.68
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.94 |
| Max. Negotiated Rate |
$163.51 |
| Rate for Payer: Aetna American Axle |
$118.09
|
| Rate for Payer: Aetna American Axle |
$130.47
|
| Rate for Payer: Aetna American Axle |
$152.35
|
| Rate for Payer: Aetna American Axle |
$251.62
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: Aetna Commercial |
$154.43
|
| Rate for Payer: Aetna Commercial |
$329.04
|
| Rate for Payer: Aetna Commercial |
$199.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.35
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cash Price |
$187.51
|
| Rate for Payer: Cash Price |
$309.68
|
| Rate for Payer: Cofinity Commercial |
$127.18
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$270.97
|
| Rate for Payer: Cofinity Commercial |
$201.58
|
| Rate for Payer: Cofinity Commercial |
$140.51
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$164.07
|
| Rate for Payer: Cofinity Commercial |
$332.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.34
|
| Rate for Payer: Healthscope Commercial |
$348.39
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$163.51
|
| Rate for Payer: Healthscope Commercial |
$210.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.62
|
| Rate for Payer: PHP Commercial |
$199.23
|
| Rate for Payer: PHP Commercial |
$154.43
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: PHP Commercial |
$329.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.51
|
| Rate for Payer: Priority Health SBD |
$114.46
|
| Rate for Payer: Priority Health SBD |
$126.46
|
| Rate for Payer: Priority Health SBD |
$147.67
|
| Rate for Payer: Priority Health SBD |
$243.87
|
| Rate for Payer: UMR Bronson Commercial |
$88.32
|
| Rate for Payer: UMR Bronson Commercial |
$79.94
|
| Rate for Payer: UMR Bronson Commercial |
$170.32
|
| Rate for Payer: UMR Bronson Commercial |
$103.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.32
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$449.33
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$404.40 |
| Rate for Payer: Aetna American Axle |
$292.06
|
| Rate for Payer: Aetna Commercial |
$381.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.06
|
| Rate for Payer: BCBS Complete |
$179.73
|
| Rate for Payer: BCBS Trust/PPO |
$136.80
|
| Rate for Payer: Cash Price |
$359.46
|
| Rate for Payer: Cash Price |
$359.46
|
| Rate for Payer: Cofinity Commercial |
$314.53
|
| Rate for Payer: Cofinity Commercial |
$386.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.46
|
| Rate for Payer: Healthscope Commercial |
$404.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.93
|
| Rate for Payer: PHP Commercial |
$381.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.53
|
| Rate for Payer: Priority Health SBD |
$283.08
|
| Rate for Payer: UMR Bronson Commercial |
$166.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.00
|
|
|
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$231.17 |
| 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 |
$2,332.98
|
| 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) |
$254.29
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$231.17
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
