|
DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET
|
Facility
|
IP
|
$1,037.11
|
|
|
Service Code
|
NDC 0025-0061-31
|
| Hospital Charge Code |
2516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.33 |
| Max. Negotiated Rate |
$933.40 |
| Rate for Payer: Aetna American Axle |
$674.12
|
| Rate for Payer: Aetna Commercial |
$881.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.12
|
| Rate for Payer: Cash Price |
$829.69
|
| Rate for Payer: Cofinity Commercial |
$725.98
|
| Rate for Payer: Cofinity Commercial |
$891.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.69
|
| Rate for Payer: Healthscope Commercial |
$933.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$725.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$777.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$881.54
|
| Rate for Payer: PHP Commercial |
$881.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.98
|
| Rate for Payer: Priority Health SBD |
$653.38
|
| Rate for Payer: UMR Bronson Commercial |
$456.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$777.83
|
|
|
DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET
|
Facility
|
IP
|
$286.90
|
|
|
Service Code
|
NDC 69315-910-01
|
| Hospital Charge Code |
2516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$258.21 |
| Rate for Payer: Aetna American Axle |
$186.48
|
| Rate for Payer: Aetna Commercial |
$243.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.48
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Commercial |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$246.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$258.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.86
|
| Rate for Payer: PHP Commercial |
$243.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.83
|
| Rate for Payer: Priority Health SBD |
$180.75
|
| Rate for Payer: UMR Bronson Commercial |
$126.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.18
|
|
|
DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET
|
Facility
|
IP
|
$361.95
|
|
|
Service Code
|
NDC 59762-1061-1
|
| Hospital Charge Code |
2516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.26 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna American Axle |
$235.27
|
| Rate for Payer: Aetna Commercial |
$307.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.27
|
| Rate for Payer: Cash Price |
$289.56
|
| Rate for Payer: Cofinity Commercial |
$253.36
|
| Rate for Payer: Cofinity Commercial |
$311.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.56
|
| Rate for Payer: Healthscope Commercial |
$325.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.66
|
| Rate for Payer: PHP Commercial |
$307.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.36
|
| Rate for Payer: Priority Health SBD |
$228.03
|
| Rate for Payer: UMR Bronson Commercial |
$159.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.46
|
|
|
DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET
|
Facility
|
IP
|
$312.48
|
|
|
Service Code
|
NDC 0378-0415-01
|
| Hospital Charge Code |
2516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.49 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna American Axle |
$203.11
|
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.11
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$218.74
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.98
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$265.61
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health SBD |
$196.86
|
| Rate for Payer: UMR Bronson Commercial |
$137.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.36
|
|
|
DIPH,PERTUS(ACEL),TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE
|
Facility
|
IP
|
$115.61
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
19451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.87 |
| Max. Negotiated Rate |
$104.05 |
| Rate for Payer: Aetna American Axle |
$75.15
|
| Rate for Payer: Aetna Commercial |
$98.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cofinity Commercial |
$80.93
|
| Rate for Payer: Cofinity Commercial |
$99.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.49
|
| Rate for Payer: Healthscope Commercial |
$104.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.27
|
| Rate for Payer: PHP Commercial |
$98.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.93
|
| Rate for Payer: Priority Health SBD |
$72.83
|
| Rate for Payer: UMR Bronson Commercial |
$50.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.71
|
|
|
DIPHTH,PERTUS(ACEL)TETANUS(PF)2LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SUSP
|
Facility
|
IP
|
$161.17
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
41628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.91 |
| Max. Negotiated Rate |
$145.05 |
| Rate for Payer: Aetna American Axle |
$104.76
|
| Rate for Payer: Aetna Commercial |
$136.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.76
|
| Rate for Payer: Cash Price |
$128.94
|
| Rate for Payer: Cofinity Commercial |
$138.61
|
| Rate for Payer: Cofinity Commercial |
$112.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.94
|
| Rate for Payer: Healthscope Commercial |
$145.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.99
|
| Rate for Payer: PHP Commercial |
$136.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.82
|
| Rate for Payer: Priority Health SBD |
$101.54
|
| Rate for Payer: UMR Bronson Commercial |
$70.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.88
|
|
|
DIPHTH,PERTUS(AC)TETANUS(PF)2 LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$161.17
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
118169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.91 |
| Max. Negotiated Rate |
$145.05 |
| Rate for Payer: Aetna American Axle |
$104.76
|
| Rate for Payer: Aetna Commercial |
$136.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.76
|
| Rate for Payer: Cash Price |
$128.94
|
| Rate for Payer: Cofinity Commercial |
$112.82
|
| Rate for Payer: Cofinity Commercial |
$138.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.94
|
| Rate for Payer: Healthscope Commercial |
$145.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.99
|
| Rate for Payer: PHP Commercial |
$136.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.82
|
| Rate for Payer: Priority Health SBD |
$101.54
|
| Rate for Payer: UMR Bronson Commercial |
$70.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.88
|
|
|
DIPYRIDAMOLE 25 MG TABLET
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
NDC 68382-187-01
|
| Hospital Charge Code |
2528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.82 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$109.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
DIPYRIDAMOLE 25 MG TABLET
|
Facility
|
IP
|
$528.48
|
|
|
Service Code
|
NDC 64980-133-01
|
| Hospital Charge Code |
2528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.53 |
| Max. Negotiated Rate |
$475.63 |
| Rate for Payer: Aetna American Axle |
$343.51
|
| Rate for Payer: Aetna Commercial |
$449.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.51
|
| Rate for Payer: Cash Price |
$422.78
|
| Rate for Payer: Cofinity Commercial |
$369.94
|
| Rate for Payer: Cofinity Commercial |
$454.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.78
|
| Rate for Payer: Healthscope Commercial |
$475.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$449.21
|
| Rate for Payer: PHP Commercial |
$449.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.94
|
| Rate for Payer: Priority Health SBD |
$332.94
|
| Rate for Payer: UMR Bronson Commercial |
$232.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.36
|
|
|
DISOPYRAMIDE PHOSPHATE ER 100 MG CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$1,471.12
|
|
|
Service Code
|
NDC 0025-2732-31
|
| Hospital Charge Code |
2537
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$647.29 |
| Max. Negotiated Rate |
$1,324.01 |
| Rate for Payer: Aetna American Axle |
$956.23
|
| Rate for Payer: Aetna Commercial |
$1,250.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$956.23
|
| Rate for Payer: Cash Price |
$1,176.90
|
| Rate for Payer: Cofinity Commercial |
$1,265.16
|
| Rate for Payer: Cofinity Commercial |
$1,029.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,176.90
|
| Rate for Payer: Healthscope Commercial |
$1,324.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,029.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,103.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,250.45
|
| Rate for Payer: PHP Commercial |
$1,250.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.78
|
| Rate for Payer: Priority Health SBD |
$926.81
|
| Rate for Payer: UMR Bronson Commercial |
$647.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,103.34
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$18,869.37
|
|
|
Service Code
|
MS-DRG 442
|
| Min. Negotiated Rate |
$7,452.41 |
| Max. Negotiated Rate |
$18,869.37 |
| Rate for Payer: Aetna Medicare |
$8,158.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,805.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,805.80
|
| Rate for Payer: BCBS MAPPO |
$7,844.64
|
| Rate for Payer: BCBS Trust/PPO |
$18,869.37
|
| Rate for Payer: BCN Medicare Advantage |
$7,844.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,844.64
|
| Rate for Payer: Mclaren Medicare |
$7,844.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,236.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,021.34
|
| Rate for Payer: PACE Medicare |
$7,452.41
|
| Rate for Payer: PACE SWMI |
$7,844.64
|
| Rate for Payer: PHP Medicare Advantage |
$7,844.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,653.95
|
| Rate for Payer: Priority Health Medicare |
$7,844.64
|
| Rate for Payer: Priority Health Narrow Network |
$10,923.16
|
| Rate for Payer: Railroad Medicare Medicare |
$7,844.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,514.18
|
| Rate for Payer: UHC Core |
$11,901.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,844.64
|
| Rate for Payer: UHC Exchange |
$9,461.72
|
| Rate for Payer: UHC Medicare Advantage |
$8,079.98
|
| Rate for Payer: VA VA |
$7,844.64
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$50,411.29
|
|
|
Service Code
|
MS-DRG 441
|
| Min. Negotiated Rate |
$13,870.49 |
| Max. Negotiated Rate |
$50,411.29 |
| Rate for Payer: Aetna Medicare |
$15,184.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,250.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,250.65
|
| Rate for Payer: BCBS MAPPO |
$14,600.52
|
| Rate for Payer: BCBS Trust/PPO |
$50,411.29
|
| Rate for Payer: BCN Medicare Advantage |
$14,600.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,600.52
|
| Rate for Payer: Mclaren Medicare |
$14,600.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,330.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,790.60
|
| Rate for Payer: PACE Medicare |
$13,870.49
|
| Rate for Payer: PACE SWMI |
$14,600.52
|
| Rate for Payer: PHP Medicare Advantage |
$14,600.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,234.52
|
| Rate for Payer: Priority Health Medicare |
$14,600.52
|
| Rate for Payer: Priority Health Narrow Network |
$20,987.62
|
| Rate for Payer: Railroad Medicare Medicare |
$14,600.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,887.36
|
| Rate for Payer: UHC Core |
$22,867.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,600.52
|
| Rate for Payer: UHC Exchange |
$18,179.62
|
| Rate for Payer: UHC Medicare Advantage |
$15,038.54
|
| Rate for Payer: VA VA |
$14,600.52
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,994.47
|
|
|
Service Code
|
MS-DRG 443
|
| Min. Negotiated Rate |
$5,718.87 |
| Max. Negotiated Rate |
$14,994.47 |
| Rate for Payer: Aetna Medicare |
$6,260.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,524.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,524.82
|
| Rate for Payer: BCBS MAPPO |
$6,019.86
|
| Rate for Payer: BCBS Trust/PPO |
$14,994.47
|
| Rate for Payer: BCN Medicare Advantage |
$6,019.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,019.86
|
| Rate for Payer: Mclaren Medicare |
$6,019.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,320.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,922.84
|
| Rate for Payer: PACE Medicare |
$5,718.87
|
| Rate for Payer: PACE SWMI |
$6,019.86
|
| Rate for Payer: PHP Medicare Advantage |
$6,019.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,255.89
|
| Rate for Payer: Priority Health Medicare |
$6,019.86
|
| Rate for Payer: Priority Health Narrow Network |
$8,204.71
|
| Rate for Payer: Railroad Medicare Medicare |
$6,019.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,902.03
|
| Rate for Payer: UHC Core |
$8,939.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,019.86
|
| Rate for Payer: UHC Exchange |
$7,106.98
|
| Rate for Payer: UHC Medicare Advantage |
$6,200.46
|
| Rate for Payer: VA VA |
$6,019.86
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC
|
Facility
|
IP
|
$16,783.66
|
|
|
Service Code
|
MS-DRG 439
|
| Min. Negotiated Rate |
$6,747.43 |
| Max. Negotiated Rate |
$16,783.66 |
| Rate for Payer: Aetna Medicare |
$7,386.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,878.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,878.20
|
| Rate for Payer: BCBS MAPPO |
$7,102.56
|
| Rate for Payer: BCBS Trust/PPO |
$16,783.66
|
| Rate for Payer: BCN Medicare Advantage |
$7,102.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,102.56
|
| Rate for Payer: Mclaren Medicare |
$7,102.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,457.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,167.94
|
| Rate for Payer: PACE Medicare |
$6,747.43
|
| Rate for Payer: PACE SWMI |
$7,102.56
|
| Rate for Payer: PHP Medicare Advantage |
$7,102.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,272.05
|
| Rate for Payer: Priority Health Medicare |
$7,102.56
|
| Rate for Payer: Priority Health Narrow Network |
$9,817.64
|
| Rate for Payer: Railroad Medicare Medicare |
$7,102.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,045.22
|
| Rate for Payer: UHC Core |
$10,696.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,102.56
|
| Rate for Payer: UHC Exchange |
$8,504.11
|
| Rate for Payer: UHC Medicare Advantage |
$7,315.64
|
| Rate for Payer: VA VA |
$7,102.56
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$32,607.39
|
|
|
Service Code
|
MS-DRG 438
|
| Min. Negotiated Rate |
$12,703.56 |
| Max. Negotiated Rate |
$32,607.39 |
| Rate for Payer: Aetna Medicare |
$13,907.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,715.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,715.21
|
| Rate for Payer: BCBS MAPPO |
$13,372.17
|
| Rate for Payer: BCBS Trust/PPO |
$32,607.39
|
| Rate for Payer: BCN Medicare Advantage |
$13,372.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,372.17
|
| Rate for Payer: Mclaren Medicare |
$13,372.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,040.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,378.00
|
| Rate for Payer: PACE Medicare |
$12,703.56
|
| Rate for Payer: PACE SWMI |
$13,372.17
|
| Rate for Payer: PHP Medicare Advantage |
$13,372.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,947.15
|
| Rate for Payer: Priority Health Medicare |
$13,372.17
|
| Rate for Payer: Priority Health Narrow Network |
$19,157.72
|
| Rate for Payer: Railroad Medicare Medicare |
$13,372.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,455.88
|
| Rate for Payer: UHC Core |
$20,873.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,372.17
|
| Rate for Payer: UHC Exchange |
$16,594.55
|
| Rate for Payer: UHC Medicare Advantage |
$13,773.34
|
| Rate for Payer: VA VA |
$13,372.17
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$12,298.13
|
|
|
Service Code
|
MS-DRG 440
|
| Min. Negotiated Rate |
$4,993.37 |
| Max. Negotiated Rate |
$12,298.13 |
| Rate for Payer: Aetna Medicare |
$5,466.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,570.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,570.22
|
| Rate for Payer: BCBS MAPPO |
$5,256.18
|
| Rate for Payer: BCBS Trust/PPO |
$12,298.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,256.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,256.18
|
| Rate for Payer: Mclaren Medicare |
$5,256.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,518.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,044.61
|
| Rate for Payer: PACE Medicare |
$4,993.37
|
| Rate for Payer: PACE SWMI |
$5,256.18
|
| Rate for Payer: PHP Medicare Advantage |
$5,256.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,833.81
|
| Rate for Payer: Priority Health Medicare |
$5,256.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,067.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5,256.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,390.36
|
| Rate for Payer: UHC Core |
$7,699.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,256.18
|
| Rate for Payer: UHC Exchange |
$6,121.53
|
| Rate for Payer: UHC Medicare Advantage |
$5,413.87
|
| Rate for Payer: VA VA |
$5,256.18
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$28,607.35
|
|
|
Service Code
|
MS-DRG 883
|
| Min. Negotiated Rate |
$14,216.05 |
| Max. Negotiated Rate |
$28,607.35 |
| Rate for Payer: Aetna Medicare |
$15,562.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,705.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,705.32
|
| Rate for Payer: BCBS MAPPO |
$14,964.26
|
| Rate for Payer: BCBS Trust/PPO |
$20,364.54
|
| Rate for Payer: BCN Medicare Advantage |
$14,964.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,964.26
|
| Rate for Payer: Mclaren Medicare |
$14,964.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,712.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,208.90
|
| Rate for Payer: PACE Medicare |
$14,216.05
|
| Rate for Payer: PACE SWMI |
$14,964.26
|
| Rate for Payer: PHP Medicare Advantage |
$14,964.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,911.84
|
| Rate for Payer: Priority Health Medicare |
$14,964.26
|
| Rate for Payer: Priority Health Narrow Network |
$21,529.47
|
| Rate for Payer: Railroad Medicare Medicare |
$14,964.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,607.35
|
| Rate for Payer: UHC Core |
$23,457.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,964.26
|
| Rate for Payer: UHC Exchange |
$18,648.98
|
| Rate for Payer: UHC Medicare Advantage |
$15,413.19
|
| Rate for Payer: VA VA |
$14,964.26
|
|
|
DISORDERS OF THE BILIARY TRACT WITH CC
|
Facility
|
IP
|
$19,806.68
|
|
|
Service Code
|
MS-DRG 445
|
| Min. Negotiated Rate |
$8,442.91 |
| Max. Negotiated Rate |
$19,806.68 |
| Rate for Payer: Aetna Medicare |
$9,242.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,109.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,109.09
|
| Rate for Payer: BCBS MAPPO |
$8,887.27
|
| Rate for Payer: BCBS Trust/PPO |
$19,806.68
|
| Rate for Payer: BCN Medicare Advantage |
$8,887.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,887.27
|
| Rate for Payer: Mclaren Medicare |
$8,887.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,331.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,220.36
|
| Rate for Payer: PACE Medicare |
$8,442.91
|
| Rate for Payer: PACE SWMI |
$8,887.27
|
| Rate for Payer: PHP Medicare Advantage |
$8,887.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,595.49
|
| Rate for Payer: Priority Health Medicare |
$8,887.27
|
| Rate for Payer: Priority Health Narrow Network |
$12,476.39
|
| Rate for Payer: Railroad Medicare Medicare |
$8,887.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,578.05
|
| Rate for Payer: UHC Core |
$13,593.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,887.27
|
| Rate for Payer: UHC Exchange |
$10,807.14
|
| Rate for Payer: UHC Medicare Advantage |
$9,153.89
|
| Rate for Payer: VA VA |
$8,887.27
|
|
|
DISORDERS OF THE BILIARY TRACT WITH MCC
|
Facility
|
IP
|
$33,662.81
|
|
|
Service Code
|
MS-DRG 444
|
| Min. Negotiated Rate |
$12,442.96 |
| Max. Negotiated Rate |
$33,662.81 |
| Rate for Payer: Aetna Medicare |
$13,621.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,372.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,372.31
|
| Rate for Payer: BCBS MAPPO |
$13,097.85
|
| Rate for Payer: BCBS Trust/PPO |
$33,662.81
|
| Rate for Payer: BCN Medicare Advantage |
$13,097.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,097.85
|
| Rate for Payer: Mclaren Medicare |
$13,097.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,752.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,062.53
|
| Rate for Payer: PACE Medicare |
$12,442.96
|
| Rate for Payer: PACE SWMI |
$13,097.85
|
| Rate for Payer: PHP Medicare Advantage |
$13,097.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,436.29
|
| Rate for Payer: Priority Health Medicare |
$13,097.85
|
| Rate for Payer: Priority Health Narrow Network |
$18,749.03
|
| Rate for Payer: Railroad Medicare Medicare |
$13,097.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,912.83
|
| Rate for Payer: UHC Core |
$20,428.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,097.85
|
| Rate for Payer: UHC Exchange |
$16,240.54
|
| Rate for Payer: UHC Medicare Advantage |
$13,490.79
|
| Rate for Payer: VA VA |
$13,097.85
|
|
|
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC
|
Facility
|
IP
|
$16,745.97
|
|
|
Service Code
|
MS-DRG 446
|
| Min. Negotiated Rate |
$6,354.29 |
| Max. Negotiated Rate |
$16,745.97 |
| Rate for Payer: Aetna Medicare |
$6,956.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,360.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,360.91
|
| Rate for Payer: BCBS MAPPO |
$6,688.73
|
| Rate for Payer: BCBS Trust/PPO |
$16,745.97
|
| Rate for Payer: BCN Medicare Advantage |
$6,688.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,688.73
|
| Rate for Payer: Mclaren Medicare |
$6,688.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,023.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,692.04
|
| Rate for Payer: PACE Medicare |
$6,354.29
|
| Rate for Payer: PACE SWMI |
$6,688.73
|
| Rate for Payer: PHP Medicare Advantage |
$6,688.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,501.46
|
| Rate for Payer: Priority Health Medicare |
$6,688.73
|
| Rate for Payer: Priority Health Narrow Network |
$9,201.17
|
| Rate for Payer: Railroad Medicare Medicare |
$6,688.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,226.08
|
| Rate for Payer: UHC Core |
$10,025.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,688.73
|
| Rate for Payer: UHC Exchange |
$7,970.12
|
| Rate for Payer: UHC Medicare Advantage |
$6,889.39
|
| Rate for Payer: VA VA |
$6,688.73
|
|
|
DISPOSABLE PAIN PUMP
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS C2626
|
| Hospital Charge Code |
154972
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna American Axle |
$390.00
|
| Rate for Payer: Aetna Commercial |
$510.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$516.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.00
|
| Rate for Payer: Healthscope Commercial |
$540.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$420.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.00
|
| Rate for Payer: PHP Commercial |
$510.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health SBD |
$378.00
|
| Rate for Payer: UMR Bronson Commercial |
$264.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.00
|
|
|
DISTAL REVASCULARIZATION AND INTERVAL LIGATION (DRIL), UPPER EXTREMITY HEMODIALYSIS ACCESS (STEAL SYNDROME)
|
Facility
|
OP
|
$15,377.24
|
|
|
Service Code
|
CPT 36838
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,093.66 |
| Max. Negotiated Rate |
$15,377.24 |
| Rate for Payer: Aetna Medicare |
$5,080.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,494.64
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,377.24
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,301.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,203.03
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,884.69
|
| Rate for Payer: UHC Exchange |
$1,093.66
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
IP
|
$327.84
|
|
|
Service Code
|
NDC 68084-313-01
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna American Axle |
$213.10
|
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.10
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$229.49
|
| Rate for Payer: Cofinity Commercial |
$281.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Healthscope Commercial |
$295.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$278.66
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.49
|
| Rate for Payer: Priority Health SBD |
$206.54
|
| Rate for Payer: UMR Bronson Commercial |
$144.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.88
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
IP
|
$327.84
|
|
|
Service Code
|
NDC 68084-313-11
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna American Axle |
$213.10
|
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.10
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$229.49
|
| Rate for Payer: Cofinity Commercial |
$281.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Healthscope Commercial |
$295.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$278.66
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.49
|
| Rate for Payer: Priority Health SBD |
$206.54
|
| Rate for Payer: UMR Bronson Commercial |
$144.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.88
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
IP
|
$202.35
|
|
|
Service Code
|
NDC 68382-106-01
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna American Axle |
$131.53
|
| Rate for Payer: Aetna Commercial |
$172.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: Cash Price |
$161.88
|
| Rate for Payer: Cofinity Commercial |
$141.64
|
| Rate for Payer: Cofinity Commercial |
$174.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
| Rate for Payer: Healthscope Commercial |
$182.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.00
|
| Rate for Payer: PHP Commercial |
$172.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.64
|
| Rate for Payer: Priority Health SBD |
$127.48
|
| Rate for Payer: UMR Bronson Commercial |
$89.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.76
|
|
