|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna American Axle |
$2.19
|
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna American Axle |
$1.37
|
| Rate for Payer: Aetna American Axle |
$1.45
|
| Rate for Payer: Aetna American Axle |
$1.39
|
| Rate for Payer: Aetna American Axle |
$2.85
|
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Commercial |
$1.79
|
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Advantage |
$3.07
|
| Rate for Payer: Cofinity Advantage |
$1.50
|
| Rate for Payer: Cofinity Advantage |
$1.78
|
| Rate for Payer: Cofinity Advantage |
$1.56
|
| Rate for Payer: Cofinity Advantage |
$1.48
|
| Rate for Payer: Cofinity Advantage |
$2.36
|
| Rate for Payer: Cofinity Advantage |
$2.47
|
| Rate for Payer: Cofinity Advantage |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.69
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$2.01
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.29
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$1.90
|
| Rate for Payer: PHP Commercial |
$1.82
|
| Rate for Payer: PHP Commercial |
$1.79
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.76
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: UMR Bronson Commercial |
$1.93
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.53
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna American Axle |
$2.85
|
| Rate for Payer: Aetna American Axle |
$2.19
|
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna American Axle |
$1.39
|
| Rate for Payer: Aetna American Axle |
$1.37
|
| Rate for Payer: Aetna American Axle |
$1.45
|
| Rate for Payer: Aetna Commercial |
$1.79
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Aetna Medicare |
$1.69
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS Complete |
$0.89
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Advantage |
$1.50
|
| Rate for Payer: Cofinity Advantage |
$1.48
|
| Rate for Payer: Cofinity Advantage |
$1.56
|
| Rate for Payer: Cofinity Advantage |
$1.78
|
| Rate for Payer: Cofinity Advantage |
$1.80
|
| Rate for Payer: Cofinity Advantage |
$2.36
|
| Rate for Payer: Cofinity Advantage |
$2.47
|
| Rate for Payer: Cofinity Advantage |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$2.01
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.58
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$1.82
|
| Rate for Payer: PHP Commercial |
$1.79
|
| Rate for Payer: PHP Commercial |
$1.90
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.07
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: Priority Health SBD |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.40
|
| Rate for Payer: Priority Health SBD |
$2.76
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.39
|
| Rate for Payer: UHC Core |
$1.32
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: UHC Core |
$1.11
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Core |
$1.10
|
| Rate for Payer: UHC Core |
$1.76
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: UHC Core |
$1.16
|
| Rate for Payer: UHC Exchange |
$1.32
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UHC Exchange |
$0.83
|
| Rate for Payer: UHC Exchange |
$1.00
|
| Rate for Payer: UHC Exchange |
$0.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$0.79
|
| Rate for Payer: UMR Bronson Commercial |
$0.83
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.29
|
|
|
ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$533.55
|
|
|
Service Code
|
NDC 00472082516
|
| Hospital Charge Code |
252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.41 |
| Max. Negotiated Rate |
$480.19 |
| Rate for Payer: Aetna American Axle |
$346.81
|
| Rate for Payer: Aetna Commercial |
$453.52
|
| Rate for Payer: Aetna Medicare |
$266.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.81
|
| Rate for Payer: BCBS Complete |
$213.42
|
| Rate for Payer: Cash Price |
$426.84
|
| Rate for Payer: Cofinity Advantage |
$373.49
|
| Rate for Payer: Cofinity Commercial |
$458.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.84
|
| Rate for Payer: Healthscope Commercial |
$480.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$400.16
|
| Rate for Payer: PHP Commercial |
$453.52
|
| Rate for Payer: Priority Health SBD |
$336.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.81
|
| Rate for Payer: UHC Core |
$277.98
|
| Rate for Payer: UHC Exchange |
$209.69
|
| Rate for Payer: UMR Bronson Commercial |
$197.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.16
|
|
|
ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$533.55
|
|
|
Service Code
|
NDC 00472082516
|
| Hospital Charge Code |
252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$480.19 |
| Rate for Payer: Aetna American Axle |
$346.81
|
| Rate for Payer: Aetna Commercial |
$453.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.81
|
| Rate for Payer: Cash Price |
$426.84
|
| Rate for Payer: Cofinity Advantage |
$373.49
|
| Rate for Payer: Cofinity Commercial |
$458.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.84
|
| Rate for Payer: Healthscope Commercial |
$480.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$400.16
|
| Rate for Payer: PHP Commercial |
$453.52
|
| Rate for Payer: Priority Health SBD |
$336.14
|
| Rate for Payer: UMR Bronson Commercial |
$234.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.16
|
|
|
ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$600.24
|
|
|
Service Code
|
NDC 70752010212
|
| Hospital Charge Code |
252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.11 |
| Max. Negotiated Rate |
$540.22 |
| Rate for Payer: Aetna American Axle |
$390.16
|
| Rate for Payer: Aetna Commercial |
$510.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.16
|
| Rate for Payer: Cash Price |
$480.19
|
| Rate for Payer: Cofinity Advantage |
$420.17
|
| Rate for Payer: Cofinity Commercial |
$516.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.19
|
| Rate for Payer: Healthscope Commercial |
$540.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$420.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.18
|
| Rate for Payer: PHP Commercial |
$510.20
|
| Rate for Payer: Priority Health SBD |
$378.15
|
| Rate for Payer: UMR Bronson Commercial |
$264.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.18
|
|
|
ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$600.24
|
|
|
Service Code
|
NDC 70752010212
|
| Hospital Charge Code |
252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.09 |
| Max. Negotiated Rate |
$540.22 |
| Rate for Payer: Aetna American Axle |
$390.16
|
| Rate for Payer: Aetna Commercial |
$510.20
|
| Rate for Payer: Aetna Medicare |
$300.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.16
|
| Rate for Payer: BCBS Complete |
$240.10
|
| Rate for Payer: Cash Price |
$480.19
|
| Rate for Payer: Cofinity Advantage |
$420.17
|
| Rate for Payer: Cofinity Commercial |
$516.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.19
|
| Rate for Payer: Healthscope Commercial |
$540.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$420.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$480.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.18
|
| Rate for Payer: PHP Commercial |
$510.20
|
| Rate for Payer: Priority Health SBD |
$378.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.16
|
| Rate for Payer: UHC Core |
$312.73
|
| Rate for Payer: UHC Exchange |
$235.89
|
| Rate for Payer: UMR Bronson Commercial |
$222.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.18
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Advantage |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.83
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Advantage |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.26
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: Priority Health Tiered Network |
$0.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.18
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: UHC Exchange |
$1.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$165.17
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.67 |
| Max. Negotiated Rate |
$148.65 |
| Rate for Payer: Aetna American Axle |
$107.36
|
| Rate for Payer: Aetna American Axle |
$24.05
|
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Commercial |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.05
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Advantage |
$25.90
|
| Rate for Payer: Cofinity Advantage |
$115.62
|
| Rate for Payer: Cofinity Commercial |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$142.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.60
|
| Rate for Payer: Healthscope Commercial |
$148.65
|
| Rate for Payer: Healthscope Commercial |
$33.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: PHP Commercial |
$31.45
|
| Rate for Payer: Priority Health SBD |
$23.31
|
| Rate for Payer: Priority Health SBD |
$104.06
|
| Rate for Payer: UMR Bronson Commercial |
$72.67
|
| Rate for Payer: UMR Bronson Commercial |
$16.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.75
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna American Axle |
$24.05
|
| Rate for Payer: Aetna American Axle |
$107.36
|
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Commercial |
$31.45
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: Aetna Medicare |
$82.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.36
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Complete |
$66.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.83
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cofinity Advantage |
$115.62
|
| Rate for Payer: Cofinity Advantage |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$142.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.14
|
| Rate for Payer: Healthscope Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$148.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: PHP Commercial |
$31.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.26
|
| Rate for Payer: Priority Health SBD |
$23.31
|
| Rate for Payer: Priority Health SBD |
$104.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.21
|
| Rate for Payer: Priority Health Tiered Network |
$0.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.05
|
| Rate for Payer: UHC Core |
$86.05
|
| Rate for Payer: UHC Core |
$19.28
|
| Rate for Payer: UHC Exchange |
$14.54
|
| Rate for Payer: UHC Exchange |
$64.91
|
| Rate for Payer: UMR Bronson Commercial |
$61.11
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.75
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna American Axle |
$70.98
|
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: Aetna Medicare |
$54.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.98
|
| Rate for Payer: BCBS Complete |
$43.68
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Advantage |
$76.44
|
| Rate for Payer: Cofinity Commercial |
$93.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$98.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.90
|
| Rate for Payer: PHP Commercial |
$92.82
|
| Rate for Payer: Priority Health SBD |
$68.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.98
|
| Rate for Payer: UHC Core |
$56.89
|
| Rate for Payer: UHC Exchange |
$42.92
|
| Rate for Payer: UMR Bronson Commercial |
$40.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.05 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna American Axle |
$70.98
|
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.98
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Advantage |
$76.44
|
| Rate for Payer: Cofinity Commercial |
$93.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$98.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.90
|
| Rate for Payer: PHP Commercial |
$92.82
|
| Rate for Payer: Priority Health SBD |
$68.80
|
| Rate for Payer: UMR Bronson Commercial |
$48.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.90
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,874.68
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$6,547.31 |
| Max. Negotiated Rate |
$6,874.68 |
| Rate for Payer: BCBS Complete |
$6,874.68
|
| Rate for Payer: Mclaren Medicaid |
$6,547.31
|
| Rate for Payer: Meridian Medicaid |
$6,874.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,547.31
|
| Rate for Payer: UHC Medicaid |
$6,547.31
|
| Rate for Payer: UHCCP Medicaid |
$6,547.31
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,166.45
|
|
|
Service Code
|
APR-DRG 7752
|
| Min. Negotiated Rate |
$3,968.05 |
| Max. Negotiated Rate |
$4,166.45 |
| Rate for Payer: BCBS Complete |
$4,166.45
|
| Rate for Payer: Mclaren Medicaid |
$3,968.05
|
| Rate for Payer: Meridian Medicaid |
$4,166.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,968.05
|
| Rate for Payer: UHC Medicaid |
$3,968.05
|
| Rate for Payer: UHCCP Medicaid |
$3,968.05
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,401.93
|
|
|
Service Code
|
APR-DRG 7751
|
| Min. Negotiated Rate |
$3,239.93 |
| Max. Negotiated Rate |
$3,401.93 |
| Rate for Payer: BCBS Complete |
$3,401.93
|
| Rate for Payer: Mclaren Medicaid |
$3,239.93
|
| Rate for Payer: Meridian Medicaid |
$3,401.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,239.93
|
| Rate for Payer: UHC Medicaid |
$3,239.93
|
| Rate for Payer: UHCCP Medicaid |
$3,239.93
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$13,885.55
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$13,224.33 |
| Max. Negotiated Rate |
$13,885.55 |
| Rate for Payer: BCBS Complete |
$13,885.55
|
| Rate for Payer: Mclaren Medicaid |
$13,224.33
|
| Rate for Payer: Meridian Medicaid |
$13,885.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,224.33
|
| Rate for Payer: UHC Medicaid |
$13,224.33
|
| Rate for Payer: UHCCP Medicaid |
$13,224.33
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
|
IP
|
$10,785.50
|
|
|
Service Code
|
MSDRG 894
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$10,785.50 |
| Rate for Payer: Aetna Medicare |
$5,982.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,189.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,189.90
|
| Rate for Payer: BCBS MAPPO |
$5,751.92
|
| Rate for Payer: BCBS Trust/PPO |
$10,785.50
|
| Rate for Payer: BCN Commercial |
$10,785.50
|
| Rate for Payer: BCN Medicare Advantage |
$5,751.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,751.92
|
| Rate for Payer: Mclaren Medicare |
$5,751.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,039.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,614.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,327.11
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$5,464.32
|
| Rate for Payer: PACE SWMI |
$5,751.92
|
| Rate for Payer: PHP Medicare Advantage |
$5,751.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,945.75
|
| Rate for Payer: Priority Health Medicare |
$5,751.92
|
| Rate for Payer: Priority Health Tiered Network |
$7,956.60
|
| Rate for Payer: Railroad Medicare Medicare |
$5,751.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,055.47
|
| Rate for Payer: UHC Core |
$8,412.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,751.92
|
| Rate for Payer: UHC Exchange |
$6,870.42
|
| Rate for Payer: VA VA |
$5,751.92
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
|
IP
|
$28,445.13
|
|
|
Service Code
|
MSDRG 896
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$28,445.13 |
| Rate for Payer: Aetna Medicare |
$15,794.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,983.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,983.38
|
| Rate for Payer: BCBS MAPPO |
$15,186.70
|
| Rate for Payer: BCBS Trust/PPO |
$28,285.51
|
| Rate for Payer: BCN Commercial |
$28,285.51
|
| Rate for Payer: BCN Medicare Advantage |
$15,186.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,186.70
|
| Rate for Payer: Mclaren Medicare |
$15,186.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,946.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,464.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,705.37
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$14,427.36
|
| Rate for Payer: PACE SWMI |
$15,186.70
|
| Rate for Payer: PHP Medicare Advantage |
$15,186.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,134.75
|
| Rate for Payer: Priority Health Medicare |
$15,186.70
|
| Rate for Payer: Priority Health Tiered Network |
$22,507.79
|
| Rate for Payer: Railroad Medicare Medicare |
$15,186.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,445.13
|
| Rate for Payer: UHC Core |
$23,797.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,186.70
|
| Rate for Payer: UHC Exchange |
$19,435.18
|
| Rate for Payer: VA VA |
$15,186.70
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
|
IP
|
$14,389.64
|
|
|
Service Code
|
MSDRG 897
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$14,389.64 |
| Rate for Payer: Aetna Medicare |
$8,294.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,969.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,969.45
|
| Rate for Payer: BCBS MAPPO |
$7,975.56
|
| Rate for Payer: BCBS Trust/PPO |
$13,464.72
|
| Rate for Payer: BCN Commercial |
$13,464.72
|
| Rate for Payer: BCN Medicare Advantage |
$7,975.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,975.56
|
| Rate for Payer: Mclaren Medicare |
$7,975.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,374.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,171.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,773.12
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$7,576.78
|
| Rate for Payer: PACE SWMI |
$7,975.56
|
| Rate for Payer: PHP Medicare Advantage |
$7,975.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,232.63
|
| Rate for Payer: Priority Health Medicare |
$7,975.56
|
| Rate for Payer: Priority Health Tiered Network |
$11,386.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7,975.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,389.64
|
| Rate for Payer: UHC Core |
$12,038.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,975.56
|
| Rate for Payer: UHC Exchange |
$9,831.74
|
| Rate for Payer: VA VA |
$7,975.56
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
|
IP
|
$25,631.00
|
|
|
Service Code
|
MSDRG 895
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$25,631.00 |
| Rate for Payer: Aetna Medicare |
$12,928.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,539.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,539.00
|
| Rate for Payer: BCBS MAPPO |
$12,431.20
|
| Rate for Payer: BCBS Trust/PPO |
$25,631.00
|
| Rate for Payer: BCN Commercial |
$25,631.00
|
| Rate for Payer: BCN Medicare Advantage |
$12,431.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,431.20
|
| Rate for Payer: Mclaren Medicare |
$12,431.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,052.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,295.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,674.32
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$11,809.64
|
| Rate for Payer: PACE SWMI |
$12,431.20
|
| Rate for Payer: PHP Medicare Advantage |
$12,431.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,822.50
|
| Rate for Payer: Priority Health Medicare |
$12,431.20
|
| Rate for Payer: Priority Health Tiered Network |
$18,258.00
|
| Rate for Payer: Railroad Medicare Medicare |
$12,431.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,074.28
|
| Rate for Payer: UHC Core |
$19,304.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,431.20
|
| Rate for Payer: UHC Exchange |
$15,765.54
|
| Rate for Payer: VA VA |
$12,431.20
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$4,808.70
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$4,579.72 |
| Max. Negotiated Rate |
$4,808.70 |
| Rate for Payer: BCBS Complete |
$4,808.70
|
| Rate for Payer: Mclaren Medicaid |
$4,579.72
|
| Rate for Payer: Meridian Medicaid |
$4,808.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,579.72
|
| Rate for Payer: UHC Medicaid |
$4,579.72
|
| Rate for Payer: UHCCP Medicaid |
$4,579.72
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$15,532.64
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$14,792.99 |
| Max. Negotiated Rate |
$15,532.64 |
| Rate for Payer: BCBS Complete |
$15,532.64
|
| Rate for Payer: Mclaren Medicaid |
$14,792.99
|
| Rate for Payer: Meridian Medicaid |
$15,532.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,792.99
|
| Rate for Payer: UHC Medicaid |
$14,792.99
|
| Rate for Payer: UHCCP Medicaid |
$14,792.99
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$6,648.28
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$6,331.70 |
| Max. Negotiated Rate |
$6,648.28 |
| Rate for Payer: BCBS Complete |
$6,648.28
|
| Rate for Payer: Mclaren Medicaid |
$6,331.70
|
| Rate for Payer: Meridian Medicaid |
$6,648.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,331.70
|
| Rate for Payer: UHC Medicaid |
$6,331.70
|
| Rate for Payer: UHCCP Medicaid |
$6,331.70
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$3,602.29
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$3,430.75 |
| Max. Negotiated Rate |
$3,602.29 |
| Rate for Payer: BCBS Complete |
$3,602.29
|
| Rate for Payer: Mclaren Medicaid |
$3,430.75
|
| Rate for Payer: Meridian Medicaid |
$3,602.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,430.75
|
| Rate for Payer: UHC Medicaid |
$3,430.75
|
| Rate for Payer: UHCCP Medicaid |
$3,430.75
|
|
|
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,926.11
|
|
|
Service Code
|
HCPCS J9015
|
| Hospital Charge Code |
8993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10,967.49 |
| Max. Negotiated Rate |
$22,433.50 |
| Rate for Payer: Aetna American Axle |
$16,201.97
|
| Rate for Payer: Aetna Commercial |
$21,187.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,201.97
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cofinity Advantage |
$17,448.28
|
| Rate for Payer: Cofinity Commercial |
$21,436.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,940.89
|
| Rate for Payer: Healthscope Commercial |
$22,433.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,448.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,694.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,187.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,694.58
|
| Rate for Payer: PHP Commercial |
$21,187.19
|
| Rate for Payer: Priority Health SBD |
$15,703.45
|
| Rate for Payer: UMR Bronson Commercial |
$10,967.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,694.58
|
|
