|
SPIRONOLACTONE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,170.97
|
|
|
Service Code
|
NDC 69238202708
|
| Hospital Charge Code |
184259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$433.26 |
| Max. Negotiated Rate |
$1,053.87 |
| Rate for Payer: Aetna American Axle |
$761.13
|
| Rate for Payer: Aetna Commercial |
$995.32
|
| Rate for Payer: Aetna Medicare |
$585.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.13
|
| Rate for Payer: BCBS Complete |
$468.39
|
| Rate for Payer: Cash Price |
$936.78
|
| Rate for Payer: Cofinity Advantage |
$819.68
|
| Rate for Payer: Cofinity Commercial |
$1,007.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.78
|
| Rate for Payer: Healthscope Commercial |
$1,053.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$819.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$936.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$995.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.23
|
| Rate for Payer: PHP Commercial |
$995.32
|
| Rate for Payer: Priority Health SBD |
$737.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$761.13
|
| Rate for Payer: UHC Core |
$610.08
|
| Rate for Payer: UHC Exchange |
$460.19
|
| Rate for Payer: UMR Bronson Commercial |
$433.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.23
|
|
|
SPIRONOLACTONE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,373.11
|
|
|
Service Code
|
NDC 46287002004
|
| Hospital Charge Code |
184259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,235.80 |
| Rate for Payer: Aetna American Axle |
$892.52
|
| Rate for Payer: Aetna Commercial |
$1,167.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$892.52
|
| Rate for Payer: Cash Price |
$1,098.49
|
| Rate for Payer: Cofinity Advantage |
$961.18
|
| Rate for Payer: Cofinity Commercial |
$1,180.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,098.49
|
| Rate for Payer: Healthscope Commercial |
$1,235.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$961.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,167.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.83
|
| Rate for Payer: PHP Commercial |
$1,167.14
|
| Rate for Payer: Priority Health SBD |
$865.06
|
| Rate for Payer: UMR Bronson Commercial |
$604.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.83
|
|
|
SPIRONOLACTONE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,170.97
|
|
|
Service Code
|
NDC 69238202708
|
| Hospital Charge Code |
184259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$515.23 |
| Max. Negotiated Rate |
$1,053.87 |
| Rate for Payer: Aetna American Axle |
$761.13
|
| Rate for Payer: Aetna Commercial |
$995.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.13
|
| Rate for Payer: Cash Price |
$936.78
|
| Rate for Payer: Cofinity Advantage |
$819.68
|
| Rate for Payer: Cofinity Commercial |
$1,007.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.78
|
| Rate for Payer: Healthscope Commercial |
$1,053.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$819.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$995.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.23
|
| Rate for Payer: PHP Commercial |
$995.32
|
| Rate for Payer: Priority Health SBD |
$737.71
|
| Rate for Payer: UMR Bronson Commercial |
$515.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.23
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.08 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna American Axle |
$183.30
|
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health SBD |
$177.66
|
| Rate for Payer: UMR Bronson Commercial |
$124.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 51079010320
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Medicare |
$184.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.82
|
| Rate for Payer: UHC Core |
$192.22
|
| Rate for Payer: UHC Exchange |
$145.00
|
| Rate for Payer: UMR Bronson Commercial |
$136.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 59746021601
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.48
|
| Rate for Payer: UHC Core |
$66.11
|
| Rate for Payer: UHC Exchange |
$49.87
|
| Rate for Payer: UMR Bronson Commercial |
$46.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.17
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 59746021601
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UMR Bronson Commercial |
$55.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.17
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 00904692761
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$168.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Advantage |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.43
|
| Rate for Payer: UHC Core |
$175.08
|
| Rate for Payer: UHC Exchange |
$132.07
|
| Rate for Payer: UMR Bronson Commercial |
$124.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 53746051101
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Advantage |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$1.92
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.34 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna American Axle |
$183.30
|
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health SBD |
$177.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.30
|
| Rate for Payer: UHC Core |
$146.92
|
| Rate for Payer: UHC Exchange |
$110.83
|
| Rate for Payer: UMR Bronson Commercial |
$104.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 53746051101
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.73 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$137.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Advantage |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.72
|
| Rate for Payer: UHC Core |
$143.25
|
| Rate for Payer: UHC Exchange |
$108.06
|
| Rate for Payer: UMR Bronson Commercial |
$101.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 00904692761
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Advantage |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$147.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 51079010320
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.34 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UMR Bronson Commercial |
$162.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$10,212.44
|
|
|
Service Code
|
APR-DRG 6501
|
| Min. Negotiated Rate |
$9,726.13 |
| Max. Negotiated Rate |
$10,212.44 |
| Rate for Payer: BCBS Complete |
$10,212.44
|
| Rate for Payer: Mclaren Medicaid |
$9,726.13
|
| Rate for Payer: Meridian Medicaid |
$10,212.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,726.13
|
| Rate for Payer: UHC Medicaid |
$9,726.13
|
| Rate for Payer: UHCCP Medicaid |
$9,726.13
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$24,643.99
|
|
|
Service Code
|
APR-DRG 6504
|
| Min. Negotiated Rate |
$23,470.47 |
| Max. Negotiated Rate |
$24,643.99 |
| Rate for Payer: BCBS Complete |
$24,643.99
|
| Rate for Payer: Mclaren Medicaid |
$23,470.47
|
| Rate for Payer: Meridian Medicaid |
$24,643.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,470.47
|
| Rate for Payer: UHC Medicaid |
$23,470.47
|
| Rate for Payer: UHCCP Medicaid |
$23,470.47
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$17,518.71
|
|
|
Service Code
|
APR-DRG 6503
|
| Min. Negotiated Rate |
$16,684.49 |
| Max. Negotiated Rate |
$17,518.71 |
| Rate for Payer: BCBS Complete |
$17,518.71
|
| Rate for Payer: Mclaren Medicaid |
$16,684.49
|
| Rate for Payer: Meridian Medicaid |
$17,518.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,684.49
|
| Rate for Payer: UHC Medicaid |
$16,684.49
|
| Rate for Payer: UHCCP Medicaid |
$16,684.49
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$13,955.77
|
|
|
Service Code
|
APR-DRG 6502
|
| Min. Negotiated Rate |
$13,291.21 |
| Max. Negotiated Rate |
$13,955.77 |
| Rate for Payer: BCBS Complete |
$13,955.77
|
| Rate for Payer: Mclaren Medicaid |
$13,291.21
|
| Rate for Payer: Meridian Medicaid |
$13,955.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,291.21
|
| Rate for Payer: UHC Medicaid |
$13,291.21
|
| Rate for Payer: UHCCP Medicaid |
$13,291.21
|
|
|
SPLENIC PROCEDURES WITH CC
|
Facility
|
IP
|
$52,774.55
|
|
|
Service Code
|
MSDRG 800
|
| Min. Negotiated Rate |
$22,882.77 |
| Max. Negotiated Rate |
$52,774.55 |
| Rate for Payer: Aetna Medicare |
$25,050.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,108.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,108.91
|
| Rate for Payer: BCBS MAPPO |
$24,087.13
|
| Rate for Payer: BCBS Trust/PPO |
$52,774.55
|
| Rate for Payer: BCN Commercial |
$52,774.55
|
| Rate for Payer: BCN Medicare Advantage |
$24,087.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,087.13
|
| Rate for Payer: Mclaren Medicare |
$24,087.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,291.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,700.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$26,495.84
|
| Rate for Payer: Nomi Health Commercial |
$36,241.26
|
| Rate for Payer: PACE Medicare |
$22,882.77
|
| Rate for Payer: PACE SWMI |
$24,087.13
|
| Rate for Payer: PHP Medicare Advantage |
$24,087.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$45,293.54
|
| Rate for Payer: Priority Health Medicare |
$24,087.13
|
| Rate for Payer: Priority Health Tiered Network |
$36,234.83
|
| Rate for Payer: Railroad Medicare Medicare |
$24,087.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,793.22
|
| Rate for Payer: UHC Core |
$38,311.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,087.13
|
| Rate for Payer: UHC Exchange |
$31,288.29
|
| Rate for Payer: VA VA |
$24,087.13
|
|
|
SPLENIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$73,821.07
|
|
|
Service Code
|
MSDRG 799
|
| Min. Negotiated Rate |
$36,543.44 |
| Max. Negotiated Rate |
$73,821.07 |
| Rate for Payer: Aetna Medicare |
$40,005.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,083.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,083.47
|
| Rate for Payer: BCBS MAPPO |
$38,466.78
|
| Rate for Payer: BCBS Trust/PPO |
$72,525.54
|
| Rate for Payer: BCN Commercial |
$72,525.54
|
| Rate for Payer: BCN Medicare Advantage |
$38,466.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,466.78
|
| Rate for Payer: Mclaren Medicare |
$38,466.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40,390.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,236.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$42,313.46
|
| Rate for Payer: Nomi Health Commercial |
$58,422.81
|
| Rate for Payer: PACE Medicare |
$36,543.44
|
| Rate for Payer: PACE SWMI |
$38,466.78
|
| Rate for Payer: PHP Medicare Advantage |
$38,466.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73,015.56
|
| Rate for Payer: Priority Health Medicare |
$38,466.78
|
| Rate for Payer: Priority Health Tiered Network |
$58,412.44
|
| Rate for Payer: Railroad Medicare Medicare |
$38,466.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73,821.07
|
| Rate for Payer: UHC Core |
$61,760.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38,466.78
|
| Rate for Payer: UHC Exchange |
$50,438.36
|
| Rate for Payer: VA VA |
$38,466.78
|
|
|
SPLENIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$51,069.84
|
|
|
Service Code
|
MSDRG 801
|
| Min. Negotiated Rate |
$15,728.68 |
| Max. Negotiated Rate |
$51,069.84 |
| Rate for Payer: Aetna Medicare |
$17,218.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,695.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,695.64
|
| Rate for Payer: BCBS MAPPO |
$16,556.51
|
| Rate for Payer: BCBS Trust/PPO |
$51,069.84
|
| Rate for Payer: BCN Commercial |
$51,069.84
|
| Rate for Payer: BCN Medicare Advantage |
$16,556.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,556.51
|
| Rate for Payer: Mclaren Medicare |
$16,556.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,384.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,039.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,212.16
|
| Rate for Payer: Nomi Health Commercial |
$24,624.81
|
| Rate for Payer: PACE Medicare |
$15,728.68
|
| Rate for Payer: PACE SWMI |
$16,556.51
|
| Rate for Payer: PHP Medicare Advantage |
$16,556.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,775.55
|
| Rate for Payer: Priority Health Medicare |
$16,556.51
|
| Rate for Payer: Priority Health Tiered Network |
$24,620.44
|
| Rate for Payer: Railroad Medicare Medicare |
$16,556.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,115.07
|
| Rate for Payer: UHC Core |
$26,031.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,556.51
|
| Rate for Payer: UHC Exchange |
$21,259.42
|
| Rate for Payer: VA VA |
$16,556.51
|
|
|
SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,501.50
|
|
|
Service Code
|
CPT 15121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,501.50 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: BCBS Trust/PPO |
$1,501.50
|
| Rate for Payer: BCN Commercial |
$1,501.50
|
|
|
SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$11,418.88
|
|
|
Service Code
|
CPT 15120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$5,797.10
|
| Rate for Payer: BCN Commercial |
$5,797.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 15100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,759.78
|
| Rate for Payer: BCN Commercial |
$4,759.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
