|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 31722053101
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.03 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$233.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: BCBS Complete |
$187.06
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.97
|
| Rate for Payer: UHC Core |
$243.65
|
| Rate for Payer: UHC Exchange |
$183.79
|
| Rate for Payer: UMR Bronson Commercial |
$173.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 31722053101
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.77 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UMR Bronson Commercial |
$205.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 31722052901
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.57
|
| Rate for Payer: UHC Core |
$159.17
|
| Rate for Payer: UHC Exchange |
$120.06
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
OP
|
$121.60
|
|
|
Service Code
|
NDC 50268075415
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.99 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna American Axle |
$79.04
|
| Rate for Payer: Aetna Commercial |
$103.36
|
| Rate for Payer: Aetna Medicare |
$60.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.04
|
| Rate for Payer: BCBS Complete |
$48.64
|
| Rate for Payer: Cash Price |
$97.28
|
| Rate for Payer: Cofinity Advantage |
$85.12
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.28
|
| Rate for Payer: Healthscope Commercial |
$109.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.20
|
| Rate for Payer: PHP Commercial |
$103.36
|
| Rate for Payer: Priority Health SBD |
$76.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.04
|
| Rate for Payer: UHC Core |
$63.35
|
| Rate for Payer: UHC Exchange |
$47.79
|
| Rate for Payer: UMR Bronson Commercial |
$44.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.20
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
NDC 50268075411
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna American Axle |
$1.59
|
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.59
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cofinity Advantage |
$1.71
|
| Rate for Payer: Cofinity Commercial |
$2.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.95
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.83
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health SBD |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.59
|
| Rate for Payer: UHC Core |
$1.27
|
| Rate for Payer: UHC Exchange |
$0.96
|
| Rate for Payer: UMR Bronson Commercial |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.83
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$121.60
|
|
|
Service Code
|
NDC 50268075415
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna American Axle |
$79.04
|
| Rate for Payer: Aetna Commercial |
$103.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.04
|
| Rate for Payer: Cash Price |
$97.28
|
| Rate for Payer: Cofinity Advantage |
$85.12
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.28
|
| Rate for Payer: Healthscope Commercial |
$109.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.20
|
| Rate for Payer: PHP Commercial |
$103.36
|
| Rate for Payer: Priority Health SBD |
$76.61
|
| Rate for Payer: UMR Bronson Commercial |
$53.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.20
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 31722052901
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$419.90
|
|
|
Service Code
|
NDC 50111091501
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.76 |
| Max. Negotiated Rate |
$377.91 |
| Rate for Payer: Aetna American Axle |
$272.94
|
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.94
|
| Rate for Payer: Cash Price |
$335.92
|
| Rate for Payer: Cofinity Advantage |
$293.93
|
| Rate for Payer: Cofinity Commercial |
$361.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.92
|
| Rate for Payer: Healthscope Commercial |
$377.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.93
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: Priority Health SBD |
$264.54
|
| Rate for Payer: UMR Bronson Commercial |
$184.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.93
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
OP
|
$419.90
|
|
|
Service Code
|
NDC 50111091501
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.36 |
| Max. Negotiated Rate |
$377.91 |
| Rate for Payer: Aetna American Axle |
$272.94
|
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna Medicare |
$209.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.94
|
| Rate for Payer: BCBS Complete |
$167.96
|
| Rate for Payer: Cash Price |
$335.92
|
| Rate for Payer: Cofinity Advantage |
$293.93
|
| Rate for Payer: Cofinity Commercial |
$361.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.92
|
| Rate for Payer: Healthscope Commercial |
$377.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$335.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.93
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: Priority Health SBD |
$264.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.94
|
| Rate for Payer: UHC Core |
$218.77
|
| Rate for Payer: UHC Exchange |
$165.02
|
| Rate for Payer: UMR Bronson Commercial |
$155.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.93
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$2.44
|
|
|
Service Code
|
NDC 50268075411
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna American Axle |
$1.59
|
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.59
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cofinity Advantage |
$1.71
|
| Rate for Payer: Cofinity Commercial |
$2.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.95
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.83
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health SBD |
$1.54
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.83
|
|
|
TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S);
|
Facility
|
OP
|
$9,589.93
|
|
|
Service Code
|
CPT 58150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,589.93 |
| Max. Negotiated Rate |
$9,589.93 |
| Rate for Payer: BCBS Trust/PPO |
$9,589.93
|
| Rate for Payer: BCN Commercial |
$9,589.93
|
|
|
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SECOND LEVEL, CERVICAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$30,794.96
|
|
|
Service Code
|
CPT 22858
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$30,794.96 |
| Max. Negotiated Rate |
$30,794.96 |
| Rate for Payer: BCBS Trust/PPO |
$30,794.96
|
| Rate for Payer: BCN Commercial |
$30,794.96
|
|
|
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SINGLE INTERSPACE, CERVICAL
|
Facility
|
OP
|
$56,498.90
|
|
|
Service Code
|
CPT 22856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,137.21 |
| Max. Negotiated Rate |
$56,498.90 |
| Rate for Payer: Aetna Medicare |
$18,169.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,838.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,838.46
|
| Rate for Payer: BCBS Complete |
$9,594.95
|
| Rate for Payer: BCBS MAPPO |
$17,470.77
|
| Rate for Payer: BCBS Trust/PPO |
$20,903.46
|
| Rate for Payer: BCN Commercial |
$20,903.46
|
| Rate for Payer: BCN Medicare Advantage |
$17,470.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,470.77
|
| Rate for Payer: Mclaren Medicaid |
$17,470.77
|
| Rate for Payer: Mclaren Medicare |
$17,470.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,344.31
|
| Rate for Payer: Meridian Medicaid |
$18,344.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,091.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,217.85
|
| Rate for Payer: Nomi Health Commercial |
$52,412.31
|
| Rate for Payer: PACE Medicare |
$16,597.23
|
| Rate for Payer: PACE SWMI |
$17,470.77
|
| Rate for Payer: PHP Medicare Advantage |
$17,470.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,137.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56,498.90
|
| Rate for Payer: Priority Health Medicare |
$17,470.77
|
| Rate for Payer: Priority Health Tiered Network |
$45,199.12
|
| Rate for Payer: Railroad Medicare Medicare |
$17,470.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,470.77
|
| Rate for Payer: UHC Medicaid |
$9,137.21
|
| Rate for Payer: UHCCP Medicaid |
$9,137.21
|
| Rate for Payer: VA VA |
$17,470.77
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
|
Facility
|
OP
|
$19,480.40
|
|
|
Service Code
|
CPT 60220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.44 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$7,323.84
|
| Rate for Payer: BCN Commercial |
$7,323.84
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Mclaren Medicaid |
$6,023.79
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$3,509.67
|
|
|
Service Code
|
APR-DRG 8162
|
| Min. Negotiated Rate |
$3,342.55 |
| Max. Negotiated Rate |
$3,509.67 |
| Rate for Payer: BCBS Complete |
$3,509.67
|
| Rate for Payer: Mclaren Medicaid |
$3,342.55
|
| Rate for Payer: Meridian Medicaid |
$3,509.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,342.55
|
| Rate for Payer: UHC Medicaid |
$3,342.55
|
| Rate for Payer: UHCCP Medicaid |
$3,342.55
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$2,179.17
|
|
|
Service Code
|
APR-DRG 8161
|
| Min. Negotiated Rate |
$2,075.40 |
| Max. Negotiated Rate |
$2,179.17 |
| Rate for Payer: BCBS Complete |
$2,179.17
|
| Rate for Payer: Mclaren Medicaid |
$2,075.40
|
| Rate for Payer: Meridian Medicaid |
$2,179.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,075.40
|
| Rate for Payer: UHC Medicaid |
$2,075.40
|
| Rate for Payer: UHCCP Medicaid |
$2,075.40
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$7,710.02
|
|
|
Service Code
|
APR-DRG 8163
|
| Min. Negotiated Rate |
$7,342.88 |
| Max. Negotiated Rate |
$7,710.02 |
| Rate for Payer: BCBS Complete |
$7,710.02
|
| Rate for Payer: Mclaren Medicaid |
$7,342.88
|
| Rate for Payer: Meridian Medicaid |
$7,710.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,342.88
|
| Rate for Payer: UHC Medicaid |
$7,342.88
|
| Rate for Payer: UHCCP Medicaid |
$7,342.88
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$13,167.03
|
|
|
Service Code
|
APR-DRG 8164
|
| Min. Negotiated Rate |
$12,540.03 |
| Max. Negotiated Rate |
$13,167.03 |
| Rate for Payer: BCBS Complete |
$13,167.03
|
| Rate for Payer: Mclaren Medicaid |
$12,540.03
|
| Rate for Payer: Meridian Medicaid |
$13,167.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,540.03
|
| Rate for Payer: UHC Medicaid |
$12,540.03
|
| Rate for Payer: UHCCP Medicaid |
$12,540.03
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,565.14
|
|
|
Service Code
|
HCPCS J9352
|
| Hospital Charge Code |
175966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.53 |
| Max. Negotiated Rate |
$14,908.63 |
| Rate for Payer: Aetna American Axle |
$10,767.34
|
| Rate for Payer: Aetna Commercial |
$14,080.37
|
| Rate for Payer: Aetna Medicare |
$406.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,767.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.84
|
| Rate for Payer: BCBS Complete |
$214.78
|
| Rate for Payer: BCBS MAPPO |
$391.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,268.08
|
| Rate for Payer: BCN Commercial |
$1,268.08
|
| Rate for Payer: BCN Medicare Advantage |
$391.07
|
| Rate for Payer: Cash Price |
$13,252.11
|
| Rate for Payer: Cash Price |
$13,252.11
|
| Rate for Payer: Cofinity Advantage |
$11,595.60
|
| Rate for Payer: Cofinity Commercial |
$14,246.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,252.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.07
|
| Rate for Payer: Healthscope Commercial |
$14,908.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,595.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,423.85
|
| Rate for Payer: Mclaren Medicaid |
$391.07
|
| Rate for Payer: Mclaren Medicare |
$391.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.62
|
| Rate for Payer: Meridian Medicaid |
$410.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$430.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,080.37
|
| Rate for Payer: Nomi Health Commercial |
$1,173.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,423.85
|
| Rate for Payer: PACE Medicare |
$371.52
|
| Rate for Payer: PACE SWMI |
$391.07
|
| Rate for Payer: PHP Commercial |
$14,080.37
|
| Rate for Payer: PHP Medicare Advantage |
$391.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,233.43
|
| Rate for Payer: Priority Health Medicare |
$391.07
|
| Rate for Payer: Priority Health SBD |
$10,436.04
|
| Rate for Payer: Priority Health Tiered Network |
$986.74
|
| Rate for Payer: Railroad Medicare Medicare |
$391.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.27
|
| Rate for Payer: UHC Core |
$645.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$391.07
|
| Rate for Payer: UHC Exchange |
$645.27
|
| Rate for Payer: UHC Medicaid |
$204.53
|
| Rate for Payer: UHCCP Medicaid |
$204.53
|
| Rate for Payer: UMR Bronson Commercial |
$6,129.10
|
| Rate for Payer: VA VA |
$391.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,423.85
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,565.14
|
|
|
Service Code
|
HCPCS J9352
|
| Hospital Charge Code |
175966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,288.66 |
| Max. Negotiated Rate |
$14,908.63 |
| Rate for Payer: Aetna American Axle |
$10,767.34
|
| Rate for Payer: Aetna Commercial |
$14,080.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,767.34
|
| Rate for Payer: Cash Price |
$13,252.11
|
| Rate for Payer: Cofinity Advantage |
$11,595.60
|
| Rate for Payer: Cofinity Commercial |
$14,246.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,252.11
|
| Rate for Payer: Healthscope Commercial |
$14,908.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,595.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,423.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,080.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,423.85
|
| Rate for Payer: PHP Commercial |
$14,080.37
|
| Rate for Payer: Priority Health SBD |
$10,436.04
|
| Rate for Payer: UMR Bronson Commercial |
$7,288.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,423.85
|
|
|
TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS
|
Facility
|
IP
|
$74.18
|
|
|
Service Code
|
NDC 00517920325
|
| Hospital Charge Code |
18266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$66.76 |
| Rate for Payer: Aetna American Axle |
$48.22
|
| Rate for Payer: Aetna Commercial |
$63.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.22
|
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Cofinity Advantage |
$51.93
|
| Rate for Payer: Cofinity Commercial |
$63.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.34
|
| Rate for Payer: Healthscope Commercial |
$66.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.63
|
| Rate for Payer: PHP Commercial |
$63.05
|
| Rate for Payer: Priority Health SBD |
$46.73
|
| Rate for Payer: UMR Bronson Commercial |
$32.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.63
|
|
|
TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS
|
Facility
|
OP
|
$74.18
|
|
|
Service Code
|
NDC 00517920325
|
| Hospital Charge Code |
18266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$66.76 |
| Rate for Payer: Aetna American Axle |
$48.22
|
| Rate for Payer: Aetna Commercial |
$63.05
|
| Rate for Payer: Aetna Medicare |
$37.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.22
|
| Rate for Payer: BCBS Complete |
$29.67
|
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Cofinity Advantage |
$51.93
|
| Rate for Payer: Cofinity Commercial |
$63.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.34
|
| Rate for Payer: Healthscope Commercial |
$66.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.63
|
| Rate for Payer: PHP Commercial |
$63.05
|
| Rate for Payer: Priority Health SBD |
$46.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.22
|
| Rate for Payer: UHC Core |
$38.65
|
| Rate for Payer: UHC Exchange |
$29.15
|
| Rate for Payer: UMR Bronson Commercial |
$27.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.63
|
|
|
TRACE ELEMENTS ADULT INJECTION (NORWAY)
|
Facility
|
IP
|
$90.92
|
|
|
Service Code
|
NDC 09900000558
|
| Hospital Charge Code |
168908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$81.83 |
| Rate for Payer: Aetna American Axle |
$59.10
|
| Rate for Payer: Aetna Commercial |
$77.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.10
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cofinity Advantage |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$78.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.74
|
| Rate for Payer: Healthscope Commercial |
$81.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.19
|
| Rate for Payer: PHP Commercial |
$77.28
|
| Rate for Payer: Priority Health SBD |
$57.28
|
| Rate for Payer: UMR Bronson Commercial |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.19
|
|
|
TRACE ELEMENTS ADULT INJECTION (NORWAY)
|
Facility
|
IP
|
$97.48
|
|
|
Service Code
|
NDC 00517720125
|
| Hospital Charge Code |
168908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.89 |
| Max. Negotiated Rate |
$87.73 |
| Rate for Payer: Aetna American Axle |
$63.36
|
| Rate for Payer: Aetna Commercial |
$82.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.36
|
| Rate for Payer: Cash Price |
$77.98
|
| Rate for Payer: Cofinity Advantage |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$83.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.98
|
| Rate for Payer: Healthscope Commercial |
$87.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.11
|
| Rate for Payer: PHP Commercial |
$82.86
|
| Rate for Payer: Priority Health SBD |
$61.41
|
| Rate for Payer: UMR Bronson Commercial |
$42.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.11
|
|
|
TRACE ELEMENTS ADULT INJECTION (NORWAY)
|
Facility
|
OP
|
$90.92
|
|
|
Service Code
|
NDC 09900000558
|
| Hospital Charge Code |
168908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$81.83 |
| Rate for Payer: Aetna American Axle |
$59.10
|
| Rate for Payer: Aetna Commercial |
$77.28
|
| Rate for Payer: Aetna Medicare |
$45.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.10
|
| Rate for Payer: BCBS Complete |
$36.37
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cofinity Advantage |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$78.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.74
|
| Rate for Payer: Healthscope Commercial |
$81.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.19
|
| Rate for Payer: PHP Commercial |
$77.28
|
| Rate for Payer: Priority Health SBD |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.10
|
| Rate for Payer: UHC Core |
$47.37
|
| Rate for Payer: UHC Exchange |
$35.73
|
| Rate for Payer: UMR Bronson Commercial |
$33.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.19
|
|
