|
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
|
|
|
TRACE ELEMENTS CR-CU-MN-ZN 0.85 MCG-0.1 MG-25 MCG-1.5MG/ML INTRAVENOUS
|
Facility
|
IP
|
$14.12
|
|
|
Service Code
|
NDC 00517620225
|
| Hospital Charge Code |
18267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$12.71 |
| Rate for Payer: Aetna American Axle |
$9.18
|
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.18
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cofinity Advantage |
$9.88
|
| Rate for Payer: Cofinity Commercial |
$12.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.30
|
| Rate for Payer: Healthscope Commercial |
$12.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.59
|
| Rate for Payer: PHP Commercial |
$12.00
|
| Rate for Payer: Priority Health SBD |
$8.90
|
| Rate for Payer: UMR Bronson Commercial |
$6.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.59
|
|
|
TRACE ELEMENTS CR-CU-MN-ZN 0.85 MCG-0.1 MG-25 MCG-1.5MG/ML INTRAVENOUS
|
Facility
|
OP
|
$14.12
|
|
|
Service Code
|
NDC 00517620225
|
| Hospital Charge Code |
18267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$12.71 |
| Rate for Payer: Aetna American Axle |
$9.18
|
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare |
$7.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.18
|
| Rate for Payer: BCBS Complete |
$5.65
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cofinity Advantage |
$9.88
|
| Rate for Payer: Cofinity Commercial |
$12.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.30
|
| Rate for Payer: Healthscope Commercial |
$12.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.59
|
| Rate for Payer: PHP Commercial |
$12.00
|
| Rate for Payer: Priority Health SBD |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.18
|
| Rate for Payer: UHC Core |
$7.36
|
| Rate for Payer: UHC Exchange |
$5.55
|
| Rate for Payer: UMR Bronson Commercial |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.59
|
|
|
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG-0.5 MG-5 MG/ML INTRAVENOUS SOLN
|
Facility
|
OP
|
$47.26
|
|
|
Service Code
|
NDC 517720125
|
| Hospital Charge Code |
18262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Aetna American Axle |
$30.72
|
| Rate for Payer: Aetna Commercial |
$40.17
|
| Rate for Payer: Aetna Medicare |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.72
|
| Rate for Payer: BCBS Complete |
$18.90
|
| Rate for Payer: Cash Price |
$37.81
|
| Rate for Payer: Cofinity Advantage |
$33.08
|
| Rate for Payer: Cofinity Commercial |
$40.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.81
|
| Rate for Payer: Healthscope Commercial |
$42.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.45
|
| Rate for Payer: PHP Commercial |
$40.17
|
| Rate for Payer: Priority Health SBD |
$29.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.72
|
| Rate for Payer: UHC Core |
$24.62
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.45
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$104.62
|
|
|
Service Code
|
NDC 00517930525
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna American Axle |
$68.00
|
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Aetna Medicare |
$52.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.00
|
| Rate for Payer: BCBS Complete |
$41.85
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Advantage |
$73.23
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.47
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: Priority Health SBD |
$65.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.00
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: UHC Exchange |
$41.12
|
| Rate for Payer: UMR Bronson Commercial |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$104.62
|
|
|
Service Code
|
NDC 00517930525
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna American Axle |
$68.00
|
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.00
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Advantage |
$73.23
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.47
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: Priority Health SBD |
$65.91
|
| Rate for Payer: UMR Bronson Commercial |
$46.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$104.62
|
|
|
Service Code
|
NDC 00517930501
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna American Axle |
$68.00
|
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.00
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Advantage |
$73.23
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.47
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: Priority Health SBD |
$65.91
|
| Rate for Payer: UMR Bronson Commercial |
$46.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$104.62
|
|
|
Service Code
|
NDC 00517930501
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna American Axle |
$68.00
|
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Aetna Medicare |
$52.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.00
|
| Rate for Payer: BCBS Complete |
$41.85
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Advantage |
$73.23
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.47
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: Priority Health SBD |
$65.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.00
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: UHC Exchange |
$41.12
|
| Rate for Payer: UMR Bronson Commercial |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
|
IP
|
$113,474.20
|
|
|
Service Code
|
MSDRG 012
|
| Min. Negotiated Rate |
$34,057.58 |
| Max. Negotiated Rate |
$113,474.20 |
| Rate for Payer: Aetna Medicare |
$37,284.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,812.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,812.60
|
| Rate for Payer: BCBS MAPPO |
$35,850.08
|
| Rate for Payer: BCBS Trust/PPO |
$113,474.20
|
| Rate for Payer: BCN Commercial |
$113,474.20
|
| Rate for Payer: BCN Medicare Advantage |
$35,850.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,850.08
|
| Rate for Payer: Mclaren Medicare |
$35,850.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,642.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,227.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,435.09
|
| Rate for Payer: Nomi Health Commercial |
$54,386.40
|
| Rate for Payer: PACE Medicare |
$34,057.58
|
| Rate for Payer: PACE SWMI |
$35,850.08
|
| Rate for Payer: PHP Medicare Advantage |
$35,850.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67,970.94
|
| Rate for Payer: Priority Health Medicare |
$35,850.08
|
| Rate for Payer: Priority Health Tiered Network |
$54,376.75
|
| Rate for Payer: Railroad Medicare Medicare |
$35,850.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,720.80
|
| Rate for Payer: UHC Core |
$57,493.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,850.08
|
| Rate for Payer: UHC Exchange |
$46,953.59
|
| Rate for Payer: VA VA |
$35,850.08
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
|
IP
|
$113,584.00
|
|
|
Service Code
|
MSDRG 011
|
| Min. Negotiated Rate |
$43,893.72 |
| Max. Negotiated Rate |
$113,584.00 |
| Rate for Payer: Aetna Medicare |
$48,052.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57,754.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57,754.90
|
| Rate for Payer: BCBS MAPPO |
$46,203.92
|
| Rate for Payer: BCBS Trust/PPO |
$113,584.00
|
| Rate for Payer: BCN Commercial |
$113,584.00
|
| Rate for Payer: BCN Medicare Advantage |
$46,203.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,203.92
|
| Rate for Payer: Mclaren Medicare |
$46,203.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48,514.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53,134.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$50,824.31
|
| Rate for Payer: Nomi Health Commercial |
$70,357.89
|
| Rate for Payer: PACE Medicare |
$43,893.72
|
| Rate for Payer: PACE SWMI |
$46,203.92
|
| Rate for Payer: PHP Medicare Advantage |
$46,203.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87,931.76
|
| Rate for Payer: Priority Health Medicare |
$46,203.92
|
| Rate for Payer: Priority Health Tiered Network |
$70,345.40
|
| Rate for Payer: Railroad Medicare Medicare |
$46,203.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88,901.83
|
| Rate for Payer: UHC Core |
$74,377.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46,203.92
|
| Rate for Payer: UHC Exchange |
$60,742.31
|
| Rate for Payer: VA VA |
$46,203.92
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$79,511.82
|
|
|
Service Code
|
MSDRG 013
|
| Min. Negotiated Rate |
$23,457.95 |
| Max. Negotiated Rate |
$79,511.82 |
| Rate for Payer: Aetna Medicare |
$25,680.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,865.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,865.72
|
| Rate for Payer: BCBS MAPPO |
$24,692.58
|
| Rate for Payer: BCBS Trust/PPO |
$79,511.82
|
| Rate for Payer: BCN Commercial |
$79,511.82
|
| Rate for Payer: BCN Medicare Advantage |
$24,692.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,692.58
|
| Rate for Payer: Mclaren Medicare |
$24,692.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,927.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,396.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,161.84
|
| Rate for Payer: Nomi Health Commercial |
$37,175.22
|
| Rate for Payer: PACE Medicare |
$23,457.95
|
| Rate for Payer: PACE SWMI |
$24,692.58
|
| Rate for Payer: PHP Medicare Advantage |
$24,692.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46,460.78
|
| Rate for Payer: Priority Health Medicare |
$24,692.58
|
| Rate for Payer: Priority Health Tiered Network |
$37,168.62
|
| Rate for Payer: Railroad Medicare Medicare |
$24,692.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46,973.34
|
| Rate for Payer: UHC Core |
$39,299.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,692.58
|
| Rate for Payer: UHC Exchange |
$32,094.61
|
| Rate for Payer: VA VA |
$24,692.58
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$249,101.35
|
|
|
Service Code
|
MSDRG 004
|
| Min. Negotiated Rate |
$110,606.58 |
| Max. Negotiated Rate |
$249,101.35 |
| Rate for Payer: Aetna Medicare |
$121,085.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145,534.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145,534.98
|
| Rate for Payer: BCBS MAPPO |
$116,427.98
|
| Rate for Payer: BCBS Trust/PPO |
$249,101.35
|
| Rate for Payer: BCN Commercial |
$249,101.35
|
| Rate for Payer: BCN Medicare Advantage |
$116,427.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116,427.98
|
| Rate for Payer: Mclaren Medicare |
$116,427.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122,249.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133,892.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$128,070.78
|
| Rate for Payer: Nomi Health Commercial |
$178,683.06
|
| Rate for Payer: PACE Medicare |
$110,606.58
|
| Rate for Payer: PACE SWMI |
$116,427.98
|
| Rate for Payer: PHP Medicare Advantage |
$116,427.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$223,314.21
|
| Rate for Payer: Priority Health Medicare |
$116,427.98
|
| Rate for Payer: Priority Health Tiered Network |
$178,651.34
|
| Rate for Payer: Railroad Medicare Medicare |
$116,427.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225,777.82
|
| Rate for Payer: UHC Core |
$188,891.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$116,427.98
|
| Rate for Payer: UHC Exchange |
$154,263.04
|
| Rate for Payer: VA VA |
$116,427.98
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$112,599.53
|
|
|
Service Code
|
APR-DRG 0044
|
| Min. Negotiated Rate |
$107,237.65 |
| Max. Negotiated Rate |
$112,599.53 |
| Rate for Payer: BCBS Complete |
$112,599.53
|
| Rate for Payer: Mclaren Medicaid |
$107,237.65
|
| Rate for Payer: Meridian Medicaid |
$112,599.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$107,237.65
|
| Rate for Payer: UHC Medicaid |
$107,237.65
|
| Rate for Payer: UHCCP Medicaid |
$107,237.65
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$43,743.81
|
|
|
Service Code
|
APR-DRG 0042
|
| Min. Negotiated Rate |
$41,660.77 |
| Max. Negotiated Rate |
$43,743.81 |
| Rate for Payer: BCBS Complete |
$43,743.81
|
| Rate for Payer: Mclaren Medicaid |
$41,660.77
|
| Rate for Payer: Meridian Medicaid |
$43,743.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$41,660.77
|
| Rate for Payer: UHC Medicaid |
$41,660.77
|
| Rate for Payer: UHCCP Medicaid |
$41,660.77
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$69,723.75
|
|
|
Service Code
|
APR-DRG 0043
|
| Min. Negotiated Rate |
$66,403.58 |
| Max. Negotiated Rate |
$69,723.75 |
| Rate for Payer: BCBS Complete |
$69,723.75
|
| Rate for Payer: Mclaren Medicaid |
$66,403.58
|
| Rate for Payer: Meridian Medicaid |
$69,723.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$66,403.58
|
| Rate for Payer: UHC Medicaid |
$66,403.58
|
| Rate for Payer: UHCCP Medicaid |
$66,403.58
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$29,326.18
|
|
|
Service Code
|
APR-DRG 0041
|
| Min. Negotiated Rate |
$27,929.70 |
| Max. Negotiated Rate |
$29,326.18 |
| Rate for Payer: BCBS Complete |
$29,326.18
|
| Rate for Payer: Mclaren Medicaid |
$27,929.70
|
| Rate for Payer: Meridian Medicaid |
$29,326.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,929.70
|
| Rate for Payer: UHC Medicaid |
$27,929.70
|
| Rate for Payer: UHCCP Medicaid |
$27,929.70
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$13,382.53
|
|
|
Service Code
|
APR-DRG 0051
|
| Min. Negotiated Rate |
$12,745.26 |
| Max. Negotiated Rate |
$13,382.53 |
| Rate for Payer: BCBS Complete |
$13,382.53
|
| Rate for Payer: Mclaren Medicaid |
$12,745.26
|
| Rate for Payer: Meridian Medicaid |
$13,382.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,745.26
|
| Rate for Payer: UHC Medicaid |
$12,745.26
|
| Rate for Payer: UHCCP Medicaid |
$12,745.26
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$25,697.86
|
|
|
Service Code
|
APR-DRG 0052
|
| Min. Negotiated Rate |
$24,474.15 |
| Max. Negotiated Rate |
$25,697.86 |
| Rate for Payer: BCBS Complete |
$25,697.86
|
| Rate for Payer: Mclaren Medicaid |
$24,474.15
|
| Rate for Payer: Meridian Medicaid |
$25,697.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,474.15
|
| Rate for Payer: UHC Medicaid |
$24,474.15
|
| Rate for Payer: UHCCP Medicaid |
$24,474.15
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$72,267.94
|
|
|
Service Code
|
APR-DRG 0054
|
| Min. Negotiated Rate |
$68,826.61 |
| Max. Negotiated Rate |
$72,267.94 |
| Rate for Payer: BCBS Complete |
$72,267.94
|
| Rate for Payer: Mclaren Medicaid |
$68,826.61
|
| Rate for Payer: Meridian Medicaid |
$72,267.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$68,826.61
|
| Rate for Payer: UHC Medicaid |
$68,826.61
|
| Rate for Payer: UHCCP Medicaid |
$68,826.61
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$58,466.53
|
|
|
Service Code
|
APR-DRG 0053
|
| Min. Negotiated Rate |
$55,682.41 |
| Max. Negotiated Rate |
$58,466.53 |
| Rate for Payer: BCBS Complete |
$58,466.53
|
| Rate for Payer: Mclaren Medicaid |
$55,682.41
|
| Rate for Payer: Meridian Medicaid |
$58,466.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$55,682.41
|
| Rate for Payer: UHC Medicaid |
$55,682.41
|
| Rate for Payer: UHCCP Medicaid |
$55,682.41
|
|
|
TRAMADOL 25 MG TABLET
|
Facility
|
OP
|
$378.40
|
|
|
Service Code
|
NDC 72888016230
|
| Hospital Charge Code |
206318
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.01 |
| Max. Negotiated Rate |
$340.56 |
| Rate for Payer: Aetna American Axle |
$245.96
|
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: Aetna Medicare |
$189.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.96
|
| Rate for Payer: BCBS Complete |
$151.36
|
| Rate for Payer: Cash Price |
$302.72
|
| Rate for Payer: Cofinity Advantage |
$264.88
|
| Rate for Payer: Cofinity Commercial |
$325.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.72
|
| Rate for Payer: Healthscope Commercial |
$340.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.80
|
| Rate for Payer: PHP Commercial |
$321.64
|
| Rate for Payer: Priority Health SBD |
$238.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.96
|
| Rate for Payer: UHC Core |
$197.15
|
| Rate for Payer: UHC Exchange |
$148.71
|
| Rate for Payer: UMR Bronson Commercial |
$140.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.80
|
|
|
TRAMADOL 25 MG TABLET
|
Facility
|
IP
|
$378.40
|
|
|
Service Code
|
NDC 72888016230
|
| Hospital Charge Code |
206318
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$340.56 |
| Rate for Payer: Aetna American Axle |
$245.96
|
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.96
|
| Rate for Payer: Cash Price |
$302.72
|
| Rate for Payer: Cofinity Advantage |
$264.88
|
| Rate for Payer: Cofinity Commercial |
$325.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.72
|
| Rate for Payer: Healthscope Commercial |
$340.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.80
|
| Rate for Payer: PHP Commercial |
$321.64
|
| Rate for Payer: Priority Health SBD |
$238.39
|
| Rate for Payer: UMR Bronson Commercial |
$166.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.80
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 68084080801
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna American Axle |
$184.83
|
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Advantage |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.83
|
| Rate for Payer: UHC Core |
$148.15
|
| Rate for Payer: UHC Exchange |
$111.75
|
| Rate for Payer: UMR Bronson Commercial |
$105.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
NDC 65162062750
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.94 |
| Max. Negotiated Rate |
$697.95 |
| Rate for Payer: Aetna American Axle |
$504.07
|
| Rate for Payer: Aetna Commercial |
$659.17
|
| Rate for Payer: Aetna Medicare |
$387.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.07
|
| Rate for Payer: BCBS Complete |
$310.20
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cofinity Advantage |
$542.85
|
| Rate for Payer: Cofinity Commercial |
$666.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.40
|
| Rate for Payer: Healthscope Commercial |
$697.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$620.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$581.62
|
| Rate for Payer: PHP Commercial |
$659.17
|
| Rate for Payer: Priority Health SBD |
$488.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.07
|
| Rate for Payer: UHC Core |
$404.04
|
| Rate for Payer: UHC Exchange |
$304.77
|
| Rate for Payer: UMR Bronson Commercial |
$286.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.62
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 55154254104
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.59
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
