|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$344.75
|
|
|
Service Code
|
NDC 31604002621
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.69 |
| Max. Negotiated Rate |
$310.27 |
| Rate for Payer: Aetna American Axle |
$224.09
|
| Rate for Payer: Aetna Commercial |
$293.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.09
|
| Rate for Payer: Cash Price |
$275.80
|
| Rate for Payer: Cofinity Advantage |
$241.32
|
| Rate for Payer: Cofinity Commercial |
$296.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.80
|
| Rate for Payer: Healthscope Commercial |
$310.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.56
|
| Rate for Payer: PHP Commercial |
$293.04
|
| Rate for Payer: Priority Health SBD |
$217.19
|
| Rate for Payer: UMR Bronson Commercial |
$151.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.56
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 00761009840
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 80681016900
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna American Axle |
$25.97
|
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna Medicare |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Advantage |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.97
|
| Rate for Payer: UHC Core |
$20.81
|
| Rate for Payer: UHC Exchange |
$15.70
|
| Rate for Payer: UMR Bronson Commercial |
$14.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.57
|
| Rate for Payer: UHC Core |
$47.75
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UMR Bronson Commercial |
$33.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 00761009840
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.21
|
| Rate for Payer: UHC Core |
$53.87
|
| Rate for Payer: UHC Exchange |
$40.64
|
| Rate for Payer: UMR Bronson Commercial |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 80681016900
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna American Axle |
$25.97
|
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Advantage |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: UMR Bronson Commercial |
$17.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$7,708.21
|
|
|
Service Code
|
APR-DRG 2631
|
| Min. Negotiated Rate |
$7,341.15 |
| Max. Negotiated Rate |
$7,708.21 |
| Rate for Payer: BCBS Complete |
$7,708.21
|
| Rate for Payer: Mclaren Medicaid |
$7,341.15
|
| Rate for Payer: Meridian Medicaid |
$7,708.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,341.15
|
| Rate for Payer: UHC Medicaid |
$7,341.15
|
| Rate for Payer: UHCCP Medicaid |
$7,341.15
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$9,897.67
|
|
|
Service Code
|
APR-DRG 2632
|
| Min. Negotiated Rate |
$9,426.35 |
| Max. Negotiated Rate |
$9,897.67 |
| Rate for Payer: BCBS Complete |
$9,897.67
|
| Rate for Payer: Mclaren Medicaid |
$9,426.35
|
| Rate for Payer: Meridian Medicaid |
$9,897.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,426.35
|
| Rate for Payer: UHC Medicaid |
$9,426.35
|
| Rate for Payer: UHCCP Medicaid |
$9,426.35
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$13,403.71
|
|
|
Service Code
|
APR-DRG 2633
|
| Min. Negotiated Rate |
$12,765.44 |
| Max. Negotiated Rate |
$13,403.71 |
| Rate for Payer: BCBS Complete |
$13,403.71
|
| Rate for Payer: Mclaren Medicaid |
$12,765.44
|
| Rate for Payer: Meridian Medicaid |
$13,403.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,765.44
|
| Rate for Payer: UHC Medicaid |
$12,765.44
|
| Rate for Payer: UHCCP Medicaid |
$12,765.44
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$22,143.39
|
|
|
Service Code
|
APR-DRG 2634
|
| Min. Negotiated Rate |
$21,088.95 |
| Max. Negotiated Rate |
$22,143.39 |
| Rate for Payer: BCBS Complete |
$22,143.39
|
| Rate for Payer: Mclaren Medicaid |
$21,088.95
|
| Rate for Payer: Meridian Medicaid |
$22,143.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,088.95
|
| Rate for Payer: UHC Medicaid |
$21,088.95
|
| Rate for Payer: UHCCP Medicaid |
$21,088.95
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$42,700.03
|
|
|
Service Code
|
MSDRG 415
|
| Min. Negotiated Rate |
$16,982.34 |
| Max. Negotiated Rate |
$42,700.03 |
| Rate for Payer: Aetna Medicare |
$18,591.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,345.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,345.19
|
| Rate for Payer: BCBS MAPPO |
$17,876.15
|
| Rate for Payer: BCBS Trust/PPO |
$42,700.03
|
| Rate for Payer: BCN Commercial |
$42,700.03
|
| Rate for Payer: BCN Medicare Advantage |
$17,876.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,876.15
|
| Rate for Payer: Mclaren Medicare |
$17,876.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,769.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,557.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,663.76
|
| Rate for Payer: Nomi Health Commercial |
$26,660.43
|
| Rate for Payer: PACE Medicare |
$16,982.34
|
| Rate for Payer: PACE SWMI |
$17,876.15
|
| Rate for Payer: PHP Medicare Advantage |
$17,876.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,319.63
|
| Rate for Payer: Priority Health Medicare |
$17,876.15
|
| Rate for Payer: Priority Health Tiered Network |
$26,655.70
|
| Rate for Payer: Railroad Medicare Medicare |
$17,876.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,687.21
|
| Rate for Payer: UHC Core |
$28,183.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,876.15
|
| Rate for Payer: UHC Exchange |
$23,016.84
|
| Rate for Payer: VA VA |
$17,876.15
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$74,120.45
|
|
|
Service Code
|
MSDRG 414
|
| Min. Negotiated Rate |
$28,866.60 |
| Max. Negotiated Rate |
$74,120.45 |
| Rate for Payer: Aetna Medicare |
$31,601.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,982.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,982.38
|
| Rate for Payer: BCBS MAPPO |
$30,385.90
|
| Rate for Payer: BCBS Trust/PPO |
$74,120.45
|
| Rate for Payer: BCN Commercial |
$74,120.45
|
| Rate for Payer: BCN Medicare Advantage |
$30,385.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,385.90
|
| Rate for Payer: Mclaren Medicare |
$30,385.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,905.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,943.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,424.49
|
| Rate for Payer: Nomi Health Commercial |
$45,957.54
|
| Rate for Payer: PACE Medicare |
$28,866.60
|
| Rate for Payer: PACE SWMI |
$30,385.90
|
| Rate for Payer: PHP Medicare Advantage |
$30,385.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57,436.74
|
| Rate for Payer: Priority Health Medicare |
$30,385.90
|
| Rate for Payer: Priority Health Tiered Network |
$45,949.38
|
| Rate for Payer: Railroad Medicare Medicare |
$30,385.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58,070.38
|
| Rate for Payer: UHC Core |
$48,583.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,385.90
|
| Rate for Payer: UHC Exchange |
$39,676.68
|
| Rate for Payer: VA VA |
$30,385.90
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$33,092.18
|
|
|
Service Code
|
MSDRG 416
|
| Min. Negotiated Rate |
$11,394.13 |
| Max. Negotiated Rate |
$33,092.18 |
| Rate for Payer: Aetna Medicare |
$12,473.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,992.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,992.27
|
| Rate for Payer: BCBS MAPPO |
$11,993.82
|
| Rate for Payer: BCBS Trust/PPO |
$33,092.18
|
| Rate for Payer: BCN Commercial |
$33,092.18
|
| Rate for Payer: BCN Medicare Advantage |
$11,993.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,993.82
|
| Rate for Payer: Mclaren Medicare |
$11,993.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,593.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,792.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,193.20
|
| Rate for Payer: Nomi Health Commercial |
$17,586.57
|
| Rate for Payer: PACE Medicare |
$11,394.13
|
| Rate for Payer: PACE SWMI |
$11,993.82
|
| Rate for Payer: PHP Medicare Advantage |
$11,993.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,979.31
|
| Rate for Payer: Priority Health Medicare |
$11,993.82
|
| Rate for Payer: Priority Health Tiered Network |
$17,583.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11,993.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,221.79
|
| Rate for Payer: UHC Core |
$18,591.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,993.82
|
| Rate for Payer: UHC Exchange |
$15,183.07
|
| Rate for Payer: VA VA |
$11,993.82
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$36,767.87
|
|
|
Service Code
|
MSDRG 412
|
| Min. Negotiated Rate |
$17,266.74 |
| Max. Negotiated Rate |
$36,767.87 |
| Rate for Payer: Aetna Medicare |
$18,902.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,719.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,719.40
|
| Rate for Payer: BCBS MAPPO |
$18,175.52
|
| Rate for Payer: BCBS Trust/PPO |
$36,767.87
|
| Rate for Payer: BCN Commercial |
$36,767.87
|
| Rate for Payer: BCN Medicare Advantage |
$18,175.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,175.52
|
| Rate for Payer: Mclaren Medicare |
$18,175.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,084.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,901.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,993.07
|
| Rate for Payer: Nomi Health Commercial |
$27,122.25
|
| Rate for Payer: PACE Medicare |
$17,266.74
|
| Rate for Payer: PACE SWMI |
$18,175.52
|
| Rate for Payer: PHP Medicare Advantage |
$18,175.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,896.80
|
| Rate for Payer: Priority Health Medicare |
$18,175.52
|
| Rate for Payer: Priority Health Tiered Network |
$27,117.44
|
| Rate for Payer: Railroad Medicare Medicare |
$18,175.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,270.75
|
| Rate for Payer: UHC Core |
$28,671.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,175.52
|
| Rate for Payer: UHC Exchange |
$23,415.54
|
| Rate for Payer: VA VA |
$18,175.52
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH MCC
|
Facility
|
IP
|
$55,190.24
|
|
|
Service Code
|
MSDRG 411
|
| Min. Negotiated Rate |
$26,806.58 |
| Max. Negotiated Rate |
$55,190.24 |
| Rate for Payer: Aetna Medicare |
$29,346.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,271.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,271.81
|
| Rate for Payer: BCBS MAPPO |
$28,217.45
|
| Rate for Payer: BCBS Trust/PPO |
$55,190.24
|
| Rate for Payer: BCN Commercial |
$55,190.24
|
| Rate for Payer: BCN Medicare Advantage |
$28,217.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,217.45
|
| Rate for Payer: Mclaren Medicare |
$28,217.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,628.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,450.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,039.19
|
| Rate for Payer: Nomi Health Commercial |
$42,612.57
|
| Rate for Payer: PACE Medicare |
$26,806.58
|
| Rate for Payer: PACE SWMI |
$28,217.45
|
| Rate for Payer: PHP Medicare Advantage |
$28,217.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53,256.27
|
| Rate for Payer: Priority Health Medicare |
$28,217.45
|
| Rate for Payer: Priority Health Tiered Network |
$42,605.01
|
| Rate for Payer: Railroad Medicare Medicare |
$28,217.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,843.79
|
| Rate for Payer: UHC Core |
$45,047.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,217.45
|
| Rate for Payer: UHC Exchange |
$36,788.85
|
| Rate for Payer: VA VA |
$28,217.45
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$33,287.08
|
|
|
Service Code
|
MSDRG 413
|
| Min. Negotiated Rate |
$13,755.27 |
| Max. Negotiated Rate |
$33,287.08 |
| Rate for Payer: Aetna Medicare |
$15,058.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,099.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,099.04
|
| Rate for Payer: BCBS MAPPO |
$14,479.23
|
| Rate for Payer: BCBS Trust/PPO |
$33,287.08
|
| Rate for Payer: BCN Commercial |
$33,287.08
|
| Rate for Payer: BCN Medicare Advantage |
$14,479.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,479.23
|
| Rate for Payer: Mclaren Medicare |
$14,479.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,203.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,651.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,927.15
|
| Rate for Payer: Nomi Health Commercial |
$21,420.45
|
| Rate for Payer: PACE Medicare |
$13,755.27
|
| Rate for Payer: PACE SWMI |
$14,479.23
|
| Rate for Payer: PHP Medicare Advantage |
$14,479.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,770.81
|
| Rate for Payer: Priority Health Medicare |
$14,479.23
|
| Rate for Payer: Priority Health Tiered Network |
$21,416.65
|
| Rate for Payer: Railroad Medicare Medicare |
$14,479.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,066.15
|
| Rate for Payer: UHC Core |
$22,644.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,479.23
|
| Rate for Payer: UHC Exchange |
$18,492.99
|
| Rate for Payer: VA VA |
$14,479.23
|
|
|
CHOLECYSTOSTOMY, PERCUTANEOUS, COMPLETE PROCEDURE, INCLUDING IMAGING GUIDANCE, CATHETER PLACEMENT, CHOLECYSTOGRAM WHEN PERFORMED, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$11,537.07
|
|
|
Service Code
|
CPT 47490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,865.82 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,230.13
|
| Rate for Payer: BCN Commercial |
$3,230.13
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Mclaren Medicaid |
$3,567.53
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
CHOLESTYRAMINE 4 GRAM ORAL POWDER FOR SUSPENSION IN A PACKET
|
Facility
|
OP
|
$9.16
|
|
|
Service Code
|
NDC 00245003689
|
| Hospital Charge Code |
210852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna American Axle |
$5.95
|
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: BCBS Complete |
$3.66
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Advantage |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.87
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health SBD |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.95
|
| Rate for Payer: UHC Core |
$4.77
|
| Rate for Payer: UHC Exchange |
$3.60
|
| Rate for Payer: UMR Bronson Commercial |
$3.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
CHOLESTYRAMINE 4 GRAM ORAL POWDER FOR SUSPENSION IN A PACKET
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 49884046665
|
| Hospital Charge Code |
210852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna American Axle |
$5.95
|
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Advantage |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.87
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health SBD |
$5.77
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
CHOLESTYRAMINE 4 GRAM ORAL POWDER FOR SUSPENSION IN A PACKET
|
Facility
|
OP
|
$9.16
|
|
|
Service Code
|
NDC 49884046665
|
| Hospital Charge Code |
210852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna American Axle |
$5.95
|
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: BCBS Complete |
$3.66
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Advantage |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.87
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health SBD |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.95
|
| Rate for Payer: UHC Core |
$4.77
|
| Rate for Payer: UHC Exchange |
$3.60
|
| Rate for Payer: UMR Bronson Commercial |
$3.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
CHOLESTYRAMINE 4 GRAM ORAL POWDER FOR SUSPENSION IN A PACKET
|
Facility
|
IP
|
$423.36
|
|
|
Service Code
|
NDC 00245003660
|
| Hospital Charge Code |
210852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$381.02 |
| Rate for Payer: Aetna American Axle |
$275.18
|
| Rate for Payer: Aetna Commercial |
$359.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.18
|
| Rate for Payer: Cash Price |
$338.69
|
| Rate for Payer: Cofinity Advantage |
$296.35
|
| Rate for Payer: Cofinity Commercial |
$364.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.69
|
| Rate for Payer: Healthscope Commercial |
$381.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.52
|
| Rate for Payer: PHP Commercial |
$359.86
|
| Rate for Payer: Priority Health SBD |
$266.72
|
| Rate for Payer: UMR Bronson Commercial |
$186.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.52
|
|
|
CHOLESTYRAMINE 4 GRAM ORAL POWDER FOR SUSPENSION IN A PACKET
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 00245003689
|
| Hospital Charge Code |
210852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna American Axle |
$5.95
|
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Advantage |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.87
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health SBD |
$5.77
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
CHOLESTYRAMINE 4 GRAM ORAL POWDER FOR SUSPENSION IN A PACKET
|
Facility
|
OP
|
$423.36
|
|
|
Service Code
|
NDC 00245003660
|
| Hospital Charge Code |
210852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.64 |
| Max. Negotiated Rate |
$381.02 |
| Rate for Payer: Aetna American Axle |
$275.18
|
| Rate for Payer: Aetna Commercial |
$359.86
|
| Rate for Payer: Aetna Medicare |
$211.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.18
|
| Rate for Payer: BCBS Complete |
$169.34
|
| Rate for Payer: Cash Price |
$338.69
|
| Rate for Payer: Cofinity Advantage |
$296.35
|
| Rate for Payer: Cofinity Commercial |
$364.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.69
|
| Rate for Payer: Healthscope Commercial |
$381.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.52
|
| Rate for Payer: PHP Commercial |
$359.86
|
| Rate for Payer: Priority Health SBD |
$266.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.18
|
| Rate for Payer: UHC Core |
$220.57
|
| Rate for Payer: UHC Exchange |
$166.38
|
| Rate for Payer: UMR Bronson Commercial |
$156.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.52
|
|
|
CHOLESTYRAMINE 4 GRAM ORAL POWDER FOR SUSPENSION IN A PACKET
|
Facility
|
OP
|
$178.27
|
|
|
Service Code
|
NDC 68382052960
|
| Hospital Charge Code |
210852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.96 |
| Max. Negotiated Rate |
$160.44 |
| Rate for Payer: Aetna American Axle |
$115.88
|
| Rate for Payer: Aetna Commercial |
$151.53
|
| Rate for Payer: Aetna Medicare |
$89.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.88
|
| Rate for Payer: BCBS Complete |
$71.31
|
| Rate for Payer: Cash Price |
$142.62
|
| Rate for Payer: Cofinity Advantage |
$124.79
|
| Rate for Payer: Cofinity Commercial |
$153.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.62
|
| Rate for Payer: Healthscope Commercial |
$160.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.70
|
| Rate for Payer: PHP Commercial |
$151.53
|
| Rate for Payer: Priority Health SBD |
$112.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.88
|
| Rate for Payer: UHC Core |
$92.88
|
| Rate for Payer: UHC Exchange |
$70.06
|
| Rate for Payer: UMR Bronson Commercial |
$65.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.70
|
|
