|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$507.28
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$456.55 |
| Rate for Payer: Aetna American Axle |
$329.73
|
| Rate for Payer: Aetna Commercial |
$431.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.73
|
| Rate for Payer: Cash Price |
$405.82
|
| Rate for Payer: Cofinity Advantage |
$355.10
|
| Rate for Payer: Cofinity Commercial |
$436.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.82
|
| Rate for Payer: Healthscope Commercial |
$456.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.46
|
| Rate for Payer: PHP Commercial |
$431.19
|
| Rate for Payer: Priority Health SBD |
$319.59
|
| Rate for Payer: UMR Bronson Commercial |
$223.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.46
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$507.28
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$456.55 |
| Rate for Payer: Aetna American Axle |
$329.73
|
| Rate for Payer: Aetna Commercial |
$431.19
|
| Rate for Payer: Aetna Medicare |
$253.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.73
|
| Rate for Payer: BCBS Complete |
$202.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.80
|
| Rate for Payer: BCN Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$405.82
|
| Rate for Payer: Cash Price |
$405.82
|
| Rate for Payer: Cofinity Advantage |
$355.10
|
| Rate for Payer: Cofinity Commercial |
$436.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.82
|
| Rate for Payer: Healthscope Commercial |
$456.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.46
|
| Rate for Payer: PHP Commercial |
$431.19
|
| Rate for Payer: Priority Health SBD |
$319.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.55
|
| Rate for Payer: UHC Core |
$8.55
|
| Rate for Payer: UHC Exchange |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$187.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.46
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$109.27
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
8597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.08 |
| Max. Negotiated Rate |
$98.34 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Advantage |
$76.49
|
| Rate for Payer: Cofinity Commercial |
$93.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.95
|
| Rate for Payer: PHP Commercial |
$92.88
|
| Rate for Payer: Priority Health SBD |
$68.84
|
| Rate for Payer: UMR Bronson Commercial |
$48.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.95
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$109.27
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
8597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$98.34 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.88
|
| Rate for Payer: Aetna Medicare |
$54.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: BCBS Trust/PPO |
$25.94
|
| Rate for Payer: BCN Commercial |
$25.94
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Advantage |
$76.49
|
| Rate for Payer: Cofinity Commercial |
$93.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.95
|
| Rate for Payer: PHP Commercial |
$92.88
|
| Rate for Payer: Priority Health SBD |
$68.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.45
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Exchange |
$13.45
|
| Rate for Payer: UMR Bronson Commercial |
$40.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.95
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
118463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.44 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna American Axle |
$195.65
|
| Rate for Payer: Aetna American Axle |
$132.05
|
| Rate for Payer: Aetna Commercial |
$172.69
|
| Rate for Payer: Aetna Commercial |
$255.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.65
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$162.53
|
| Rate for Payer: Cofinity Advantage |
$210.70
|
| Rate for Payer: Cofinity Advantage |
$142.21
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$258.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.80
|
| Rate for Payer: Healthscope Commercial |
$270.90
|
| Rate for Payer: Healthscope Commercial |
$182.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.75
|
| Rate for Payer: PHP Commercial |
$172.69
|
| Rate for Payer: PHP Commercial |
$255.85
|
| Rate for Payer: Priority Health SBD |
$127.99
|
| Rate for Payer: Priority Health SBD |
$189.63
|
| Rate for Payer: UMR Bronson Commercial |
$132.44
|
| Rate for Payer: UMR Bronson Commercial |
$89.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.37
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$203.16
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
118463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$182.84 |
| Rate for Payer: Aetna American Axle |
$132.05
|
| Rate for Payer: Aetna American Axle |
$195.65
|
| Rate for Payer: Aetna Commercial |
$172.69
|
| Rate for Payer: Aetna Commercial |
$255.85
|
| Rate for Payer: Aetna Medicare |
$101.58
|
| Rate for Payer: Aetna Medicare |
$150.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.65
|
| Rate for Payer: BCBS Complete |
$120.40
|
| Rate for Payer: BCBS Complete |
$81.26
|
| Rate for Payer: BCBS Trust/PPO |
$25.94
|
| Rate for Payer: BCBS Trust/PPO |
$25.94
|
| Rate for Payer: BCN Commercial |
$25.94
|
| Rate for Payer: BCN Commercial |
$25.94
|
| Rate for Payer: Cash Price |
$162.53
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$162.53
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cofinity Advantage |
$142.21
|
| Rate for Payer: Cofinity Advantage |
$210.70
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$258.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.80
|
| Rate for Payer: Healthscope Commercial |
$182.84
|
| Rate for Payer: Healthscope Commercial |
$270.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.37
|
| Rate for Payer: PHP Commercial |
$172.69
|
| Rate for Payer: PHP Commercial |
$255.85
|
| Rate for Payer: Priority Health SBD |
$127.99
|
| Rate for Payer: Priority Health SBD |
$189.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.45
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Exchange |
$13.45
|
| Rate for Payer: UHC Exchange |
$13.45
|
| Rate for Payer: UMR Bronson Commercial |
$75.17
|
| Rate for Payer: UMR Bronson Commercial |
$111.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.75
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$151.50
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$136.35 |
| Rate for Payer: Aetna American Axle |
$98.47
|
| Rate for Payer: Aetna Commercial |
$128.78
|
| Rate for Payer: Aetna Medicare |
$75.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.47
|
| Rate for Payer: BCBS Complete |
$60.60
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cofinity Advantage |
$106.05
|
| Rate for Payer: Cofinity Commercial |
$130.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.20
|
| Rate for Payer: Healthscope Commercial |
$136.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.62
|
| Rate for Payer: PHP Commercial |
$128.78
|
| Rate for Payer: Priority Health SBD |
$95.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.98
|
| Rate for Payer: UHC Core |
$8.98
|
| Rate for Payer: UHC Exchange |
$8.98
|
| Rate for Payer: UMR Bronson Commercial |
$56.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.62
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$271.73
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$244.56 |
| Rate for Payer: Aetna American Axle |
$176.62
|
| Rate for Payer: Aetna Commercial |
$230.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.62
|
| Rate for Payer: Cash Price |
$217.38
|
| Rate for Payer: Cofinity Advantage |
$190.21
|
| Rate for Payer: Cofinity Commercial |
$233.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.38
|
| Rate for Payer: Healthscope Commercial |
$244.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.80
|
| Rate for Payer: PHP Commercial |
$230.97
|
| Rate for Payer: Priority Health SBD |
$171.19
|
| Rate for Payer: UMR Bronson Commercial |
$119.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.80
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$271.73
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$244.56 |
| Rate for Payer: Aetna American Axle |
$176.62
|
| Rate for Payer: Aetna Commercial |
$230.97
|
| Rate for Payer: Aetna Medicare |
$135.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.62
|
| Rate for Payer: BCBS Complete |
$108.69
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$217.38
|
| Rate for Payer: Cash Price |
$217.38
|
| Rate for Payer: Cofinity Advantage |
$190.21
|
| Rate for Payer: Cofinity Commercial |
$233.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.38
|
| Rate for Payer: Healthscope Commercial |
$244.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.80
|
| Rate for Payer: PHP Commercial |
$230.97
|
| Rate for Payer: Priority Health SBD |
$171.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.98
|
| Rate for Payer: UHC Core |
$8.98
|
| Rate for Payer: UHC Exchange |
$8.98
|
| Rate for Payer: UMR Bronson Commercial |
$100.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.80
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$9,018.13
|
|
|
Service Code
|
APR-DRG 7234
|
| Min. Negotiated Rate |
$8,588.70 |
| Max. Negotiated Rate |
$9,018.13 |
| Rate for Payer: BCBS Complete |
$9,018.13
|
| Rate for Payer: Mclaren Medicaid |
$8,588.70
|
| Rate for Payer: Meridian Medicaid |
$9,018.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,588.70
|
| Rate for Payer: UHC Medicaid |
$8,588.70
|
| Rate for Payer: UHCCP Medicaid |
$8,588.70
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$3,586.55
|
|
|
Service Code
|
APR-DRG 7232
|
| Min. Negotiated Rate |
$3,415.76 |
| Max. Negotiated Rate |
$3,586.55 |
| Rate for Payer: BCBS Complete |
$3,586.55
|
| Rate for Payer: Mclaren Medicaid |
$3,415.76
|
| Rate for Payer: Meridian Medicaid |
$3,586.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,415.76
|
| Rate for Payer: UHC Medicaid |
$3,415.76
|
| Rate for Payer: UHCCP Medicaid |
$3,415.76
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$2,861.37
|
|
|
Service Code
|
APR-DRG 7231
|
| Min. Negotiated Rate |
$2,725.12 |
| Max. Negotiated Rate |
$2,861.37 |
| Rate for Payer: BCBS Complete |
$2,861.37
|
| Rate for Payer: Mclaren Medicaid |
$2,725.12
|
| Rate for Payer: Meridian Medicaid |
$2,861.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,725.12
|
| Rate for Payer: UHC Medicaid |
$2,725.12
|
| Rate for Payer: UHCCP Medicaid |
$2,725.12
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$6,331.70
|
|
|
Service Code
|
APR-DRG 7233
|
| Min. Negotiated Rate |
$6,030.19 |
| Max. Negotiated Rate |
$6,331.70 |
| Rate for Payer: BCBS Complete |
$6,331.70
|
| Rate for Payer: Mclaren Medicaid |
$6,030.19
|
| Rate for Payer: Meridian Medicaid |
$6,331.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,030.19
|
| Rate for Payer: UHC Medicaid |
$6,030.19
|
| Rate for Payer: UHCCP Medicaid |
$6,030.19
|
|
|
VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$27,909.43
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$12,466.64 |
| Max. Negotiated Rate |
$27,909.43 |
| Rate for Payer: Aetna Medicare |
$13,647.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,403.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,403.47
|
| Rate for Payer: BCBS MAPPO |
$13,122.78
|
| Rate for Payer: BCBS Trust/PPO |
$27,909.43
|
| Rate for Payer: BCN Commercial |
$27,909.43
|
| Rate for Payer: BCN Medicare Advantage |
$13,122.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,122.78
|
| Rate for Payer: Mclaren Medicare |
$13,122.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,778.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,091.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,435.06
|
| Rate for Payer: Nomi Health Commercial |
$19,328.07
|
| Rate for Payer: PACE Medicare |
$12,466.64
|
| Rate for Payer: PACE SWMI |
$13,122.78
|
| Rate for Payer: PHP Medicare Advantage |
$13,122.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,155.80
|
| Rate for Payer: Priority Health Medicare |
$13,122.78
|
| Rate for Payer: Priority Health Tiered Network |
$19,324.64
|
| Rate for Payer: Railroad Medicare Medicare |
$13,122.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,422.29
|
| Rate for Payer: UHC Core |
$20,432.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,122.78
|
| Rate for Payer: UHC Exchange |
$16,686.57
|
| Rate for Payer: VA VA |
$13,122.78
|
|
|
VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$14,174.48
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$7,471.91 |
| Max. Negotiated Rate |
$14,174.48 |
| Rate for Payer: Aetna Medicare |
$8,179.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,831.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,831.46
|
| Rate for Payer: BCBS MAPPO |
$7,865.17
|
| Rate for Payer: BCBS Trust/PPO |
$12,575.30
|
| Rate for Payer: BCN Commercial |
$12,575.30
|
| Rate for Payer: BCN Medicare Advantage |
$7,865.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,865.17
|
| Rate for Payer: Mclaren Medicare |
$7,865.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,258.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,044.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,651.69
|
| Rate for Payer: Nomi Health Commercial |
$11,217.84
|
| Rate for Payer: PACE Medicare |
$7,471.91
|
| Rate for Payer: PACE SWMI |
$7,865.17
|
| Rate for Payer: PHP Medicare Advantage |
$7,865.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,019.81
|
| Rate for Payer: Priority Health Medicare |
$7,865.17
|
| Rate for Payer: Priority Health Tiered Network |
$11,215.85
|
| Rate for Payer: Railroad Medicare Medicare |
$7,865.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,174.48
|
| Rate for Payer: UHC Core |
$11,858.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,865.17
|
| Rate for Payer: UHC Exchange |
$9,684.74
|
| Rate for Payer: VA VA |
$7,865.17
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$4,582.31
|
|
|
Service Code
|
APR-DRG 0512
|
| Min. Negotiated Rate |
$4,364.10 |
| Max. Negotiated Rate |
$4,582.31 |
| Rate for Payer: BCBS Complete |
$4,582.31
|
| Rate for Payer: Mclaren Medicaid |
$4,364.10
|
| Rate for Payer: Meridian Medicaid |
$4,582.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,364.10
|
| Rate for Payer: UHC Medicaid |
$4,364.10
|
| Rate for Payer: UHCCP Medicaid |
$4,364.10
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$3,411.01
|
|
|
Service Code
|
APR-DRG 0511
|
| Min. Negotiated Rate |
$3,248.58 |
| Max. Negotiated Rate |
$3,411.01 |
| Rate for Payer: BCBS Complete |
$3,411.01
|
| Rate for Payer: Mclaren Medicaid |
$3,248.58
|
| Rate for Payer: Meridian Medicaid |
$3,411.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,248.58
|
| Rate for Payer: UHC Medicaid |
$3,248.58
|
| Rate for Payer: UHCCP Medicaid |
$3,248.58
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$11,979.99
|
|
|
Service Code
|
APR-DRG 0514
|
| Min. Negotiated Rate |
$11,409.51 |
| Max. Negotiated Rate |
$11,979.99 |
| Rate for Payer: BCBS Complete |
$11,979.99
|
| Rate for Payer: Mclaren Medicaid |
$11,409.51
|
| Rate for Payer: Meridian Medicaid |
$11,979.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,409.51
|
| Rate for Payer: UHC Medicaid |
$11,409.51
|
| Rate for Payer: UHCCP Medicaid |
$11,409.51
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$7,564.14
|
|
|
Service Code
|
APR-DRG 0513
|
| Min. Negotiated Rate |
$7,203.94 |
| Max. Negotiated Rate |
$7,564.14 |
| Rate for Payer: BCBS Complete |
$7,564.14
|
| Rate for Payer: Mclaren Medicaid |
$7,203.94
|
| Rate for Payer: Meridian Medicaid |
$7,564.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,203.94
|
| Rate for Payer: UHC Medicaid |
$7,203.94
|
| Rate for Payer: UHCCP Medicaid |
$7,203.94
|
|
|
VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$31,255.25
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$15,797.02 |
| Max. Negotiated Rate |
$31,255.25 |
| Rate for Payer: Aetna Medicare |
$17,293.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,785.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,785.55
|
| Rate for Payer: BCBS MAPPO |
$16,628.44
|
| Rate for Payer: BCBS Trust/PPO |
$21,057.66
|
| Rate for Payer: BCN Commercial |
$21,057.66
|
| Rate for Payer: BCN Medicare Advantage |
$16,628.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,628.44
|
| Rate for Payer: Mclaren Medicare |
$16,628.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,459.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,122.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,291.28
|
| Rate for Payer: Nomi Health Commercial |
$24,735.75
|
| Rate for Payer: PACE Medicare |
$15,797.02
|
| Rate for Payer: PACE SWMI |
$16,628.44
|
| Rate for Payer: PHP Medicare Advantage |
$16,628.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,914.20
|
| Rate for Payer: Priority Health Medicare |
$16,628.44
|
| Rate for Payer: Priority Health Tiered Network |
$24,731.36
|
| Rate for Payer: Railroad Medicare Medicare |
$16,628.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,255.25
|
| Rate for Payer: UHC Core |
$26,148.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,628.44
|
| Rate for Payer: UHC Exchange |
$21,355.20
|
| Rate for Payer: VA VA |
$16,628.44
|
|
|
VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$13,303.99
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$7,119.18 |
| Max. Negotiated Rate |
$13,303.99 |
| Rate for Payer: Aetna Medicare |
$7,793.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,367.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,367.34
|
| Rate for Payer: BCBS MAPPO |
$7,493.87
|
| Rate for Payer: BCBS Trust/PPO |
$12,182.75
|
| Rate for Payer: BCN Commercial |
$12,182.75
|
| Rate for Payer: BCN Medicare Advantage |
$7,493.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,493.87
|
| Rate for Payer: Mclaren Medicare |
$7,493.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,868.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,617.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,243.26
|
| Rate for Payer: Nomi Health Commercial |
$9,659.52
|
| Rate for Payer: PACE Medicare |
$7,119.18
|
| Rate for Payer: PACE SWMI |
$7,493.87
|
| Rate for Payer: PHP Medicare Advantage |
$7,493.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,303.99
|
| Rate for Payer: Priority Health Medicare |
$7,493.87
|
| Rate for Payer: Priority Health Tiered Network |
$10,643.19
|
| Rate for Payer: Railroad Medicare Medicare |
$7,493.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,205.44
|
| Rate for Payer: UHC Core |
$10,211.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,493.87
|
| Rate for Payer: UHC Exchange |
$8,339.39
|
| Rate for Payer: VA VA |
$7,493.87
|
|
|
VIT A 5,000 UNIT-VIT C 60 MG-VIT E 30 UNIT-ZINC-SELENATE-COPPER TABLET
|
Facility
|
OP
|
$90.24
|
|
|
Service Code
|
NDC 00904773518
|
| Hospital Charge Code |
173055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.39 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna American Axle |
$58.66
|
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: Aetna Medicare |
$45.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.66
|
| Rate for Payer: BCBS Complete |
$36.10
|
| Rate for Payer: Cash Price |
$72.19
|
| Rate for Payer: Cofinity Advantage |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.68
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: Priority Health SBD |
$56.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.66
|
| Rate for Payer: UHC Core |
$47.02
|
| Rate for Payer: UHC Exchange |
$35.46
|
| Rate for Payer: UMR Bronson Commercial |
$33.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.68
|
|
|
VIT A 5,000 UNIT-VIT C 60 MG-VIT E 30 UNIT-ZINC-SELENATE-COPPER TABLET
|
Facility
|
IP
|
$90.24
|
|
|
Service Code
|
NDC 00904773518
|
| Hospital Charge Code |
173055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.71 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna American Axle |
$58.66
|
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.66
|
| Rate for Payer: Cash Price |
$72.19
|
| Rate for Payer: Cofinity Advantage |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.68
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: Priority Health SBD |
$56.85
|
| Rate for Payer: UMR Bronson Commercial |
$39.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.68
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
NDC 61924020504
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna American Axle |
$10.24
|
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.24
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Advantage |
$11.03
|
| Rate for Payer: Cofinity Commercial |
$13.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$14.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.81
|
| Rate for Payer: PHP Commercial |
$13.39
|
| Rate for Payer: Priority Health SBD |
$9.92
|
| Rate for Payer: UMR Bronson Commercial |
$6.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.81
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
NDC 61924020504
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna American Axle |
$10.24
|
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.24
|
| Rate for Payer: BCBS Complete |
$6.30
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Advantage |
$11.03
|
| Rate for Payer: Cofinity Commercial |
$13.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$14.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.81
|
| Rate for Payer: PHP Commercial |
$13.39
|
| Rate for Payer: Priority Health SBD |
$9.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.24
|
| Rate for Payer: UHC Core |
$8.21
|
| Rate for Payer: UHC Exchange |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.81
|
|
