|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT
|
Facility
|
IP
|
$28.11
|
|
|
Service Code
|
NDC 00023024004
|
| Hospital Charge Code |
119426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.37 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Aetna American Axle |
$18.27
|
| Rate for Payer: Aetna Commercial |
$23.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.27
|
| Rate for Payer: Cash Price |
$22.49
|
| Rate for Payer: Cofinity Advantage |
$19.68
|
| Rate for Payer: Cofinity Commercial |
$24.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.49
|
| Rate for Payer: Healthscope Commercial |
$25.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.08
|
| Rate for Payer: PHP Commercial |
$23.89
|
| Rate for Payer: Priority Health SBD |
$17.71
|
| Rate for Payer: UMR Bronson Commercial |
$12.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.08
|
|
|
WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT
|
Facility
|
OP
|
$22.10
|
|
|
Service Code
|
NDC 00904648838
|
| Hospital Charge Code |
117765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$19.89 |
| Rate for Payer: Aetna American Axle |
$14.37
|
| Rate for Payer: Aetna Commercial |
$18.79
|
| Rate for Payer: Aetna Medicare |
$11.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.37
|
| Rate for Payer: BCBS Complete |
$8.84
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Cofinity Advantage |
$15.47
|
| Rate for Payer: Cofinity Commercial |
$19.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$19.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.57
|
| Rate for Payer: PHP Commercial |
$18.79
|
| Rate for Payer: Priority Health SBD |
$13.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.37
|
| Rate for Payer: UHC Core |
$11.51
|
| Rate for Payer: UHC Exchange |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$8.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.57
|
|
|
WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT
|
Facility
|
IP
|
$22.10
|
|
|
Service Code
|
NDC 00904648838
|
| Hospital Charge Code |
117765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$19.89 |
| Rate for Payer: Aetna American Axle |
$14.37
|
| Rate for Payer: Aetna Commercial |
$18.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.37
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Cofinity Advantage |
$15.47
|
| Rate for Payer: Cofinity Commercial |
$19.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$19.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.57
|
| Rate for Payer: PHP Commercial |
$18.79
|
| Rate for Payer: Priority Health SBD |
$13.92
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.57
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
NDC 61924017804
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna American Axle |
$8.37
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Advantage |
$9.02
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.66
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: Priority Health SBD |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.37
|
| Rate for Payer: UHC Core |
$6.71
|
| Rate for Payer: UHC Exchange |
$5.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
NDC 49022013112
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna American Axle |
$11.95
|
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.95
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Advantage |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.79
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health SBD |
$11.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.79
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
OP
|
$18.39
|
|
|
Service Code
|
NDC 49022013112
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna American Axle |
$11.95
|
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: Aetna Medicare |
$9.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.95
|
| Rate for Payer: BCBS Complete |
$7.36
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Advantage |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.79
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health SBD |
$11.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.95
|
| Rate for Payer: UHC Core |
$9.58
|
| Rate for Payer: UHC Exchange |
$7.23
|
| Rate for Payer: UMR Bronson Commercial |
$6.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.79
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
IP
|
$12.88
|
|
|
Service Code
|
NDC 61924017804
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna American Axle |
$8.37
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Advantage |
$9.02
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.66
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: Priority Health SBD |
$8.11
|
| Rate for Payer: UMR Bronson Commercial |
$5.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
WHITE PETROLATUM TOPICAL JELLY
|
Facility
|
IP
|
$13.25
|
|
|
Service Code
|
NDC 00904573182
|
| Hospital Charge Code |
28809
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$11.93 |
| Rate for Payer: Aetna American Axle |
$8.61
|
| Rate for Payer: Aetna Commercial |
$11.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.61
|
| Rate for Payer: Cash Price |
$10.60
|
| Rate for Payer: Cofinity Advantage |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$11.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.60
|
| Rate for Payer: Healthscope Commercial |
$11.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.94
|
| Rate for Payer: PHP Commercial |
$11.26
|
| Rate for Payer: Priority Health SBD |
$8.35
|
| Rate for Payer: UMR Bronson Commercial |
$5.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.94
|
|
|
WHITE PETROLATUM TOPICAL JELLY
|
Facility
|
OP
|
$13.25
|
|
|
Service Code
|
NDC 00904573182
|
| Hospital Charge Code |
28809
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.93 |
| Rate for Payer: Aetna American Axle |
$8.61
|
| Rate for Payer: Aetna Commercial |
$11.26
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.61
|
| Rate for Payer: BCBS Complete |
$5.30
|
| Rate for Payer: Cash Price |
$10.60
|
| Rate for Payer: Cofinity Advantage |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$11.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.60
|
| Rate for Payer: Healthscope Commercial |
$11.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.94
|
| Rate for Payer: PHP Commercial |
$11.26
|
| Rate for Payer: Priority Health SBD |
$8.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.61
|
| Rate for Payer: UHC Core |
$6.90
|
| Rate for Payer: UHC Exchange |
$5.21
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.94
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$65,182.40
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$25,308.23 |
| Max. Negotiated Rate |
$65,182.40 |
| Rate for Payer: Aetna Medicare |
$27,705.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,300.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,300.30
|
| Rate for Payer: BCBS MAPPO |
$26,640.24
|
| Rate for Payer: BCBS Trust/PPO |
$65,182.40
|
| Rate for Payer: BCN Commercial |
$65,182.40
|
| Rate for Payer: BCN Medicare Advantage |
$26,640.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,640.24
|
| Rate for Payer: Mclaren Medicare |
$26,640.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27,972.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,636.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,304.26
|
| Rate for Payer: Nomi Health Commercial |
$40,179.63
|
| Rate for Payer: PACE Medicare |
$25,308.23
|
| Rate for Payer: PACE SWMI |
$26,640.24
|
| Rate for Payer: PHP Medicare Advantage |
$26,640.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50,215.63
|
| Rate for Payer: Priority Health Medicare |
$26,640.24
|
| Rate for Payer: Priority Health Tiered Network |
$40,172.50
|
| Rate for Payer: Railroad Medicare Medicare |
$26,640.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50,769.61
|
| Rate for Payer: UHC Core |
$42,475.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26,640.24
|
| Rate for Payer: UHC Exchange |
$34,688.41
|
| Rate for Payer: VA VA |
$26,640.24
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$119,362.44
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$45,843.34 |
| Max. Negotiated Rate |
$119,362.44 |
| Rate for Payer: Aetna Medicare |
$50,186.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60,320.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60,320.19
|
| Rate for Payer: BCBS MAPPO |
$48,256.15
|
| Rate for Payer: BCBS Trust/PPO |
$119,362.44
|
| Rate for Payer: BCN Commercial |
$119,362.44
|
| Rate for Payer: BCN Medicare Advantage |
$48,256.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48,256.15
|
| Rate for Payer: Mclaren Medicare |
$48,256.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50,668.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55,494.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$53,081.76
|
| Rate for Payer: Nomi Health Commercial |
$73,523.55
|
| Rate for Payer: PACE Medicare |
$45,843.34
|
| Rate for Payer: PACE SWMI |
$48,256.15
|
| Rate for Payer: PHP Medicare Advantage |
$48,256.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$91,888.14
|
| Rate for Payer: Priority Health Medicare |
$48,256.15
|
| Rate for Payer: Priority Health Tiered Network |
$73,510.50
|
| Rate for Payer: Railroad Medicare Medicare |
$48,256.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92,901.85
|
| Rate for Payer: UHC Core |
$77,724.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48,256.15
|
| Rate for Payer: UHC Exchange |
$63,475.33
|
| Rate for Payer: VA VA |
$48,256.15
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$37,204.34
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$15,051.82 |
| Max. Negotiated Rate |
$37,204.34 |
| Rate for Payer: Aetna Medicare |
$16,477.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,805.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,805.03
|
| Rate for Payer: BCBS MAPPO |
$15,844.02
|
| Rate for Payer: BCBS Trust/PPO |
$37,204.34
|
| Rate for Payer: BCN Commercial |
$37,204.34
|
| Rate for Payer: BCN Medicare Advantage |
$15,844.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,844.02
|
| Rate for Payer: Mclaren Medicare |
$15,844.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,636.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,220.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,428.42
|
| Rate for Payer: Nomi Health Commercial |
$23,525.73
|
| Rate for Payer: PACE Medicare |
$15,051.82
|
| Rate for Payer: PACE SWMI |
$15,844.02
|
| Rate for Payer: PHP Medicare Advantage |
$15,844.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,401.95
|
| Rate for Payer: Priority Health Medicare |
$15,844.02
|
| Rate for Payer: Priority Health Tiered Network |
$23,521.55
|
| Rate for Payer: Railroad Medicare Medicare |
$15,844.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,726.31
|
| Rate for Payer: UHC Core |
$24,869.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,844.02
|
| Rate for Payer: UHC Exchange |
$20,310.55
|
| Rate for Payer: VA VA |
$15,844.02
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$50,474.15
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$15,773.17 |
| Max. Negotiated Rate |
$50,474.15 |
| Rate for Payer: Aetna Medicare |
$17,267.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,754.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,754.17
|
| Rate for Payer: BCBS MAPPO |
$16,603.34
|
| Rate for Payer: BCBS Trust/PPO |
$50,474.15
|
| Rate for Payer: BCN Commercial |
$50,474.15
|
| Rate for Payer: BCN Medicare Advantage |
$16,603.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,603.34
|
| Rate for Payer: Mclaren Medicare |
$16,603.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,433.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,093.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,263.67
|
| Rate for Payer: Nomi Health Commercial |
$24,697.05
|
| Rate for Payer: PACE Medicare |
$15,773.17
|
| Rate for Payer: PACE SWMI |
$16,603.34
|
| Rate for Payer: PHP Medicare Advantage |
$16,603.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,865.84
|
| Rate for Payer: Priority Health Medicare |
$16,603.34
|
| Rate for Payer: Priority Health Tiered Network |
$24,692.67
|
| Rate for Payer: Railroad Medicare Medicare |
$16,603.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,206.35
|
| Rate for Payer: UHC Core |
$26,108.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,603.34
|
| Rate for Payer: UHC Exchange |
$21,321.79
|
| Rate for Payer: VA VA |
$16,603.34
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$77,516.13
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$33,903.46 |
| Max. Negotiated Rate |
$77,516.13 |
| Rate for Payer: Aetna Medicare |
$37,115.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,609.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,609.81
|
| Rate for Payer: BCBS MAPPO |
$35,687.85
|
| Rate for Payer: BCBS Trust/PPO |
$77,516.13
|
| Rate for Payer: BCN Commercial |
$77,516.13
|
| Rate for Payer: BCN Medicare Advantage |
$35,687.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,687.85
|
| Rate for Payer: Mclaren Medicare |
$35,687.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,472.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,041.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,256.64
|
| Rate for Payer: Nomi Health Commercial |
$54,136.14
|
| Rate for Payer: PACE Medicare |
$33,903.46
|
| Rate for Payer: PACE SWMI |
$35,687.85
|
| Rate for Payer: PHP Medicare Advantage |
$35,687.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67,658.17
|
| Rate for Payer: Priority Health Medicare |
$35,687.85
|
| Rate for Payer: Priority Health Tiered Network |
$54,126.53
|
| Rate for Payer: Railroad Medicare Medicare |
$35,687.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,404.58
|
| Rate for Payer: UHC Core |
$57,229.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,687.85
|
| Rate for Payer: UHC Exchange |
$46,737.53
|
| Rate for Payer: VA VA |
$35,687.85
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$28,043.94
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$9,855.28 |
| Max. Negotiated Rate |
$28,043.94 |
| Rate for Payer: Aetna Medicare |
$10,788.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,967.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,967.48
|
| Rate for Payer: BCBS MAPPO |
$10,373.98
|
| Rate for Payer: BCBS Trust/PPO |
$28,043.94
|
| Rate for Payer: BCN Commercial |
$28,043.94
|
| Rate for Payer: BCN Medicare Advantage |
$10,373.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,373.98
|
| Rate for Payer: Mclaren Medicare |
$10,373.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,892.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,930.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,411.38
|
| Rate for Payer: Nomi Health Commercial |
$15,087.84
|
| Rate for Payer: PACE Medicare |
$9,855.28
|
| Rate for Payer: PACE SWMI |
$10,373.98
|
| Rate for Payer: PHP Medicare Advantage |
$10,373.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,856.45
|
| Rate for Payer: Priority Health Medicare |
$10,373.98
|
| Rate for Payer: Priority Health Tiered Network |
$15,085.16
|
| Rate for Payer: Railroad Medicare Medicare |
$10,373.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,064.48
|
| Rate for Payer: UHC Core |
$15,949.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,373.98
|
| Rate for Payer: UHC Exchange |
$13,025.84
|
| Rate for Payer: VA VA |
$10,373.98
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$10.52
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna Commercial |
$8.94
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Advantage |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$9.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.89
|
| Rate for Payer: PHP Commercial |
$8.94
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.84
|
| Rate for Payer: UHC Core |
$5.48
|
| Rate for Payer: UHC Exchange |
$4.13
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$315.58
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.76 |
| Max. Negotiated Rate |
$284.02 |
| Rate for Payer: Aetna American Axle |
$205.13
|
| Rate for Payer: Aetna Commercial |
$268.24
|
| Rate for Payer: Aetna Medicare |
$157.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.13
|
| Rate for Payer: BCBS Complete |
$126.23
|
| Rate for Payer: Cash Price |
$252.46
|
| Rate for Payer: Cofinity Advantage |
$220.91
|
| Rate for Payer: Cofinity Commercial |
$271.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.46
|
| Rate for Payer: Healthscope Commercial |
$284.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.69
|
| Rate for Payer: PHP Commercial |
$268.24
|
| Rate for Payer: Priority Health SBD |
$198.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.13
|
| Rate for Payer: UHC Core |
$164.42
|
| Rate for Payer: UHC Exchange |
$124.02
|
| Rate for Payer: UMR Bronson Commercial |
$116.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.69
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$482.69
|
|
|
Service Code
|
NDC 55111062660
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$434.42 |
| Rate for Payer: Aetna American Axle |
$313.75
|
| Rate for Payer: Aetna Commercial |
$410.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.75
|
| Rate for Payer: Cash Price |
$386.15
|
| Rate for Payer: Cofinity Advantage |
$337.88
|
| Rate for Payer: Cofinity Commercial |
$415.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.15
|
| Rate for Payer: Healthscope Commercial |
$434.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.02
|
| Rate for Payer: PHP Commercial |
$410.29
|
| Rate for Payer: Priority Health SBD |
$304.09
|
| Rate for Payer: UMR Bronson Commercial |
$212.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.02
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$10.52
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna Commercial |
$8.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Advantage |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$9.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.89
|
| Rate for Payer: PHP Commercial |
$8.94
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: UMR Bronson Commercial |
$4.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$329.19
|
|
|
Service Code
|
NDC 31722000860
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$296.27 |
| Rate for Payer: Aetna American Axle |
$213.97
|
| Rate for Payer: Aetna Commercial |
$279.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.97
|
| Rate for Payer: Cash Price |
$263.35
|
| Rate for Payer: Cofinity Advantage |
$230.43
|
| Rate for Payer: Cofinity Commercial |
$283.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.35
|
| Rate for Payer: Healthscope Commercial |
$296.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.89
|
| Rate for Payer: PHP Commercial |
$279.81
|
| Rate for Payer: Priority Health SBD |
$207.39
|
| Rate for Payer: UMR Bronson Commercial |
$144.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$482.69
|
|
|
Service Code
|
NDC 55111062660
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.60 |
| Max. Negotiated Rate |
$434.42 |
| Rate for Payer: Aetna American Axle |
$313.75
|
| Rate for Payer: Aetna Commercial |
$410.29
|
| Rate for Payer: Aetna Medicare |
$241.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.75
|
| Rate for Payer: BCBS Complete |
$193.08
|
| Rate for Payer: Cash Price |
$386.15
|
| Rate for Payer: Cofinity Advantage |
$337.88
|
| Rate for Payer: Cofinity Commercial |
$415.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.15
|
| Rate for Payer: Healthscope Commercial |
$434.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$386.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.02
|
| Rate for Payer: PHP Commercial |
$410.29
|
| Rate for Payer: Priority Health SBD |
$304.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.75
|
| Rate for Payer: UHC Core |
$251.48
|
| Rate for Payer: UHC Exchange |
$189.70
|
| Rate for Payer: UMR Bronson Commercial |
$178.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.02
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$315.58
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.86 |
| Max. Negotiated Rate |
$284.02 |
| Rate for Payer: Aetna American Axle |
$205.13
|
| Rate for Payer: Aetna Commercial |
$268.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.13
|
| Rate for Payer: Cash Price |
$252.46
|
| Rate for Payer: Cofinity Advantage |
$220.91
|
| Rate for Payer: Cofinity Commercial |
$271.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.46
|
| Rate for Payer: Healthscope Commercial |
$284.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.69
|
| Rate for Payer: PHP Commercial |
$268.24
|
| Rate for Payer: Priority Health SBD |
$198.82
|
| Rate for Payer: UMR Bronson Commercial |
$138.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.69
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$329.19
|
|
|
Service Code
|
NDC 31722000860
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$296.27 |
| Rate for Payer: Aetna American Axle |
$213.97
|
| Rate for Payer: Aetna Commercial |
$279.81
|
| Rate for Payer: Aetna Medicare |
$164.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.97
|
| Rate for Payer: BCBS Complete |
$131.68
|
| Rate for Payer: Cash Price |
$263.35
|
| Rate for Payer: Cofinity Advantage |
$230.43
|
| Rate for Payer: Cofinity Commercial |
$283.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.35
|
| Rate for Payer: Healthscope Commercial |
$296.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.89
|
| Rate for Payer: PHP Commercial |
$279.81
|
| Rate for Payer: Priority Health SBD |
$207.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.97
|
| Rate for Payer: UHC Core |
$171.51
|
| Rate for Payer: UHC Exchange |
$129.37
|
| Rate for Payer: UMR Bronson Commercial |
$121.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.89
|
|
|
ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$200.99
|
|
|
Service Code
|
NDC 00173068122
|
| Hospital Charge Code |
28245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$180.89 |
| Rate for Payer: Aetna American Axle |
$130.64
|
| Rate for Payer: Aetna Commercial |
$170.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.64
|
| Rate for Payer: Cash Price |
$160.79
|
| Rate for Payer: Cofinity Advantage |
$140.69
|
| Rate for Payer: Cofinity Commercial |
$172.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.79
|
| Rate for Payer: Healthscope Commercial |
$180.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.74
|
| Rate for Payer: PHP Commercial |
$170.84
|
| Rate for Payer: Priority Health SBD |
$126.62
|
| Rate for Payer: UMR Bronson Commercial |
$88.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.74
|
|
|
ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$200.99
|
|
|
Service Code
|
NDC 00173068122
|
| Hospital Charge Code |
28245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$180.89 |
| Rate for Payer: Aetna American Axle |
$130.64
|
| Rate for Payer: Aetna Commercial |
$170.84
|
| Rate for Payer: Aetna Medicare |
$100.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.64
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: Cash Price |
$160.79
|
| Rate for Payer: Cofinity Advantage |
$140.69
|
| Rate for Payer: Cofinity Commercial |
$172.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.79
|
| Rate for Payer: Healthscope Commercial |
$180.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.74
|
| Rate for Payer: PHP Commercial |
$170.84
|
| Rate for Payer: Priority Health SBD |
$126.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.64
|
| Rate for Payer: UHC Core |
$104.72
|
| Rate for Payer: UHC Exchange |
$78.99
|
| Rate for Payer: UMR Bronson Commercial |
$74.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.74
|
|
