|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
IP
|
$273.60
|
|
|
Service Code
|
NDC 42571-162-01
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.52
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR
|
Facility
IP
|
$773.60
|
|
|
Service Code
|
NDC 43598-220-40
|
| Hospital Charge Code |
33862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.38 |
| Max. Negotiated Rate |
$696.24 |
| Rate for Payer: Aetna American Axle |
$502.84
|
| Rate for Payer: Aetna Commercial |
$657.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.84
|
| Rate for Payer: Cash Price |
$618.88
|
| Rate for Payer: Cofinity Commercial |
$541.52
|
| Rate for Payer: Cofinity Commercial |
$665.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.88
|
| Rate for Payer: Healthscope Commercial |
$696.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.56
|
| Rate for Payer: PHP Commercial |
$657.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.52
|
| Rate for Payer: Priority Health SBD |
$487.37
|
| Rate for Payer: UMR Bronson Commercial |
$340.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.20
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION
|
Facility
IP
|
$153.26
|
|
|
Service Code
|
HCPCS J0285
|
| Hospital Charge Code |
464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna American Axle |
$99.62
|
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.27
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.28
|
| Rate for Payer: Priority Health SBD |
$96.55
|
| Rate for Payer: UMR Bronson Commercial |
$67.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.94
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION
|
Facility
OP
|
$331.26
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
21900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$298.13 |
| Rate for Payer: Aetna American Axle |
$215.32
|
| Rate for Payer: Aetna American Axle |
$435.64
|
| Rate for Payer: Aetna Commercial |
$281.57
|
| Rate for Payer: Aetna Commercial |
$569.68
|
| Rate for Payer: Aetna Medicare |
$27.72
|
| Rate for Payer: Aetna Medicare |
$27.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.32
|
| Rate for Payer: BCBS Complete |
$15.31
|
| Rate for Payer: BCBS Complete |
$15.31
|
| Rate for Payer: BCBS MAPPO |
$26.66
|
| Rate for Payer: BCBS MAPPO |
$26.66
|
| Rate for Payer: BCBS Trust/PPO |
$86.14
|
| Rate for Payer: BCBS Trust/PPO |
$86.14
|
| Rate for Payer: BCN Medicare Advantage |
$26.66
|
| Rate for Payer: BCN Medicare Advantage |
$26.66
|
| Rate for Payer: Cash Price |
$265.01
|
| Rate for Payer: Cash Price |
$536.17
|
| Rate for Payer: Cash Price |
$265.01
|
| Rate for Payer: Cash Price |
$536.17
|
| Rate for Payer: Cofinity Commercial |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$469.15
|
| Rate for Payer: Cofinity Commercial |
$231.88
|
| Rate for Payer: Cofinity Commercial |
$284.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.66
|
| Rate for Payer: Healthscope Commercial |
$603.19
|
| Rate for Payer: Healthscope Commercial |
$298.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.66
|
| Rate for Payer: Mclaren Medicaid |
$14.58
|
| Rate for Payer: Mclaren Medicaid |
$14.58
|
| Rate for Payer: Mclaren Medicare |
$26.66
|
| Rate for Payer: Mclaren Medicare |
$26.66
|
| Rate for Payer: Meridian Medicaid |
$15.31
|
| Rate for Payer: Meridian Medicaid |
$15.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.57
|
| Rate for Payer: PACE Medicare |
$25.33
|
| Rate for Payer: PACE Medicare |
$25.33
|
| Rate for Payer: PACE SWMI |
$26.66
|
| Rate for Payer: PACE SWMI |
$26.66
|
| Rate for Payer: PHP Commercial |
$569.68
|
| Rate for Payer: PHP Commercial |
$281.57
|
| Rate for Payer: PHP Medicare Advantage |
$26.66
|
| Rate for Payer: PHP Medicare Advantage |
$26.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.02
|
| Rate for Payer: Priority Health Medicare |
$26.66
|
| Rate for Payer: Priority Health Medicare |
$26.66
|
| Rate for Payer: Priority Health Narrow Network |
$65.62
|
| Rate for Payer: Priority Health Narrow Network |
$65.62
|
| Rate for Payer: Priority Health SBD |
$422.23
|
| Rate for Payer: Priority Health SBD |
$208.69
|
| Rate for Payer: Railroad Medicare Medicare |
$26.66
|
| Rate for Payer: Railroad Medicare Medicare |
$26.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.66
|
| Rate for Payer: UHC Medicare Advantage |
$27.46
|
| Rate for Payer: UHC Medicare Advantage |
$27.46
|
| Rate for Payer: UMR Bronson Commercial |
$247.98
|
| Rate for Payer: UMR Bronson Commercial |
$122.57
|
| Rate for Payer: VA VA |
$26.66
|
| Rate for Payer: VA VA |
$26.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.66
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION
|
Facility
IP
|
$331.26
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
21900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$298.13 |
| Rate for Payer: Aetna American Axle |
$215.32
|
| Rate for Payer: Aetna Commercial |
$281.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.32
|
| Rate for Payer: Cash Price |
$265.01
|
| Rate for Payer: Cofinity Commercial |
$284.88
|
| Rate for Payer: Cofinity Commercial |
$231.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.01
|
| Rate for Payer: Healthscope Commercial |
$298.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.57
|
| Rate for Payer: PHP Commercial |
$281.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.88
|
| Rate for Payer: Priority Health SBD |
$208.69
|
| Rate for Payer: UMR Bronson Commercial |
$145.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.44
|
|
|
AMPICILLIN 1 GRAM CUSTOM SOLUTION FOR INJECTION (CHARGE IN INCREMENTS)
|
Facility
IP
|
$23.55
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.02
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$18.32
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Aetna American Axle |
$11.91
|
| Rate for Payer: Aetna American Axle |
$14.55
|
| Rate for Payer: Aetna American Axle |
$13.37
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Commercial |
$15.57
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.91
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Commercial |
$12.82
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$16.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.03
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: PHP Commercial |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.67
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$12.96
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$11.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.06
|
| Rate for Payer: UMR Bronson Commercial |
$13.66
|
| Rate for Payer: UMR Bronson Commercial |
$9.85
|
| Rate for Payer: UMR Bronson Commercial |
$9.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION (BMH OSC)
|
Facility
IP
|
$20.57
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
169408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna American Axle |
$13.37
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.48
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.40
|
| Rate for Payer: Priority Health SBD |
$12.96
|
| Rate for Payer: UMR Bronson Commercial |
$9.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.43
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$18.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna American Axle |
$12.11
|
| Rate for Payer: Aetna American Axle |
$11.56
|
| Rate for Payer: Aetna American Axle |
$21.33
|
| Rate for Payer: Aetna American Axle |
$19.13
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$12.45
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$22.97
|
| Rate for Payer: Cofinity Commercial |
$28.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: Healthscope Commercial |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.02
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$27.90
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.60
|
| Rate for Payer: Priority Health SBD |
$18.54
|
| Rate for Payer: Priority Health SBD |
$11.20
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: Priority Health SBD |
$20.68
|
| Rate for Payer: UMR Bronson Commercial |
$8.20
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
| Rate for Payer: UMR Bronson Commercial |
$12.95
|
| Rate for Payer: UMR Bronson Commercial |
$14.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.34
|
|
|
AMPICILLIN 500 MG/5 ML INJECTION SOLUTION
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
AMPICILLIN 500 MG IM
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$13.38
|
| Rate for Payer: Aetna American Axle |
$13.25
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.38
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$14.41
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$11.81
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$17.53
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.49
|
| Rate for Payer: PHP Commercial |
$17.32
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: PHP Commercial |
$17.49
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.81
|
| Rate for Payer: Priority Health SBD |
$12.84
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$12.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.97
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: UMR Bronson Commercial |
$7.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.44
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION (BMH OSC)
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
169409
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna American Axle |
$6.80
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
AMPICILLIN IV 0.0004 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
IP
|
$0.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna American Axle |
$0.41
|
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.41
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cofinity Commercial |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$0.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.54
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.44
|
| Rate for Payer: Priority Health SBD |
$0.40
|
| Rate for Payer: UMR Bronson Commercial |
$0.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.47
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
OP
|
$29.06
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$26.15 |
| Rate for Payer: Aetna American Axle |
$18.89
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.89
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS Trust/PPO |
$5.71
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.70
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: UMR Bronson Commercial |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$28.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$25.86 |
| Rate for Payer: Aetna American Axle |
$18.67
|
| Rate for Payer: Aetna American Axle |
$14.62
|
| Rate for Payer: Aetna American Axle |
$11.59
|
| Rate for Payer: Aetna American Axle |
$18.89
|
| Rate for Payer: Aetna American Axle |
$18.00
|
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna American Axle |
$12.45
|
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna American Axle |
$14.84
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$24.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$15.33
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$20.11
|
| Rate for Payer: Cofinity Commercial |
$24.71
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$13.41
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$19.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$20.55
|
| Rate for Payer: Healthscope Commercial |
$25.86
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$20.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.70
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$19.12
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$24.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.75
|
| Rate for Payer: Priority Health SBD |
$12.07
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health SBD |
$14.38
|
| Rate for Payer: Priority Health SBD |
$18.10
|
| Rate for Payer: Priority Health SBD |
$14.18
|
| Rate for Payer: Priority Health SBD |
$12.75
|
| Rate for Payer: Priority Health SBD |
$18.31
|
| Rate for Payer: UMR Bronson Commercial |
$8.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.85
|
| Rate for Payer: UMR Bronson Commercial |
$11.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.64
|
| Rate for Payer: UMR Bronson Commercial |
$12.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.90
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.80
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$91.05
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.06 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna American Axle |
$59.18
|
| Rate for Payer: Aetna American Axle |
$86.95
|
| Rate for Payer: Aetna American Axle |
$64.56
|
| Rate for Payer: Aetna Commercial |
$77.39
|
| Rate for Payer: Aetna Commercial |
$113.70
|
| Rate for Payer: Aetna Commercial |
$84.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.18
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Cofinity Commercial |
$63.74
|
| Rate for Payer: Cofinity Commercial |
$115.04
|
| Rate for Payer: Cofinity Commercial |
$93.64
|
| Rate for Payer: Cofinity Commercial |
$85.42
|
| Rate for Payer: Cofinity Commercial |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$78.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.46
|
| Rate for Payer: Healthscope Commercial |
$81.94
|
| Rate for Payer: Healthscope Commercial |
$120.39
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.39
|
| Rate for Payer: PHP Commercial |
$113.70
|
| Rate for Payer: PHP Commercial |
$77.39
|
| Rate for Payer: PHP Commercial |
$84.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.53
|
| Rate for Payer: Priority Health SBD |
$57.36
|
| Rate for Payer: Priority Health SBD |
$84.28
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: UMR Bronson Commercial |
$40.06
|
| Rate for Payer: UMR Bronson Commercial |
$43.71
|
| Rate for Payer: UMR Bronson Commercial |
$58.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.50
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION (BMH OSC)
|
Facility
IP
|
$19.16
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
169411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna American Axle |
$12.45
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.45
|
| Rate for Payer: Cash Price |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$13.41
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.33
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.29
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.41
|
| Rate for Payer: Priority Health SBD |
$12.07
|
| Rate for Payer: UMR Bronson Commercial |
$8.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.37
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$36.66
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$32.99 |
| Rate for Payer: Aetna American Axle |
$23.83
|
| Rate for Payer: Aetna American Axle |
$16.56
|
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna American Axle |
$16.36
|
| Rate for Payer: Aetna American Axle |
$21.83
|
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna American Axle |
$23.63
|
| Rate for Payer: Aetna American Axle |
$17.52
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$28.54
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$30.96
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.83
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cofinity Commercial |
$22.46
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$25.45
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$28.88
|
| Rate for Payer: Cofinity Commercial |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.67
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$30.22
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$32.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.16
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$28.54
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$30.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.49
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$21.16
|
| Rate for Payer: Priority Health SBD |
$22.91
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: UMR Bronson Commercial |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$14.12
|
| Rate for Payer: UMR Bronson Commercial |
$11.21
|
| Rate for Payer: UMR Bronson Commercial |
$14.78
|
| Rate for Payer: UMR Bronson Commercial |
$11.07
|
| Rate for Payer: UMR Bronson Commercial |
$11.86
|
| Rate for Payer: UMR Bronson Commercial |
$16.13
|
| Rate for Payer: UMR Bronson Commercial |
$16.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.50
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
OP
|
$33.58
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$30.22 |
| Rate for Payer: Aetna American Axle |
$21.83
|
| Rate for Payer: Aetna Commercial |
$28.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.83
|
| Rate for Payer: BCBS Complete |
$13.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.71
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cofinity Commercial |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$28.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.86
|
| Rate for Payer: Healthscope Commercial |
$30.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.54
|
| Rate for Payer: PHP Commercial |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.51
|
| Rate for Payer: Priority Health SBD |
$21.16
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.18
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
IP
|
$19.16
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna American Axle |
$12.45
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.45
|
| Rate for Payer: Cash Price |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$13.41
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.33
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.29
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.41
|
| Rate for Payer: Priority Health SBD |
$12.07
|
| Rate for Payer: UMR Bronson Commercial |
$8.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.37
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.73 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,515.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.80
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$700.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD)
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.08 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.19
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$681.08
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
AMPUTATION, FOOT; TRANSMETATARSAL
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$693.19 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,171.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$762.51
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$693.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
IP
|
$47,752.64
|
|
|
Service Code
|
MS-DRG 240
|
| Min. Negotiated Rate |
$21,052.14 |
| Max. Negotiated Rate |
$47,752.64 |
| Rate for Payer: Aetna Medicare |
$23,046.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,700.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,700.19
|
| Rate for Payer: BCBS MAPPO |
$22,160.15
|
| Rate for Payer: BCBS Trust/PPO |
$47,752.64
|
| Rate for Payer: BCN Medicare Advantage |
$22,160.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,160.15
|
| Rate for Payer: Mclaren Medicare |
$22,160.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,268.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,484.17
|
| Rate for Payer: PACE Medicare |
$21,052.14
|
| Rate for Payer: PACE SWMI |
$22,160.15
|
| Rate for Payer: PHP Medicare Advantage |
$22,160.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,311.80
|
| Rate for Payer: Priority Health Medicare |
$22,160.15
|
| Rate for Payer: Priority Health Narrow Network |
$32,249.44
|
| Rate for Payer: Railroad Medicare Medicare |
$22,160.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,851.54
|
| Rate for Payer: UHC Core |
$35,137.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,160.15
|
| Rate for Payer: UHC Exchange |
$27,934.68
|
| Rate for Payer: UHC Medicare Advantage |
$22,824.95
|
| Rate for Payer: VA VA |
$22,160.15
|
|
