|
COMPOUNDING VEHICLE NO.8 ORAL LIQUID
|
Facility
|
IP
|
$187.31
|
|
|
Service Code
|
NDC 00395009016
|
| Hospital Charge Code |
119063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$168.58 |
| Rate for Payer: Aetna American Axle |
$121.75
|
| Rate for Payer: Aetna Commercial |
$159.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.75
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cofinity Advantage |
$131.12
|
| Rate for Payer: Cofinity Commercial |
$161.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.85
|
| Rate for Payer: Healthscope Commercial |
$168.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.48
|
| Rate for Payer: PHP Commercial |
$159.21
|
| Rate for Payer: Priority Health SBD |
$118.01
|
| Rate for Payer: UMR Bronson Commercial |
$82.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.48
|
|
|
COMPOUNDING VEHICLE NO.8 ORAL LIQUID
|
Facility
|
OP
|
$187.31
|
|
|
Service Code
|
NDC 00395009016
|
| Hospital Charge Code |
119063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$168.58 |
| Rate for Payer: Aetna American Axle |
$121.75
|
| Rate for Payer: Aetna Commercial |
$159.21
|
| Rate for Payer: Aetna Medicare |
$93.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.75
|
| Rate for Payer: BCBS Complete |
$74.92
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cofinity Advantage |
$131.12
|
| Rate for Payer: Cofinity Commercial |
$161.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.85
|
| Rate for Payer: Healthscope Commercial |
$168.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.48
|
| Rate for Payer: PHP Commercial |
$159.21
|
| Rate for Payer: Priority Health SBD |
$118.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.75
|
| Rate for Payer: UHC Core |
$97.59
|
| Rate for Payer: UHC Exchange |
$73.61
|
| Rate for Payer: UMR Bronson Commercial |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.48
|
|
|
COMPOUNDING VEHICLE NO.8 ORAL LIQUID
|
Facility
|
IP
|
$192.99
|
|
|
Service Code
|
NDC 00574030416
|
| Hospital Charge Code |
119063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.92 |
| Max. Negotiated Rate |
$173.69 |
| Rate for Payer: Aetna American Axle |
$125.44
|
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.44
|
| Rate for Payer: Cash Price |
$154.39
|
| Rate for Payer: Cofinity Advantage |
$135.09
|
| Rate for Payer: Cofinity Commercial |
$165.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.39
|
| Rate for Payer: Healthscope Commercial |
$173.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.74
|
| Rate for Payer: PHP Commercial |
$164.04
|
| Rate for Payer: Priority Health SBD |
$121.58
|
| Rate for Payer: UMR Bronson Commercial |
$84.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.74
|
|
|
COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID
|
Facility
|
OP
|
$147.58
|
|
|
Service Code
|
NDC 00395009416
|
| Hospital Charge Code |
119062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$132.82 |
| Rate for Payer: Aetna American Axle |
$95.93
|
| Rate for Payer: Aetna Commercial |
$125.44
|
| Rate for Payer: Aetna Medicare |
$73.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.93
|
| Rate for Payer: BCBS Complete |
$59.03
|
| Rate for Payer: Cash Price |
$118.06
|
| Rate for Payer: Cofinity Advantage |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$126.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.06
|
| Rate for Payer: Healthscope Commercial |
$132.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.69
|
| Rate for Payer: PHP Commercial |
$125.44
|
| Rate for Payer: Priority Health SBD |
$92.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.93
|
| Rate for Payer: UHC Core |
$76.89
|
| Rate for Payer: UHC Exchange |
$58.00
|
| Rate for Payer: UMR Bronson Commercial |
$54.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.69
|
|
|
COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID
|
Facility
|
IP
|
$147.58
|
|
|
Service Code
|
NDC 00395009416
|
| Hospital Charge Code |
119062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$132.82 |
| Rate for Payer: Aetna American Axle |
$95.93
|
| Rate for Payer: Aetna Commercial |
$125.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.93
|
| Rate for Payer: Cash Price |
$118.06
|
| Rate for Payer: Cofinity Advantage |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$126.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.06
|
| Rate for Payer: Healthscope Commercial |
$132.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.69
|
| Rate for Payer: PHP Commercial |
$125.44
|
| Rate for Payer: Priority Health SBD |
$92.98
|
| Rate for Payer: UMR Bronson Commercial |
$64.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.69
|
|
|
COMPOUNDING VEHICLE SUSPENSION NO.19 ORAL
|
Facility
|
IP
|
$192.99
|
|
|
Service Code
|
NDC 00574031116
|
| Hospital Charge Code |
176496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.92 |
| Max. Negotiated Rate |
$173.69 |
| Rate for Payer: Aetna American Axle |
$125.44
|
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.44
|
| Rate for Payer: Cash Price |
$154.39
|
| Rate for Payer: Cofinity Advantage |
$135.09
|
| Rate for Payer: Cofinity Commercial |
$165.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.39
|
| Rate for Payer: Healthscope Commercial |
$173.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.74
|
| Rate for Payer: PHP Commercial |
$164.04
|
| Rate for Payer: Priority Health SBD |
$121.58
|
| Rate for Payer: UMR Bronson Commercial |
$84.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.74
|
|
|
COMPOUNDING VEHICLE SUSPENSION NO.19 ORAL
|
Facility
|
OP
|
$192.99
|
|
|
Service Code
|
NDC 00574031116
|
| Hospital Charge Code |
176496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.41 |
| Max. Negotiated Rate |
$173.69 |
| Rate for Payer: Aetna American Axle |
$125.44
|
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$96.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.44
|
| Rate for Payer: BCBS Complete |
$77.20
|
| Rate for Payer: Cash Price |
$154.39
|
| Rate for Payer: Cofinity Advantage |
$135.09
|
| Rate for Payer: Cofinity Commercial |
$165.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.39
|
| Rate for Payer: Healthscope Commercial |
$173.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.74
|
| Rate for Payer: PHP Commercial |
$164.04
|
| Rate for Payer: Priority Health SBD |
$121.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.44
|
| Rate for Payer: UHC Core |
$100.55
|
| Rate for Payer: UHC Exchange |
$75.85
|
| Rate for Payer: UMR Bronson Commercial |
$71.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.74
|
|
|
COMPOUNDING VEHICLE SUSPENSION NO.7 ORAL
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 00574030316
|
| Hospital Charge Code |
118921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.41 |
| Max. Negotiated Rate |
$178.79 |
| Rate for Payer: Aetna American Axle |
$129.13
|
| Rate for Payer: Aetna Commercial |
$168.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.13
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Advantage |
$139.06
|
| Rate for Payer: Cofinity Commercial |
$170.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$178.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.00
|
| Rate for Payer: PHP Commercial |
$168.86
|
| Rate for Payer: Priority Health SBD |
$125.16
|
| Rate for Payer: UMR Bronson Commercial |
$87.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.00
|
|
|
COMPOUNDING VEHICLE SUSPENSION NO.7 ORAL
|
Facility
|
OP
|
$198.66
|
|
|
Service Code
|
NDC 00574030316
|
| Hospital Charge Code |
118921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$178.79 |
| Rate for Payer: Aetna American Axle |
$129.13
|
| Rate for Payer: Aetna Commercial |
$168.86
|
| Rate for Payer: Aetna Medicare |
$99.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.13
|
| Rate for Payer: BCBS Complete |
$79.46
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Advantage |
$139.06
|
| Rate for Payer: Cofinity Commercial |
$170.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$178.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.00
|
| Rate for Payer: PHP Commercial |
$168.86
|
| Rate for Payer: Priority Health SBD |
$125.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.13
|
| Rate for Payer: UHC Core |
$103.50
|
| Rate for Payer: UHC Exchange |
$78.07
|
| Rate for Payer: UMR Bronson Commercial |
$73.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.00
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
IP
|
$181.64
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.92 |
| Max. Negotiated Rate |
$163.48 |
| Rate for Payer: Aetna American Axle |
$118.07
|
| Rate for Payer: Aetna Commercial |
$154.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.07
|
| Rate for Payer: Cash Price |
$145.31
|
| Rate for Payer: Cofinity Advantage |
$127.15
|
| Rate for Payer: Cofinity Commercial |
$156.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.31
|
| Rate for Payer: Healthscope Commercial |
$163.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.23
|
| Rate for Payer: PHP Commercial |
$154.39
|
| Rate for Payer: Priority Health SBD |
$114.43
|
| Rate for Payer: UMR Bronson Commercial |
$79.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.23
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
OP
|
$181.64
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$163.48 |
| Rate for Payer: Aetna American Axle |
$118.07
|
| Rate for Payer: Aetna Commercial |
$154.39
|
| Rate for Payer: Aetna Medicare |
$90.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.07
|
| Rate for Payer: BCBS Complete |
$72.66
|
| Rate for Payer: Cash Price |
$145.31
|
| Rate for Payer: Cofinity Advantage |
$127.15
|
| Rate for Payer: Cofinity Commercial |
$156.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.31
|
| Rate for Payer: Healthscope Commercial |
$163.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.23
|
| Rate for Payer: PHP Commercial |
$154.39
|
| Rate for Payer: Priority Health SBD |
$114.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.07
|
| Rate for Payer: UHC Core |
$94.63
|
| Rate for Payer: UHC Exchange |
$71.38
|
| Rate for Payer: UMR Bronson Commercial |
$67.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.23
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23
|
Facility
|
OP
|
$272.45
|
|
|
Service Code
|
NDC 31722095901
|
| Hospital Charge Code |
187071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.81 |
| Max. Negotiated Rate |
$245.21 |
| Rate for Payer: Aetna American Axle |
$177.09
|
| Rate for Payer: Aetna Commercial |
$231.58
|
| Rate for Payer: Aetna Medicare |
$136.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.09
|
| Rate for Payer: BCBS Complete |
$108.98
|
| Rate for Payer: Cash Price |
$217.96
|
| Rate for Payer: Cofinity Advantage |
$190.72
|
| Rate for Payer: Cofinity Commercial |
$234.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.96
|
| Rate for Payer: Healthscope Commercial |
$245.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.34
|
| Rate for Payer: PHP Commercial |
$231.58
|
| Rate for Payer: Priority Health SBD |
$171.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.09
|
| Rate for Payer: UHC Core |
$141.95
|
| Rate for Payer: UHC Exchange |
$107.07
|
| Rate for Payer: UMR Bronson Commercial |
$100.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.34
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23
|
Facility
|
IP
|
$272.45
|
|
|
Service Code
|
NDC 31722095901
|
| Hospital Charge Code |
187071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.88 |
| Max. Negotiated Rate |
$245.21 |
| Rate for Payer: Aetna American Axle |
$177.09
|
| Rate for Payer: Aetna Commercial |
$231.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.09
|
| Rate for Payer: Cash Price |
$217.96
|
| Rate for Payer: Cofinity Advantage |
$190.72
|
| Rate for Payer: Cofinity Commercial |
$234.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.96
|
| Rate for Payer: Healthscope Commercial |
$245.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.34
|
| Rate for Payer: PHP Commercial |
$231.58
|
| Rate for Payer: Priority Health SBD |
$171.64
|
| Rate for Payer: UMR Bronson Commercial |
$119.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.34
|
|
|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
|
IP
|
$260,798.23
|
|
|
Service Code
|
MSDRG 212
|
| Min. Negotiated Rate |
$86,953.23 |
| Max. Negotiated Rate |
$260,798.23 |
| Rate for Payer: Aetna Medicare |
$95,190.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114,412.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114,412.15
|
| Rate for Payer: BCBS MAPPO |
$91,529.72
|
| Rate for Payer: BCBS Trust/PPO |
$260,798.23
|
| Rate for Payer: BCN Commercial |
$260,798.23
|
| Rate for Payer: BCN Medicare Advantage |
$91,529.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91,529.72
|
| Rate for Payer: Mclaren Medicare |
$91,529.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96,106.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105,259.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$100,682.69
|
| Rate for Payer: Nomi Health Commercial |
$140,275.89
|
| Rate for Payer: PACE Medicare |
$86,953.23
|
| Rate for Payer: PACE SWMI |
$91,529.72
|
| Rate for Payer: PHP Medicare Advantage |
$91,529.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$175,313.76
|
| Rate for Payer: Priority Health Medicare |
$91,529.72
|
| Rate for Payer: Priority Health Tiered Network |
$140,250.99
|
| Rate for Payer: Railroad Medicare Medicare |
$91,529.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177,247.83
|
| Rate for Payer: UHC Core |
$148,290.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$91,529.72
|
| Rate for Payer: UHC Exchange |
$121,104.85
|
| Rate for Payer: VA VA |
$91,529.72
|
|
|
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION
|
Facility
|
IP
|
$127,089.89
|
|
|
Service Code
|
MSDRG 317
|
| Min. Negotiated Rate |
$53,684.61 |
| Max. Negotiated Rate |
$127,089.89 |
| Rate for Payer: Aetna Medicare |
$58,770.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70,637.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70,637.65
|
| Rate for Payer: BCBS MAPPO |
$56,510.12
|
| Rate for Payer: BCBS Trust/PPO |
$127,089.89
|
| Rate for Payer: BCN Commercial |
$127,089.89
|
| Rate for Payer: BCN Medicare Advantage |
$56,510.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,510.12
|
| Rate for Payer: Mclaren Medicare |
$56,510.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59,335.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64,986.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$62,161.13
|
| Rate for Payer: Nomi Health Commercial |
$86,255.85
|
| Rate for Payer: PACE Medicare |
$53,684.61
|
| Rate for Payer: PACE SWMI |
$56,510.12
|
| Rate for Payer: PHP Medicare Advantage |
$56,510.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$107,800.69
|
| Rate for Payer: Priority Health Medicare |
$56,510.12
|
| Rate for Payer: Priority Health Tiered Network |
$86,240.54
|
| Rate for Payer: Railroad Medicare Medicare |
$56,510.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108,989.95
|
| Rate for Payer: UHC Core |
$91,183.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56,510.12
|
| Rate for Payer: UHC Exchange |
$74,467.55
|
| Rate for Payer: VA VA |
$56,510.12
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$25,408.65
|
|
|
Service Code
|
MSDRG 089
|
| Min. Negotiated Rate |
$9,291.21 |
| Max. Negotiated Rate |
$25,408.65 |
| Rate for Payer: Aetna Medicare |
$10,171.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,225.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,225.27
|
| Rate for Payer: BCBS MAPPO |
$9,780.22
|
| Rate for Payer: BCBS Trust/PPO |
$25,408.65
|
| Rate for Payer: BCN Commercial |
$25,408.65
|
| Rate for Payer: BCN Medicare Advantage |
$9,780.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,780.22
|
| Rate for Payer: Mclaren Medicare |
$9,780.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,269.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,247.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,758.24
|
| Rate for Payer: Nomi Health Commercial |
$14,171.94
|
| Rate for Payer: PACE Medicare |
$9,291.21
|
| Rate for Payer: PACE SWMI |
$9,780.22
|
| Rate for Payer: PHP Medicare Advantage |
$9,780.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,711.78
|
| Rate for Payer: Priority Health Medicare |
$9,780.22
|
| Rate for Payer: Priority Health Tiered Network |
$14,169.42
|
| Rate for Payer: Railroad Medicare Medicare |
$9,780.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,907.18
|
| Rate for Payer: UHC Core |
$14,981.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,780.22
|
| Rate for Payer: UHC Exchange |
$12,235.11
|
| Rate for Payer: VA VA |
$9,780.22
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$45,703.17
|
|
|
Service Code
|
MSDRG 088
|
| Min. Negotiated Rate |
$11,302.78 |
| Max. Negotiated Rate |
$45,703.17 |
| Rate for Payer: Aetna Medicare |
$12,373.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,872.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,872.08
|
| Rate for Payer: BCBS MAPPO |
$11,897.66
|
| Rate for Payer: BCBS Trust/PPO |
$45,703.17
|
| Rate for Payer: BCN Commercial |
$45,703.17
|
| Rate for Payer: BCN Medicare Advantage |
$11,897.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,897.66
|
| Rate for Payer: Mclaren Medicare |
$11,897.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,492.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,682.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,087.43
|
| Rate for Payer: Nomi Health Commercial |
$17,438.22
|
| Rate for Payer: PACE Medicare |
$11,302.78
|
| Rate for Payer: PACE SWMI |
$11,897.66
|
| Rate for Payer: PHP Medicare Advantage |
$11,897.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,793.91
|
| Rate for Payer: Priority Health Medicare |
$11,897.66
|
| Rate for Payer: Priority Health Tiered Network |
$17,435.12
|
| Rate for Payer: Railroad Medicare Medicare |
$11,897.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,034.34
|
| Rate for Payer: UHC Core |
$18,434.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,897.66
|
| Rate for Payer: UHC Exchange |
$15,055.00
|
| Rate for Payer: VA VA |
$11,897.66
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$23,720.41
|
|
|
Service Code
|
MSDRG 090
|
| Min. Negotiated Rate |
$7,103.28 |
| Max. Negotiated Rate |
$23,720.41 |
| Rate for Payer: Aetna Medicare |
$7,776.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,346.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,346.42
|
| Rate for Payer: BCBS MAPPO |
$7,477.14
|
| Rate for Payer: BCBS Trust/PPO |
$23,720.41
|
| Rate for Payer: BCN Commercial |
$23,720.41
|
| Rate for Payer: BCN Medicare Advantage |
$7,477.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,477.14
|
| Rate for Payer: Mclaren Medicare |
$7,477.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,851.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,598.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,224.85
|
| Rate for Payer: Nomi Health Commercial |
$10,619.28
|
| Rate for Payer: PACE Medicare |
$7,103.28
|
| Rate for Payer: PACE SWMI |
$7,477.14
|
| Rate for Payer: PHP Medicare Advantage |
$7,477.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,271.75
|
| Rate for Payer: Priority Health Medicare |
$7,477.14
|
| Rate for Payer: Priority Health Tiered Network |
$10,617.39
|
| Rate for Payer: Railroad Medicare Medicare |
$7,477.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,418.16
|
| Rate for Payer: UHC Core |
$11,225.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,477.14
|
| Rate for Payer: UHC Exchange |
$9,167.98
|
| Rate for Payer: VA VA |
$7,477.14
|
|
|
CONDYLECTOMY, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 21050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,835.44
|
| Rate for Payer: BCN Commercial |
$3,835.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.31 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,597.04
|
| Rate for Payer: BCCCP Commercial |
$342.31
|
| Rate for Payer: BCN Commercial |
$3,597.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$293.81 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,788.90
|
| Rate for Payer: BCCCP Commercial |
$293.81
|
| Rate for Payer: BCN Commercial |
$2,788.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
OP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$969.39 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna American Axle |
$1,702.98
|
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna Medicare |
$1,309.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.98
|
| Rate for Payer: BCBS Complete |
$1,047.99
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Advantage |
$1,833.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,833.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,095.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health SBD |
$1,650.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,702.98
|
| Rate for Payer: UHC Core |
$1,365.00
|
| Rate for Payer: UHC Exchange |
$1,029.65
|
| Rate for Payer: UMR Bronson Commercial |
$969.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
IP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,152.79 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna American Axle |
$1,702.98
|
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.98
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Advantage |
$1,833.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,833.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health SBD |
$1,650.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,152.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,615.11
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$710.65 |
| Max. Negotiated Rate |
$1,453.60 |
| Rate for Payer: Aetna American Axle |
$1,049.82
|
| Rate for Payer: Aetna Commercial |
$1,372.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,049.82
|
| Rate for Payer: Cash Price |
$1,292.09
|
| Rate for Payer: Cofinity Advantage |
$1,130.58
|
| Rate for Payer: Cofinity Commercial |
$1,388.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,292.09
|
| Rate for Payer: Healthscope Commercial |
$1,453.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,130.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,211.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,372.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,211.33
|
| Rate for Payer: PHP Commercial |
$1,372.84
|
| Rate for Payer: Priority Health SBD |
$1,017.52
|
| Rate for Payer: UMR Bronson Commercial |
$710.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,211.33
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
OP
|
$1,615.11
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$597.59 |
| Max. Negotiated Rate |
$1,453.60 |
| Rate for Payer: Aetna American Axle |
$1,049.82
|
| Rate for Payer: Aetna Commercial |
$1,372.84
|
| Rate for Payer: Aetna Medicare |
$807.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,049.82
|
| Rate for Payer: BCBS Complete |
$646.04
|
| Rate for Payer: Cash Price |
$1,292.09
|
| Rate for Payer: Cofinity Advantage |
$1,130.58
|
| Rate for Payer: Cofinity Commercial |
$1,388.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,292.09
|
| Rate for Payer: Healthscope Commercial |
$1,453.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,130.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,211.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,292.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,372.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,211.33
|
| Rate for Payer: PHP Commercial |
$1,372.84
|
| Rate for Payer: Priority Health SBD |
$1,017.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,049.82
|
| Rate for Payer: UHC Core |
$841.47
|
| Rate for Payer: UHC Exchange |
$634.74
|
| Rate for Payer: UMR Bronson Commercial |
$597.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,211.33
|
|
