|
DEFERASIROX 90 MG TABLET
|
Facility
|
OP
|
$83.67
|
|
|
Service Code
|
NDC 43598085330
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$75.30 |
| Rate for Payer: Aetna American Axle |
$54.39
|
| Rate for Payer: Aetna Commercial |
$71.12
|
| Rate for Payer: Aetna Medicare |
$41.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.39
|
| Rate for Payer: BCBS Complete |
$33.47
|
| Rate for Payer: Cash Price |
$66.94
|
| Rate for Payer: Cofinity Advantage |
$58.57
|
| Rate for Payer: Cofinity Commercial |
$71.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.94
|
| Rate for Payer: Healthscope Commercial |
$75.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.75
|
| Rate for Payer: PHP Commercial |
$71.12
|
| Rate for Payer: Priority Health SBD |
$52.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.39
|
| Rate for Payer: UHC Core |
$43.59
|
| Rate for Payer: UHC Exchange |
$32.88
|
| Rate for Payer: UMR Bronson Commercial |
$30.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.75
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$101.69
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.74 |
| Max. Negotiated Rate |
$91.52 |
| Rate for Payer: Aetna American Axle |
$66.10
|
| Rate for Payer: Aetna American Axle |
$109.22
|
| Rate for Payer: Aetna American Axle |
$83.39
|
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna Commercial |
$86.44
|
| Rate for Payer: Aetna Commercial |
$142.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.39
|
| Rate for Payer: Cash Price |
$102.64
|
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cofinity Advantage |
$117.62
|
| Rate for Payer: Cofinity Advantage |
$71.18
|
| Rate for Payer: Cofinity Advantage |
$89.81
|
| Rate for Payer: Cofinity Commercial |
$144.51
|
| Rate for Payer: Cofinity Commercial |
$87.45
|
| Rate for Payer: Cofinity Commercial |
$110.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.42
|
| Rate for Payer: Healthscope Commercial |
$115.47
|
| Rate for Payer: Healthscope Commercial |
$151.23
|
| Rate for Payer: Healthscope Commercial |
$91.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.02
|
| Rate for Payer: PHP Commercial |
$109.06
|
| Rate for Payer: PHP Commercial |
$86.44
|
| Rate for Payer: PHP Commercial |
$142.83
|
| Rate for Payer: Priority Health SBD |
$64.06
|
| Rate for Payer: Priority Health SBD |
$80.83
|
| Rate for Payer: Priority Health SBD |
$105.86
|
| Rate for Payer: UMR Bronson Commercial |
$44.74
|
| Rate for Payer: UMR Bronson Commercial |
$73.93
|
| Rate for Payer: UMR Bronson Commercial |
$56.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.02
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$101.69
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$91.52 |
| Rate for Payer: Aetna American Axle |
$66.10
|
| Rate for Payer: Aetna American Axle |
$109.22
|
| Rate for Payer: Aetna American Axle |
$83.39
|
| Rate for Payer: Aetna Commercial |
$142.83
|
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna Commercial |
$86.44
|
| Rate for Payer: Aetna Medicare |
$84.02
|
| Rate for Payer: Aetna Medicare |
$50.84
|
| Rate for Payer: Aetna Medicare |
$64.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.10
|
| Rate for Payer: BCBS Complete |
$40.68
|
| Rate for Payer: BCBS Complete |
$51.32
|
| Rate for Payer: BCBS Complete |
$67.21
|
| Rate for Payer: BCBS Trust/PPO |
$27.43
|
| Rate for Payer: BCBS Trust/PPO |
$27.43
|
| Rate for Payer: BCBS Trust/PPO |
$27.43
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cash Price |
$102.64
|
| Rate for Payer: Cash Price |
$102.64
|
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Cofinity Advantage |
$71.18
|
| Rate for Payer: Cofinity Advantage |
$89.81
|
| Rate for Payer: Cofinity Advantage |
$117.62
|
| Rate for Payer: Cofinity Commercial |
$87.45
|
| Rate for Payer: Cofinity Commercial |
$144.51
|
| Rate for Payer: Cofinity Commercial |
$110.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.64
|
| Rate for Payer: Healthscope Commercial |
$115.47
|
| Rate for Payer: Healthscope Commercial |
$91.52
|
| Rate for Payer: Healthscope Commercial |
$151.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.27
|
| Rate for Payer: PHP Commercial |
$109.06
|
| Rate for Payer: PHP Commercial |
$86.44
|
| Rate for Payer: PHP Commercial |
$142.83
|
| Rate for Payer: Priority Health SBD |
$80.83
|
| Rate for Payer: Priority Health SBD |
$64.06
|
| Rate for Payer: Priority Health SBD |
$105.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.10
|
| Rate for Payer: UHC Core |
$52.98
|
| Rate for Payer: UHC Core |
$66.84
|
| Rate for Payer: UHC Core |
$87.54
|
| Rate for Payer: UHC Exchange |
$66.04
|
| Rate for Payer: UHC Exchange |
$39.96
|
| Rate for Payer: UHC Exchange |
$50.42
|
| Rate for Payer: UMR Bronson Commercial |
$62.17
|
| Rate for Payer: UMR Bronson Commercial |
$37.63
|
| Rate for Payer: UMR Bronson Commercial |
$47.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.22
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
IP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Aetna American Axle |
$97.92
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Advantage |
$105.45
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.99
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: UMR Bronson Commercial |
$66.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.99
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
OP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Aetna American Axle |
$97.92
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Medicare |
$75.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Trust/PPO |
$27.43
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Advantage |
$105.45
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.99
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UMR Bronson Commercial |
$55.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.99
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Aetna American Axle |
$97.92
|
| Rate for Payer: Aetna American Axle |
$39.69
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Commercial |
$51.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.69
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$48.85
|
| Rate for Payer: Cofinity Advantage |
$42.74
|
| Rate for Payer: Cofinity Advantage |
$105.45
|
| Rate for Payer: Cofinity Commercial |
$52.51
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.85
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| Rate for Payer: Healthscope Commercial |
$54.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.80
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$51.90
|
| Rate for Payer: Priority Health SBD |
$38.47
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: UMR Bronson Commercial |
$66.29
|
| Rate for Payer: UMR Bronson Commercial |
$26.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.80
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$36.98
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Aetna American Axle |
$24.04
|
| Rate for Payer: Aetna American Axle |
$97.92
|
| Rate for Payer: Aetna American Axle |
$39.69
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Commercial |
$51.90
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Medicare |
$18.49
|
| Rate for Payer: Aetna Medicare |
$75.33
|
| Rate for Payer: Aetna Medicare |
$30.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.69
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Complete |
$14.79
|
| Rate for Payer: BCBS Complete |
$24.42
|
| Rate for Payer: BCBS Trust/PPO |
$27.43
|
| Rate for Payer: BCBS Trust/PPO |
$27.43
|
| Rate for Payer: BCBS Trust/PPO |
$27.43
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$48.85
|
| Rate for Payer: Cash Price |
$48.85
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cofinity Advantage |
$42.74
|
| Rate for Payer: Cofinity Advantage |
$25.89
|
| Rate for Payer: Cofinity Advantage |
$105.45
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$52.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$54.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.80
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$51.90
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: Priority Health SBD |
$38.47
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UMR Bronson Commercial |
$22.59
|
| Rate for Payer: UMR Bronson Commercial |
$55.74
|
| Rate for Payer: UMR Bronson Commercial |
$13.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.80
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$17,114.96
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$16,299.96 |
| Max. Negotiated Rate |
$17,114.96 |
| Rate for Payer: BCBS Complete |
$17,114.96
|
| Rate for Payer: Mclaren Medicaid |
$16,299.96
|
| Rate for Payer: Meridian Medicaid |
$17,114.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,299.96
|
| Rate for Payer: UHC Medicaid |
$16,299.96
|
| Rate for Payer: UHCCP Medicaid |
$16,299.96
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$32,912.13
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$31,344.88 |
| Max. Negotiated Rate |
$32,912.13 |
| Rate for Payer: BCBS Complete |
$32,912.13
|
| Rate for Payer: Mclaren Medicaid |
$31,344.88
|
| Rate for Payer: Meridian Medicaid |
$32,912.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,344.88
|
| Rate for Payer: UHC Medicaid |
$31,344.88
|
| Rate for Payer: UHCCP Medicaid |
$31,344.88
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$20,280.20
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$19,314.48 |
| Max. Negotiated Rate |
$20,280.20 |
| Rate for Payer: BCBS Complete |
$20,280.20
|
| Rate for Payer: Mclaren Medicaid |
$19,314.48
|
| Rate for Payer: Meridian Medicaid |
$20,280.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,314.48
|
| Rate for Payer: UHC Medicaid |
$19,314.48
|
| Rate for Payer: UHCCP Medicaid |
$19,314.48
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$25,074.38
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$23,880.36 |
| Max. Negotiated Rate |
$25,074.38 |
| Rate for Payer: BCBS Complete |
$25,074.38
|
| Rate for Payer: Mclaren Medicaid |
$23,880.36
|
| Rate for Payer: Meridian Medicaid |
$25,074.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,880.36
|
| Rate for Payer: UHC Medicaid |
$23,880.36
|
| Rate for Payer: UHCCP Medicaid |
$23,880.36
|
|
|
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,755.46
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$4,279.91 |
| Rate for Payer: Aetna American Axle |
$3,091.05
|
| Rate for Payer: Aetna American Axle |
$1,545.52
|
| Rate for Payer: Aetna Commercial |
$2,021.07
|
| Rate for Payer: Aetna Commercial |
$4,042.14
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,545.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,091.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.58
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCN Commercial |
$14.42
|
| Rate for Payer: BCN Commercial |
$14.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: Cash Price |
$1,902.18
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cash Price |
$1,902.18
|
| Rate for Payer: Cofinity Advantage |
$3,328.82
|
| Rate for Payer: Cofinity Advantage |
$1,664.41
|
| Rate for Payer: Cofinity Commercial |
$2,044.85
|
| Rate for Payer: Cofinity Commercial |
$4,089.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,902.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,804.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$2,139.96
|
| Rate for Payer: Healthscope Commercial |
$4,279.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,328.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,664.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,783.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,566.59
|
| Rate for Payer: Mclaren Medicaid |
$4.46
|
| Rate for Payer: Mclaren Medicaid |
$4.46
|
| Rate for Payer: Mclaren Medicare |
$4.46
|
| Rate for Payer: Mclaren Medicare |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.68
|
| Rate for Payer: Meridian Medicaid |
$4.68
|
| Rate for Payer: Meridian Medicaid |
$4.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,021.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,042.14
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,566.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,783.30
|
| Rate for Payer: PACE Medicare |
$4.24
|
| Rate for Payer: PACE Medicare |
$4.24
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PHP Commercial |
$2,021.07
|
| Rate for Payer: PHP Commercial |
$4,042.14
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.04
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health SBD |
$1,497.97
|
| Rate for Payer: Priority Health SBD |
$2,995.94
|
| Rate for Payer: Priority Health Tiered Network |
$11.23
|
| Rate for Payer: Priority Health Tiered Network |
$11.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.34
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.46
|
| Rate for Payer: UHC Exchange |
$7.34
|
| Rate for Payer: UHC Exchange |
$7.34
|
| Rate for Payer: UHC Medicaid |
$2.33
|
| Rate for Payer: UHC Medicaid |
$2.33
|
| Rate for Payer: UHCCP Medicaid |
$2.33
|
| Rate for Payer: UHCCP Medicaid |
$2.33
|
| Rate for Payer: UMR Bronson Commercial |
$879.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,759.52
|
| Rate for Payer: VA VA |
$4.46
|
| Rate for Payer: VA VA |
$4.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,566.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,783.30
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$1,523.97
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$1,371.57 |
| Rate for Payer: Aetna American Axle |
$990.58
|
| Rate for Payer: Aetna Commercial |
$1,295.37
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.58
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCN Commercial |
$14.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cofinity Advantage |
$1,066.78
|
| Rate for Payer: Cofinity Commercial |
$1,310.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,219.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$1,371.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,066.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,142.98
|
| Rate for Payer: Mclaren Medicaid |
$4.46
|
| Rate for Payer: Mclaren Medicare |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.68
|
| Rate for Payer: Meridian Medicaid |
$4.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.37
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.98
|
| Rate for Payer: PACE Medicare |
$4.24
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PHP Commercial |
$1,295.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.04
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health SBD |
$960.10
|
| Rate for Payer: Priority Health Tiered Network |
$11.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.34
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.46
|
| Rate for Payer: UHC Exchange |
$7.34
|
| Rate for Payer: UHC Medicaid |
$2.33
|
| Rate for Payer: UHCCP Medicaid |
$2.33
|
| Rate for Payer: UMR Bronson Commercial |
$563.87
|
| Rate for Payer: VA VA |
$4.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,142.98
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$6,743.93
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$6,422.79 |
| Max. Negotiated Rate |
$6,743.93 |
| Rate for Payer: BCBS Complete |
$6,743.93
|
| Rate for Payer: Mclaren Medicaid |
$6,422.79
|
| Rate for Payer: Meridian Medicaid |
$6,743.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,422.79
|
| Rate for Payer: UHC Medicaid |
$6,422.79
|
| Rate for Payer: UHCCP Medicaid |
$6,422.79
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$10,124.67
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$9,642.54 |
| Max. Negotiated Rate |
$10,124.67 |
| Rate for Payer: BCBS Complete |
$10,124.67
|
| Rate for Payer: Mclaren Medicaid |
$9,642.54
|
| Rate for Payer: Meridian Medicaid |
$10,124.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,642.54
|
| Rate for Payer: UHC Medicaid |
$9,642.54
|
| Rate for Payer: UHCCP Medicaid |
$9,642.54
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$6,276.01
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$5,977.15 |
| Max. Negotiated Rate |
$6,276.01 |
| Rate for Payer: BCBS Complete |
$6,276.01
|
| Rate for Payer: Mclaren Medicaid |
$5,977.15
|
| Rate for Payer: Meridian Medicaid |
$6,276.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,977.15
|
| Rate for Payer: UHC Medicaid |
$5,977.15
|
| Rate for Payer: UHCCP Medicaid |
$5,977.15
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$9,747.55
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$9,283.38 |
| Max. Negotiated Rate |
$9,747.55 |
| Rate for Payer: BCBS Complete |
$9,747.55
|
| Rate for Payer: Mclaren Medicaid |
$9,283.38
|
| Rate for Payer: Meridian Medicaid |
$9,747.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,283.38
|
| Rate for Payer: UHC Medicaid |
$9,283.38
|
| Rate for Payer: UHCCP Medicaid |
$9,283.38
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$49,949.84
|
|
|
Service Code
|
MSDRG 056
|
| Min. Negotiated Rate |
$19,019.31 |
| Max. Negotiated Rate |
$49,949.84 |
| Rate for Payer: Aetna Medicare |
$20,821.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,025.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,025.41
|
| Rate for Payer: BCBS MAPPO |
$20,020.33
|
| Rate for Payer: BCBS Trust/PPO |
$49,949.84
|
| Rate for Payer: BCN Commercial |
$49,949.84
|
| Rate for Payer: BCN Medicare Advantage |
$20,020.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,020.33
|
| Rate for Payer: Mclaren Medicare |
$20,020.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,021.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,023.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,022.36
|
| Rate for Payer: Nomi Health Commercial |
$29,967.99
|
| Rate for Payer: PACE Medicare |
$19,019.31
|
| Rate for Payer: PACE SWMI |
$20,020.33
|
| Rate for Payer: PHP Medicare Advantage |
$20,020.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,453.34
|
| Rate for Payer: Priority Health Medicare |
$20,020.33
|
| Rate for Payer: Priority Health Tiered Network |
$29,962.67
|
| Rate for Payer: Railroad Medicare Medicare |
$20,020.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,866.53
|
| Rate for Payer: UHC Core |
$31,680.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,020.33
|
| Rate for Payer: UHC Exchange |
$25,872.36
|
| Rate for Payer: VA VA |
$20,020.33
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$36,789.83
|
|
|
Service Code
|
MSDRG 057
|
| Min. Negotiated Rate |
$10,856.31 |
| Max. Negotiated Rate |
$36,789.83 |
| Rate for Payer: Aetna Medicare |
$11,884.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,284.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,284.61
|
| Rate for Payer: BCBS MAPPO |
$11,427.69
|
| Rate for Payer: BCBS Trust/PPO |
$36,789.83
|
| Rate for Payer: BCN Commercial |
$36,789.83
|
| Rate for Payer: BCN Medicare Advantage |
$11,427.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,427.69
|
| Rate for Payer: Mclaren Medicare |
$11,427.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,999.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,141.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,570.46
|
| Rate for Payer: Nomi Health Commercial |
$16,713.24
|
| Rate for Payer: PACE Medicare |
$10,856.31
|
| Rate for Payer: PACE SWMI |
$11,427.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,427.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,887.84
|
| Rate for Payer: Priority Health Medicare |
$11,427.69
|
| Rate for Payer: Priority Health Tiered Network |
$16,710.27
|
| Rate for Payer: Railroad Medicare Medicare |
$11,427.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,118.28
|
| Rate for Payer: UHC Core |
$17,668.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,427.69
|
| Rate for Payer: UHC Exchange |
$14,429.10
|
| Rate for Payer: VA VA |
$11,427.69
|
|
|
DEIONIZED WATER
|
Facility
|
IP
|
$889.48
|
|
|
Service Code
|
NDC 09900000039
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$391.37 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna American Axle |
$578.16
|
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Advantage |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.58
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$622.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$667.11
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health SBD |
$560.37
|
| Rate for Payer: UMR Bronson Commercial |
$391.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.11
|
|
|
DEIONIZED WATER
|
Facility
|
OP
|
$889.48
|
|
|
Service Code
|
NDC 09900000039
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.11 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna American Axle |
$578.16
|
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna Medicare |
$444.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: BCBS Complete |
$355.79
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Advantage |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.58
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$622.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$711.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$667.11
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health SBD |
$560.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.16
|
| Rate for Payer: UHC Core |
$463.42
|
| Rate for Payer: UHC Exchange |
$349.57
|
| Rate for Payer: UMR Bronson Commercial |
$329.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.11
|
|
|
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR LIPS
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 15630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.74
|
| Rate for Payer: BCN Commercial |
$1,693.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
DEMECLOCYCLINE 150 MG TABLET
|
Facility
|
IP
|
$1,243.94
|
|
|
Service Code
|
NDC 42806014301
|
| Hospital Charge Code |
9726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$547.33 |
| Max. Negotiated Rate |
$1,119.55 |
| Rate for Payer: Aetna American Axle |
$808.56
|
| Rate for Payer: Aetna Commercial |
$1,057.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.56
|
| Rate for Payer: Cash Price |
$995.15
|
| Rate for Payer: Cofinity Advantage |
$870.76
|
| Rate for Payer: Cofinity Commercial |
$1,069.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$995.15
|
| Rate for Payer: Healthscope Commercial |
$1,119.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$870.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$932.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$932.96
|
| Rate for Payer: PHP Commercial |
$1,057.35
|
| Rate for Payer: Priority Health SBD |
$783.68
|
| Rate for Payer: UMR Bronson Commercial |
$547.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$932.96
|
|
|
DEMECLOCYCLINE 150 MG TABLET
|
Facility
|
OP
|
$1,243.94
|
|
|
Service Code
|
NDC 42806014301
|
| Hospital Charge Code |
9726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$460.26 |
| Max. Negotiated Rate |
$1,119.55 |
| Rate for Payer: Aetna American Axle |
$808.56
|
| Rate for Payer: Aetna Commercial |
$1,057.35
|
| Rate for Payer: Aetna Medicare |
$621.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.56
|
| Rate for Payer: BCBS Complete |
$497.58
|
| Rate for Payer: Cash Price |
$995.15
|
| Rate for Payer: Cofinity Advantage |
$870.76
|
| Rate for Payer: Cofinity Commercial |
$1,069.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$995.15
|
| Rate for Payer: Healthscope Commercial |
$1,119.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$870.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$932.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$995.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$932.96
|
| Rate for Payer: PHP Commercial |
$1,057.35
|
| Rate for Payer: Priority Health SBD |
$783.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.56
|
| Rate for Payer: UHC Core |
$648.09
|
| Rate for Payer: UHC Exchange |
$488.87
|
| Rate for Payer: UMR Bronson Commercial |
$460.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$932.96
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$8,340.65
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$7,506.59 |
| Rate for Payer: Aetna American Axle |
$5,421.42
|
| Rate for Payer: Aetna Commercial |
$7,089.55
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,421.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.89
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS Trust/PPO |
$95.51
|
| Rate for Payer: BCN Commercial |
$95.51
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: Cash Price |
$6,672.52
|
| Rate for Payer: Cash Price |
$6,672.52
|
| Rate for Payer: Cofinity Advantage |
$5,838.45
|
| Rate for Payer: Cofinity Commercial |
$7,172.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,672.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Healthscope Commercial |
$7,506.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,838.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,255.49
|
| Rate for Payer: Mclaren Medicaid |
$29.51
|
| Rate for Payer: Mclaren Medicare |
$29.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.99
|
| Rate for Payer: Meridian Medicaid |
$30.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,089.55
|
| Rate for Payer: Nomi Health Commercial |
$88.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,255.49
|
| Rate for Payer: PACE Medicare |
$28.03
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PHP Commercial |
$7,089.55
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Priority Health SBD |
$5,254.61
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Core |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Exchange |
$48.61
|
| Rate for Payer: UHC Medicaid |
$15.43
|
| Rate for Payer: UHCCP Medicaid |
$15.43
|
| Rate for Payer: UMR Bronson Commercial |
$3,086.04
|
| Rate for Payer: VA VA |
$29.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,255.49
|
|
