|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$8,340.65
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,669.89 |
| 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 New Business (MI Preferred) |
$5,421.42
|
| 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: 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: Multiplan/Beech St/PHCS Commercial |
$7,089.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,255.49
|
| Rate for Payer: PHP Commercial |
$7,089.55
|
| Rate for Payer: Priority Health SBD |
$5,254.61
|
| Rate for Payer: UMR Bronson Commercial |
$3,669.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,255.49
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,581.28
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,455.76 |
| Max. Negotiated Rate |
$5,023.15 |
| Rate for Payer: Aetna American Axle |
$3,627.83
|
| Rate for Payer: Aetna Commercial |
$4,744.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,627.83
|
| Rate for Payer: Cash Price |
$4,465.02
|
| Rate for Payer: Cofinity Advantage |
$3,906.90
|
| Rate for Payer: Cofinity Commercial |
$4,799.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,465.02
|
| Rate for Payer: Healthscope Commercial |
$5,023.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,906.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,185.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,744.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,185.96
|
| Rate for Payer: PHP Commercial |
$4,744.09
|
| Rate for Payer: Priority Health SBD |
$3,516.21
|
| Rate for Payer: UMR Bronson Commercial |
$2,455.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,185.96
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,581.28
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$5,023.15 |
| Rate for Payer: Aetna American Axle |
$3,627.83
|
| Rate for Payer: Aetna American Axle |
$3,736.30
|
| Rate for Payer: Aetna Commercial |
$4,744.09
|
| Rate for Payer: Aetna Commercial |
$4,885.94
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,627.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,736.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.89
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS Trust/PPO |
$95.51
|
| Rate for Payer: BCBS Trust/PPO |
$95.51
|
| Rate for Payer: BCN Commercial |
$95.51
|
| Rate for Payer: BCN Commercial |
$95.51
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: Cash Price |
$4,598.53
|
| Rate for Payer: Cash Price |
$4,465.02
|
| Rate for Payer: Cash Price |
$4,465.02
|
| Rate for Payer: Cash Price |
$4,598.53
|
| Rate for Payer: Cofinity Advantage |
$4,023.71
|
| Rate for Payer: Cofinity Advantage |
$3,906.90
|
| Rate for Payer: Cofinity Commercial |
$4,799.90
|
| Rate for Payer: Cofinity Commercial |
$4,943.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,598.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,465.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Healthscope Commercial |
$5,023.15
|
| Rate for Payer: Healthscope Commercial |
$5,173.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,906.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,023.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,311.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,185.96
|
| Rate for Payer: Mclaren Medicaid |
$29.51
|
| Rate for Payer: Mclaren Medicaid |
$29.51
|
| Rate for Payer: Mclaren Medicare |
$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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.99
|
| Rate for Payer: Meridian Medicaid |
$30.99
|
| Rate for Payer: Meridian Medicaid |
$30.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,885.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,744.09
|
| Rate for Payer: Nomi Health Commercial |
$88.53
|
| Rate for Payer: Nomi Health Commercial |
$88.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,185.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,311.12
|
| Rate for Payer: PACE Medicare |
$28.03
|
| Rate for Payer: PACE Medicare |
$28.03
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PHP Commercial |
$4,744.09
|
| Rate for Payer: PHP Commercial |
$4,885.94
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.43
|
| 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 Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Priority Health SBD |
$3,621.34
|
| Rate for Payer: Priority Health SBD |
$3,516.21
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Core |
$48.61
|
| Rate for Payer: UHC Core |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Exchange |
$48.61
|
| Rate for Payer: UHC Exchange |
$48.61
|
| Rate for Payer: UHC Medicaid |
$15.43
|
| Rate for Payer: UHC Medicaid |
$15.43
|
| Rate for Payer: UHCCP Medicaid |
$15.43
|
| Rate for Payer: UHCCP Medicaid |
$15.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,065.07
|
| Rate for Payer: UMR Bronson Commercial |
$2,126.82
|
| Rate for Payer: VA VA |
$29.51
|
| Rate for Payer: VA VA |
$29.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,185.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,311.12
|
|
|
DENOSUMAB-BBDZ 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,487.46
|
|
|
Service Code
|
HCPCS Q5136
|
| Hospital Charge Code |
211425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$4,038.71 |
| Rate for Payer: Aetna American Axle |
$2,916.85
|
| Rate for Payer: Aetna Commercial |
$3,814.34
|
| Rate for Payer: Aetna Medicare |
$29.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,916.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.89
|
| Rate for Payer: BCBS Complete |
$15.33
|
| Rate for Payer: BCBS MAPPO |
$27.91
|
| Rate for Payer: BCBS Trust/PPO |
$89.37
|
| Rate for Payer: BCN Commercial |
$89.37
|
| Rate for Payer: BCN Medicare Advantage |
$27.91
|
| Rate for Payer: Cash Price |
$3,589.97
|
| Rate for Payer: Cash Price |
$3,589.97
|
| Rate for Payer: Cofinity Advantage |
$3,141.22
|
| Rate for Payer: Cofinity Commercial |
$3,859.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,589.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.91
|
| Rate for Payer: Healthscope Commercial |
$4,038.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,141.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,365.59
|
| Rate for Payer: Mclaren Medicaid |
$27.91
|
| Rate for Payer: Mclaren Medicare |
$27.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.31
|
| Rate for Payer: Meridian Medicaid |
$29.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,814.34
|
| Rate for Payer: Nomi Health Commercial |
$83.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,365.59
|
| Rate for Payer: PACE Medicare |
$26.51
|
| Rate for Payer: PACE SWMI |
$27.91
|
| Rate for Payer: PHP Commercial |
$3,814.34
|
| Rate for Payer: PHP Medicare Advantage |
$27.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$86.84
|
| Rate for Payer: Priority Health Medicare |
$27.91
|
| Rate for Payer: Priority Health SBD |
$2,827.10
|
| Rate for Payer: Priority Health Tiered Network |
$69.47
|
| Rate for Payer: Railroad Medicare Medicare |
$27.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.58
|
| Rate for Payer: UHC Core |
$46.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.91
|
| Rate for Payer: UHC Exchange |
$46.58
|
| Rate for Payer: UHC Medicaid |
$14.60
|
| Rate for Payer: UHCCP Medicaid |
$14.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,660.36
|
| Rate for Payer: VA VA |
$27.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,365.59
|
|
|
DENOSUMAB-BBDZ 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,487.46
|
|
|
Service Code
|
HCPCS Q5136
|
| Hospital Charge Code |
211425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,974.48 |
| Max. Negotiated Rate |
$4,038.71 |
| Rate for Payer: Aetna American Axle |
$2,916.85
|
| Rate for Payer: Aetna Commercial |
$3,814.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,916.85
|
| Rate for Payer: Cash Price |
$3,589.97
|
| Rate for Payer: Cofinity Advantage |
$3,141.22
|
| Rate for Payer: Cofinity Commercial |
$3,859.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,589.97
|
| Rate for Payer: Healthscope Commercial |
$4,038.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,141.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,365.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,814.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,365.59
|
| Rate for Payer: PHP Commercial |
$3,814.34
|
| Rate for Payer: Priority Health SBD |
$2,827.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,974.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,365.59
|
|
|
DENOSUMAB-BMWO 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,924.39
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
211791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$7,131.95 |
| Rate for Payer: Aetna American Axle |
$5,150.85
|
| Rate for Payer: Aetna Commercial |
$6,735.73
|
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,150.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.76
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: BCBS MAPPO |
$26.21
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$86.88
|
| Rate for Payer: BCN Medicare Advantage |
$26.21
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cofinity Advantage |
$5,547.07
|
| Rate for Payer: Cofinity Commercial |
$6,814.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,339.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$7,131.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,547.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,943.29
|
| Rate for Payer: Mclaren Medicaid |
$26.21
|
| Rate for Payer: Mclaren Medicare |
$26.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.52
|
| Rate for Payer: Meridian Medicaid |
$27.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,735.73
|
| Rate for Payer: Nomi Health Commercial |
$78.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,943.29
|
| Rate for Payer: PACE Medicare |
$24.90
|
| Rate for Payer: PACE SWMI |
$26.21
|
| Rate for Payer: PHP Commercial |
$6,735.73
|
| Rate for Payer: PHP Medicare Advantage |
$26.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.72
|
| Rate for Payer: Priority Health Medicare |
$26.21
|
| Rate for Payer: Priority Health SBD |
$4,992.37
|
| Rate for Payer: Priority Health Tiered Network |
$70.98
|
| Rate for Payer: Railroad Medicare Medicare |
$26.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.41
|
| Rate for Payer: UHC Core |
$46.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.21
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$13.71
|
| Rate for Payer: UHCCP Medicaid |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$2,932.02
|
| Rate for Payer: VA VA |
$26.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,943.29
|
|
|
DENOSUMAB-BMWO 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,924.39
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
211791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,486.73 |
| Max. Negotiated Rate |
$7,131.95 |
| Rate for Payer: Aetna American Axle |
$5,150.85
|
| Rate for Payer: Aetna Commercial |
$6,735.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,150.85
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cofinity Advantage |
$5,547.07
|
| Rate for Payer: Cofinity Commercial |
$6,814.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,339.51
|
| Rate for Payer: Healthscope Commercial |
$7,131.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,547.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,943.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,735.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,943.29
|
| Rate for Payer: PHP Commercial |
$6,735.73
|
| Rate for Payer: Priority Health SBD |
$4,992.37
|
| Rate for Payer: UMR Bronson Commercial |
$3,486.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,943.29
|
|
|
DENOSUMAB-BMWO 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,825.03
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
211788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,123.01 |
| Max. Negotiated Rate |
$4,342.53 |
| Rate for Payer: Aetna American Axle |
$3,136.27
|
| Rate for Payer: Aetna Commercial |
$4,101.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.27
|
| Rate for Payer: Cash Price |
$3,860.02
|
| Rate for Payer: Cofinity Advantage |
$3,377.52
|
| Rate for Payer: Cofinity Commercial |
$4,149.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,860.02
|
| Rate for Payer: Healthscope Commercial |
$4,342.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,377.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,618.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,618.77
|
| Rate for Payer: PHP Commercial |
$4,101.28
|
| Rate for Payer: Priority Health SBD |
$3,039.77
|
| Rate for Payer: UMR Bronson Commercial |
$2,123.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,618.77
|
|
|
DENOSUMAB-BMWO 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,825.03
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
211788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$4,342.53 |
| Rate for Payer: Aetna American Axle |
$3,136.27
|
| Rate for Payer: Aetna Commercial |
$4,101.28
|
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.76
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: BCBS MAPPO |
$26.21
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$86.88
|
| Rate for Payer: BCN Medicare Advantage |
$26.21
|
| Rate for Payer: Cash Price |
$3,860.02
|
| Rate for Payer: Cash Price |
$3,860.02
|
| Rate for Payer: Cofinity Advantage |
$3,377.52
|
| Rate for Payer: Cofinity Commercial |
$4,149.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,860.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$4,342.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,377.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,618.77
|
| Rate for Payer: Mclaren Medicaid |
$26.21
|
| Rate for Payer: Mclaren Medicare |
$26.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.52
|
| Rate for Payer: Meridian Medicaid |
$27.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.28
|
| Rate for Payer: Nomi Health Commercial |
$78.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,618.77
|
| Rate for Payer: PACE Medicare |
$24.90
|
| Rate for Payer: PACE SWMI |
$26.21
|
| Rate for Payer: PHP Commercial |
$4,101.28
|
| Rate for Payer: PHP Medicare Advantage |
$26.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.72
|
| Rate for Payer: Priority Health Medicare |
$26.21
|
| Rate for Payer: Priority Health SBD |
$3,039.77
|
| Rate for Payer: Priority Health Tiered Network |
$70.98
|
| Rate for Payer: Railroad Medicare Medicare |
$26.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.41
|
| Rate for Payer: UHC Core |
$46.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.21
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$13.71
|
| Rate for Payer: UHCCP Medicaid |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,785.26
|
| Rate for Payer: VA VA |
$26.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,618.77
|
|
|
DENTAL AND ORAL DISEASES WITH CC
|
Facility
|
IP
|
$21,090.60
|
|
|
Service Code
|
MSDRG 158
|
| Min. Negotiated Rate |
$7,791.26 |
| Max. Negotiated Rate |
$21,090.60 |
| Rate for Payer: Aetna Medicare |
$8,529.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,251.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,251.66
|
| Rate for Payer: BCBS MAPPO |
$8,201.33
|
| Rate for Payer: BCBS Trust/PPO |
$21,090.60
|
| Rate for Payer: BCN Commercial |
$21,090.60
|
| Rate for Payer: BCN Medicare Advantage |
$8,201.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,201.33
|
| Rate for Payer: Mclaren Medicare |
$8,201.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,611.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,431.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,021.46
|
| Rate for Payer: Nomi Health Commercial |
$11,736.42
|
| Rate for Payer: PACE Medicare |
$7,791.26
|
| Rate for Payer: PACE SWMI |
$8,201.33
|
| Rate for Payer: PHP Medicare Advantage |
$8,201.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,667.92
|
| Rate for Payer: Priority Health Medicare |
$8,201.33
|
| Rate for Payer: Priority Health Tiered Network |
$11,734.34
|
| Rate for Payer: Railroad Medicare Medicare |
$8,201.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,829.74
|
| Rate for Payer: UHC Core |
$12,406.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,201.33
|
| Rate for Payer: UHC Exchange |
$10,132.44
|
| Rate for Payer: VA VA |
$8,201.33
|
|
|
DENTAL AND ORAL DISEASES WITH MCC
|
Facility
|
IP
|
$56,455.73
|
|
|
Service Code
|
MSDRG 157
|
| Min. Negotiated Rate |
$14,202.53 |
| Max. Negotiated Rate |
$56,455.73 |
| Rate for Payer: Aetna Medicare |
$15,548.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,687.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,687.54
|
| Rate for Payer: BCBS MAPPO |
$14,950.03
|
| Rate for Payer: BCBS Trust/PPO |
$56,455.73
|
| Rate for Payer: BCN Commercial |
$56,455.73
|
| Rate for Payer: BCN Medicare Advantage |
$14,950.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,950.03
|
| Rate for Payer: Mclaren Medicare |
$14,950.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,697.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,192.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,445.03
|
| Rate for Payer: Nomi Health Commercial |
$22,146.72
|
| Rate for Payer: PACE Medicare |
$14,202.53
|
| Rate for Payer: PACE SWMI |
$14,950.03
|
| Rate for Payer: PHP Medicare Advantage |
$14,950.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,678.49
|
| Rate for Payer: Priority Health Medicare |
$14,950.03
|
| Rate for Payer: Priority Health Tiered Network |
$22,142.79
|
| Rate for Payer: Railroad Medicare Medicare |
$14,950.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,983.84
|
| Rate for Payer: UHC Core |
$23,412.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,950.03
|
| Rate for Payer: UHC Exchange |
$19,120.00
|
| Rate for Payer: VA VA |
$14,950.03
|
|
|
DENTAL AND ORAL DISEASES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,087.07
|
|
|
Service Code
|
MSDRG 159
|
| Min. Negotiated Rate |
$6,192.04 |
| Max. Negotiated Rate |
$15,087.07 |
| Rate for Payer: Aetna Medicare |
$6,778.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,147.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,147.43
|
| Rate for Payer: BCBS MAPPO |
$6,517.94
|
| Rate for Payer: BCBS Trust/PPO |
$15,087.07
|
| Rate for Payer: BCN Commercial |
$15,087.07
|
| Rate for Payer: BCN Medicare Advantage |
$6,517.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,517.94
|
| Rate for Payer: Mclaren Medicare |
$6,517.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,843.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,495.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,169.73
|
| Rate for Payer: Nomi Health Commercial |
$9,139.65
|
| Rate for Payer: PACE Medicare |
$6,192.04
|
| Rate for Payer: PACE SWMI |
$6,517.94
|
| Rate for Payer: PHP Medicare Advantage |
$6,517.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,422.54
|
| Rate for Payer: Priority Health Medicare |
$6,517.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,138.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6,517.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,548.55
|
| Rate for Payer: UHC Core |
$9,661.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,517.94
|
| Rate for Payer: UHC Exchange |
$7,890.56
|
| Rate for Payer: VA VA |
$6,517.94
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$3,490.30
|
|
|
Service Code
|
APR-DRG 1141
|
| Min. Negotiated Rate |
$3,324.10 |
| Max. Negotiated Rate |
$3,490.30 |
| Rate for Payer: BCBS Complete |
$3,490.30
|
| Rate for Payer: Mclaren Medicaid |
$3,324.10
|
| Rate for Payer: Meridian Medicaid |
$3,490.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,324.10
|
| Rate for Payer: UHC Medicaid |
$3,324.10
|
| Rate for Payer: UHCCP Medicaid |
$3,324.10
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$16,050.19
|
|
|
Service Code
|
APR-DRG 1144
|
| Min. Negotiated Rate |
$15,285.90 |
| Max. Negotiated Rate |
$16,050.19 |
| Rate for Payer: BCBS Complete |
$16,050.19
|
| Rate for Payer: Mclaren Medicaid |
$15,285.90
|
| Rate for Payer: Meridian Medicaid |
$16,050.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,285.90
|
| Rate for Payer: UHC Medicaid |
$15,285.90
|
| Rate for Payer: UHCCP Medicaid |
$15,285.90
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$6,582.91
|
|
|
Service Code
|
APR-DRG 1143
|
| Min. Negotiated Rate |
$6,269.44 |
| Max. Negotiated Rate |
$6,582.91 |
| Rate for Payer: BCBS Complete |
$6,582.91
|
| Rate for Payer: Mclaren Medicaid |
$6,269.44
|
| Rate for Payer: Meridian Medicaid |
$6,582.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,269.44
|
| Rate for Payer: UHC Medicaid |
$6,269.44
|
| Rate for Payer: UHCCP Medicaid |
$6,269.44
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$3,580.50
|
|
|
Service Code
|
APR-DRG 1142
|
| Min. Negotiated Rate |
$3,410.00 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: BCBS Complete |
$3,580.50
|
| Rate for Payer: Mclaren Medicaid |
$3,410.00
|
| Rate for Payer: Meridian Medicaid |
$3,580.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,410.00
|
| Rate for Payer: UHC Medicaid |
$3,410.00
|
| Rate for Payer: UHCCP Medicaid |
$3,410.00
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$5,347.44
|
|
|
Service Code
|
APR-DRG 7513
|
| Min. Negotiated Rate |
$5,092.80 |
| Max. Negotiated Rate |
$5,347.44 |
| Rate for Payer: BCBS Complete |
$5,347.44
|
| Rate for Payer: Mclaren Medicaid |
$5,092.80
|
| Rate for Payer: Meridian Medicaid |
$5,347.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,092.80
|
| Rate for Payer: UHC Medicaid |
$5,092.80
|
| Rate for Payer: UHCCP Medicaid |
$5,092.80
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$3,484.25
|
|
|
Service Code
|
APR-DRG 7512
|
| Min. Negotiated Rate |
$3,318.33 |
| Max. Negotiated Rate |
$3,484.25 |
| Rate for Payer: BCBS Complete |
$3,484.25
|
| Rate for Payer: Mclaren Medicaid |
$3,318.33
|
| Rate for Payer: Meridian Medicaid |
$3,484.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,318.33
|
| Rate for Payer: UHC Medicaid |
$3,318.33
|
| Rate for Payer: UHCCP Medicaid |
$3,318.33
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$3,032.68
|
|
|
Service Code
|
APR-DRG 7511
|
| Min. Negotiated Rate |
$2,888.26 |
| Max. Negotiated Rate |
$3,032.68 |
| Rate for Payer: BCBS Complete |
$3,032.68
|
| Rate for Payer: Mclaren Medicaid |
$2,888.26
|
| Rate for Payer: Meridian Medicaid |
$3,032.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,888.26
|
| Rate for Payer: UHC Medicaid |
$2,888.26
|
| Rate for Payer: UHCCP Medicaid |
$2,888.26
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$11,087.13
|
|
|
Service Code
|
APR-DRG 7514
|
| Min. Negotiated Rate |
$10,559.17 |
| Max. Negotiated Rate |
$11,087.13 |
| Rate for Payer: BCBS Complete |
$11,087.13
|
| Rate for Payer: Mclaren Medicaid |
$10,559.17
|
| Rate for Payer: Meridian Medicaid |
$11,087.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,559.17
|
| Rate for Payer: UHC Medicaid |
$10,559.17
|
| Rate for Payer: UHCCP Medicaid |
$10,559.17
|
|
|
DEPRESSIVE NEUROSES
|
Facility
|
IP
|
$15,336.67
|
|
|
Service Code
|
MSDRG 881
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$15,336.67 |
| Rate for Payer: Aetna Medicare |
$8,799.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,576.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,576.79
|
| Rate for Payer: BCBS MAPPO |
$8,461.43
|
| Rate for Payer: BCBS Trust/PPO |
$11,469.03
|
| Rate for Payer: BCN Commercial |
$11,469.03
|
| Rate for Payer: BCN Medicare Advantage |
$8,461.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,461.43
|
| Rate for Payer: Mclaren Medicare |
$8,461.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,884.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,730.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,307.57
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$8,038.36
|
| Rate for Payer: PACE SWMI |
$8,461.43
|
| Rate for Payer: PHP Medicare Advantage |
$8,461.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,169.32
|
| Rate for Payer: Priority Health Medicare |
$8,461.43
|
| Rate for Payer: Priority Health Tiered Network |
$12,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$8,461.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,336.67
|
| Rate for Payer: UHC Core |
$12,831.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,461.43
|
| Rate for Payer: UHC Exchange |
$10,478.80
|
| Rate for Payer: VA VA |
$8,461.43
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
OP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.88 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna American Axle |
$56.00
|
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: Aetna Medicare |
$43.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.00
|
| Rate for Payer: BCBS Complete |
$34.46
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Advantage |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.62
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health SBD |
$54.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.00
|
| Rate for Payer: UHC Core |
$44.89
|
| Rate for Payer: UHC Exchange |
$33.86
|
| Rate for Payer: UMR Bronson Commercial |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.62
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
IP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna American Axle |
$56.00
|
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.00
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Advantage |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.62
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health SBD |
$54.28
|
| Rate for Payer: UMR Bronson Commercial |
$37.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.62
|
|
|
DERMAPLANNING
|
Professional
|
Both
|
$42.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
DESFLURANE 100 % INHALATION LIQUID
|
Facility
|
OP
|
$1,137.72
|
|
|
Service Code
|
NDC 10019064434
|
| Hospital Charge Code |
9747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$420.96 |
| Max. Negotiated Rate |
$1,023.95 |
| Rate for Payer: Aetna American Axle |
$739.52
|
| Rate for Payer: Aetna Commercial |
$967.06
|
| Rate for Payer: Aetna Medicare |
$568.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.52
|
| Rate for Payer: BCBS Complete |
$455.09
|
| Rate for Payer: Cash Price |
$910.18
|
| Rate for Payer: Cofinity Advantage |
$796.40
|
| Rate for Payer: Cofinity Commercial |
$978.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.18
|
| Rate for Payer: Healthscope Commercial |
$1,023.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$796.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$910.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$853.29
|
| Rate for Payer: PHP Commercial |
$967.06
|
| Rate for Payer: Priority Health SBD |
$716.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.52
|
| Rate for Payer: UHC Core |
$592.75
|
| Rate for Payer: UHC Exchange |
$447.12
|
| Rate for Payer: UMR Bronson Commercial |
$420.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.29
|
|
