|
DIABETES
|
Facility
|
IP
|
$6,449.13
|
|
|
Service Code
|
APR-DRG 4203
|
| Min. Negotiated Rate |
$6,142.03 |
| Max. Negotiated Rate |
$6,449.13 |
| Rate for Payer: BCBS Complete |
$6,449.13
|
| Rate for Payer: Mclaren Medicaid |
$6,142.03
|
| Rate for Payer: Meridian Medicaid |
$6,449.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,142.03
|
| Rate for Payer: UHC Medicaid |
$6,142.03
|
| Rate for Payer: UHCCP Medicaid |
$6,142.03
|
|
|
DIABETES
|
Facility
|
IP
|
$9,928.54
|
|
|
Service Code
|
APR-DRG 4204
|
| Min. Negotiated Rate |
$9,455.75 |
| Max. Negotiated Rate |
$9,928.54 |
| Rate for Payer: BCBS Complete |
$9,928.54
|
| Rate for Payer: Mclaren Medicaid |
$9,455.75
|
| Rate for Payer: Meridian Medicaid |
$9,928.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,455.75
|
| Rate for Payer: UHC Medicaid |
$9,455.75
|
| Rate for Payer: UHCCP Medicaid |
$9,455.75
|
|
|
DIABETES
|
Facility
|
IP
|
$3,193.09
|
|
|
Service Code
|
APR-DRG 4201
|
| Min. Negotiated Rate |
$3,041.04 |
| Max. Negotiated Rate |
$3,193.09 |
| Rate for Payer: BCBS Complete |
$3,193.09
|
| Rate for Payer: Mclaren Medicaid |
$3,041.04
|
| Rate for Payer: Meridian Medicaid |
$3,193.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,041.04
|
| Rate for Payer: UHC Medicaid |
$3,041.04
|
| Rate for Payer: UHCCP Medicaid |
$3,041.04
|
|
|
DIABETES
|
Facility
|
IP
|
$4,488.48
|
|
|
Service Code
|
APR-DRG 4202
|
| Min. Negotiated Rate |
$4,274.75 |
| Max. Negotiated Rate |
$4,488.48 |
| Rate for Payer: BCBS Complete |
$4,488.48
|
| Rate for Payer: Mclaren Medicaid |
$4,274.75
|
| Rate for Payer: Meridian Medicaid |
$4,488.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,274.75
|
| Rate for Payer: UHC Medicaid |
$4,274.75
|
| Rate for Payer: UHCCP Medicaid |
$4,274.75
|
|
|
DIABETES WITH CC
|
Facility
|
IP
|
$14,608.06
|
|
|
Service Code
|
MSDRG 638
|
| Min. Negotiated Rate |
$7,683.23 |
| Max. Negotiated Rate |
$14,608.06 |
| Rate for Payer: Aetna Medicare |
$8,411.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,109.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,109.51
|
| Rate for Payer: BCBS MAPPO |
$8,087.61
|
| Rate for Payer: BCBS Trust/PPO |
$14,332.17
|
| Rate for Payer: BCN Commercial |
$14,332.17
|
| Rate for Payer: BCN Medicare Advantage |
$8,087.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,087.61
|
| Rate for Payer: Mclaren Medicare |
$8,087.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,491.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,300.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,896.37
|
| Rate for Payer: Nomi Health Commercial |
$11,560.98
|
| Rate for Payer: PACE Medicare |
$7,683.23
|
| Rate for Payer: PACE SWMI |
$8,087.61
|
| Rate for Payer: PHP Medicare Advantage |
$8,087.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,448.66
|
| Rate for Payer: Priority Health Medicare |
$8,087.61
|
| Rate for Payer: Priority Health Tiered Network |
$11,558.93
|
| Rate for Payer: Railroad Medicare Medicare |
$8,087.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,608.06
|
| Rate for Payer: UHC Core |
$12,221.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,087.61
|
| Rate for Payer: UHC Exchange |
$9,980.98
|
| Rate for Payer: VA VA |
$8,087.61
|
|
|
DIABETES WITH MCC
|
Facility
|
IP
|
$23,418.21
|
|
|
Service Code
|
MSDRG 637
|
| Min. Negotiated Rate |
$11,977.26 |
| Max. Negotiated Rate |
$23,418.21 |
| Rate for Payer: Aetna Medicare |
$13,111.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,759.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,759.55
|
| Rate for Payer: BCBS MAPPO |
$12,607.64
|
| Rate for Payer: BCBS Trust/PPO |
$22,712.96
|
| Rate for Payer: BCN Commercial |
$22,712.96
|
| Rate for Payer: BCN Medicare Advantage |
$12,607.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,607.64
|
| Rate for Payer: Mclaren Medicare |
$12,607.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,238.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,498.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,868.40
|
| Rate for Payer: Nomi Health Commercial |
$18,533.43
|
| Rate for Payer: PACE Medicare |
$11,977.26
|
| Rate for Payer: PACE SWMI |
$12,607.64
|
| Rate for Payer: PHP Medicare Advantage |
$12,607.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,162.68
|
| Rate for Payer: Priority Health Medicare |
$12,607.64
|
| Rate for Payer: Priority Health Tiered Network |
$18,530.14
|
| Rate for Payer: Railroad Medicare Medicare |
$12,607.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,418.21
|
| Rate for Payer: UHC Core |
$19,592.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,607.64
|
| Rate for Payer: UHC Exchange |
$16,000.53
|
| Rate for Payer: VA VA |
$12,607.64
|
|
|
DIABETES WITHOUT CC/MCC
|
Facility
|
IP
|
$11,609.03
|
|
|
Service Code
|
MSDRG 639
|
| Min. Negotiated Rate |
$5,498.48 |
| Max. Negotiated Rate |
$11,609.03 |
| Rate for Payer: Aetna Medicare |
$6,019.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,234.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,234.84
|
| Rate for Payer: BCBS MAPPO |
$5,787.87
|
| Rate for Payer: BCBS Trust/PPO |
$11,609.03
|
| Rate for Payer: BCN Commercial |
$11,609.03
|
| Rate for Payer: BCN Medicare Advantage |
$5,787.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,787.87
|
| Rate for Payer: Mclaren Medicare |
$5,787.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,077.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,656.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,366.66
|
| Rate for Payer: Nomi Health Commercial |
$8,013.48
|
| Rate for Payer: PACE Medicare |
$5,498.48
|
| Rate for Payer: PACE SWMI |
$5,787.87
|
| Rate for Payer: PHP Medicare Advantage |
$5,787.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,015.07
|
| Rate for Payer: Priority Health Medicare |
$5,787.87
|
| Rate for Payer: Priority Health Tiered Network |
$8,012.06
|
| Rate for Payer: Railroad Medicare Medicare |
$5,787.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,125.56
|
| Rate for Payer: UHC Core |
$8,471.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,787.87
|
| Rate for Payer: UHC Exchange |
$6,918.30
|
| Rate for Payer: VA VA |
$5,787.87
|
|
|
DIAGNOSTIC BONE MARROW; BIOPSY(IES)
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 38221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.89
|
| Rate for Payer: BCN Commercial |
$2,031.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
DIALYSATE RFP-401 (K-4/CA-3) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 09900000034
|
| Hospital Charge Code |
150776
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Advantage |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.60
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.72
|
| Rate for Payer: UHC Core |
$108.78
|
| Rate for Payer: UHC Exchange |
$82.06
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-401 (K-4/CA-3) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 09900000034
|
| Hospital Charge Code |
150776
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Advantage |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.60
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-402 (K-0/CA-3) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 09900000035
|
| Hospital Charge Code |
150777
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Advantage |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.60
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-402 (K-0/CA-3) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 09900000035
|
| Hospital Charge Code |
150777
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Advantage |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.60
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.72
|
| Rate for Payer: UHC Core |
$108.78
|
| Rate for Payer: UHC Exchange |
$82.06
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-453 (K-2/CA-0) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 099000000036
|
| Hospital Charge Code |
150773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Advantage |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.60
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-453 (K-2/CA-0) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 099000000036
|
| Hospital Charge Code |
150773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Advantage |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.60
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.72
|
| Rate for Payer: UHC Core |
$108.78
|
| Rate for Payer: UHC Exchange |
$82.06
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-456 (K-4/CA-0) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 09900000849
|
| Hospital Charge Code |
180369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Advantage |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.60
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-456 (K-4/CA-0) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 09900000849
|
| Hospital Charge Code |
180369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Advantage |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.60
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.72
|
| Rate for Payer: UHC Core |
$108.78
|
| Rate for Payer: UHC Exchange |
$82.06
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSIS CIRCUIT PERMANENT VASCULAR EMBOLIZATION OR OCCLUSION (INCLUDING MAIN CIRCUIT OR ANY ACCESSORY VEINS), ENDOVASCULAR, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO COMPLETE THE INTERVENTION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,444.03
|
|
|
Service Code
|
CPT 36909
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,444.03 |
| Max. Negotiated Rate |
$8,444.03 |
| Rate for Payer: BCBS Trust/PPO |
$8,444.03
|
| Rate for Payer: BCN Commercial |
$8,444.03
|
|
|
DIATRIZOATE MEGLUMINE 18 % URETHRAL SOLUTION
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
9823
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Advantage |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UMR Bronson Commercial |
$33.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
DIATRIZOATE MEGLUMINE 18 % URETHRAL SOLUTION
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
9823
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Advantage |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$39.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
DIAZEPAM 2 MG TABLET
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 51079028401
|
| Hospital Charge Code |
2404
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna American Axle |
$1.01
|
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: Aetna Medicare |
$0.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.01
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cofinity Advantage |
$1.09
|
| Rate for Payer: Cofinity Commercial |
$1.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.25
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.17
|
| Rate for Payer: PHP Commercial |
$1.33
|
| Rate for Payer: Priority Health SBD |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.01
|
| Rate for Payer: UHC Core |
$0.81
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UMR Bronson Commercial |
$0.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.17
|
|
|
DIAZEPAM 2 MG TABLET
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 51079028401
|
| Hospital Charge Code |
2404
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna American Axle |
$1.01
|
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.01
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cofinity Advantage |
$1.09
|
| Rate for Payer: Cofinity Commercial |
$1.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.25
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.17
|
| Rate for Payer: PHP Commercial |
$1.33
|
| Rate for Payer: Priority Health SBD |
$0.98
|
| Rate for Payer: UMR Bronson Commercial |
$0.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.17
|
|
|
DIAZEPAM 2 MG TABLET
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
NDC 00172392560
|
| Hospital Charge Code |
2404
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna American Axle |
$36.66
|
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna Medicare |
$28.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: BCBS Complete |
$22.56
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Advantage |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health SBD |
$35.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.66
|
| Rate for Payer: UHC Core |
$29.38
|
| Rate for Payer: UHC Exchange |
$22.17
|
| Rate for Payer: UMR Bronson Commercial |
$20.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
DIAZEPAM 2 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 51079028420
|
| Hospital Charge Code |
2404
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UMR Bronson Commercial |
$68.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
DIAZEPAM 2 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 51079028420
|
| Hospital Charge Code |
2404
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.81
|
| Rate for Payer: UHC Core |
$80.81
|
| Rate for Payer: UHC Exchange |
$60.95
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
DIAZEPAM 2 MG TABLET
|
Facility
|
IP
|
$307.85
|
|
|
Service Code
|
NDC 51862094101
|
| Hospital Charge Code |
2404
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna American Axle |
$200.10
|
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.10
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Advantage |
$215.50
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.89
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: Priority Health SBD |
$193.95
|
| Rate for Payer: UMR Bronson Commercial |
$135.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
