|
DIGESTIVE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$16,725.89
|
|
|
Service Code
|
MSDRG 376
|
| Min. Negotiated Rate |
$7,906.48 |
| Max. Negotiated Rate |
$16,725.89 |
| Rate for Payer: Aetna Medicare |
$8,655.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,403.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,403.26
|
| Rate for Payer: BCBS MAPPO |
$8,322.61
|
| Rate for Payer: BCBS Trust/PPO |
$16,725.89
|
| Rate for Payer: BCN Commercial |
$16,725.89
|
| Rate for Payer: BCN Medicare Advantage |
$8,322.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,322.61
|
| Rate for Payer: Mclaren Medicare |
$8,322.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,738.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,571.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,154.87
|
| Rate for Payer: Nomi Health Commercial |
$11,923.47
|
| Rate for Payer: PACE Medicare |
$7,906.48
|
| Rate for Payer: PACE SWMI |
$8,322.61
|
| Rate for Payer: PHP Medicare Advantage |
$8,322.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,901.69
|
| Rate for Payer: Priority Health Medicare |
$8,322.61
|
| Rate for Payer: Priority Health Tiered Network |
$11,921.35
|
| Rate for Payer: Railroad Medicare Medicare |
$8,322.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,066.09
|
| Rate for Payer: UHC Core |
$12,604.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,322.61
|
| Rate for Payer: UHC Exchange |
$10,293.93
|
| Rate for Payer: VA VA |
$8,322.61
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 00143124001
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.84 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna American Axle |
$280.80
|
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: Aetna Medicare |
$216.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.80
|
| Rate for Payer: BCBS Complete |
$172.80
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cofinity Advantage |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$371.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.60
|
| Rate for Payer: Healthscope Commercial |
$388.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.00
|
| Rate for Payer: PHP Commercial |
$367.20
|
| Rate for Payer: Priority Health SBD |
$272.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.80
|
| Rate for Payer: UHC Core |
$225.07
|
| Rate for Payer: UHC Exchange |
$169.78
|
| Rate for Payer: UMR Bronson Commercial |
$159.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.00
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 00143124001
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.08 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna American Axle |
$280.80
|
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.80
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cofinity Advantage |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$371.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.60
|
| Rate for Payer: Healthscope Commercial |
$388.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.00
|
| Rate for Payer: PHP Commercial |
$367.20
|
| Rate for Payer: Priority Health SBD |
$272.16
|
| Rate for Payer: UMR Bronson Commercial |
$190.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.00
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
OP
|
$53.04
|
|
|
Service Code
|
NDC 00904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna American Axle |
$34.48
|
| Rate for Payer: Aetna Commercial |
$45.08
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Advantage |
$37.13
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.78
|
| Rate for Payer: PHP Commercial |
$45.08
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.48
|
| Rate for Payer: UHC Core |
$27.63
|
| Rate for Payer: UHC Exchange |
$20.84
|
| Rate for Payer: UMR Bronson Commercial |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.78
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 00143124101
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 00143124101
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
IP
|
$53.04
|
|
|
Service Code
|
NDC 00904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna American Axle |
$34.48
|
| Rate for Payer: Aetna Commercial |
$45.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Advantage |
$37.13
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.78
|
| Rate for Payer: PHP Commercial |
$45.08
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.78
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$16.88
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Advantage |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.86
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: UMR Bronson Commercial |
$7.43
|
| Rate for Payer: UMR Bronson Commercial |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$16.88
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna Medicare |
$10.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Trust/PPO |
$31.03
|
| Rate for Payer: BCBS Trust/PPO |
$31.03
|
| Rate for Payer: BCN Commercial |
$31.03
|
| Rate for Payer: BCN Commercial |
$31.03
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Advantage |
$11.82
|
| Rate for Payer: Cofinity Advantage |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.66
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.79
|
| Rate for Payer: UHC Core |
$15.79
|
| Rate for Payer: UHC Core |
$15.79
|
| Rate for Payer: UHC Exchange |
$15.79
|
| Rate for Payer: UHC Exchange |
$15.79
|
| Rate for Payer: UMR Bronson Commercial |
$6.25
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$567.08
|
|
|
Service Code
|
NDC 00054005746
|
| Hospital Charge Code |
43556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.52 |
| Max. Negotiated Rate |
$510.37 |
| Rate for Payer: Aetna American Axle |
$368.60
|
| Rate for Payer: Aetna Commercial |
$482.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.60
|
| Rate for Payer: Cash Price |
$453.66
|
| Rate for Payer: Cofinity Advantage |
$396.96
|
| Rate for Payer: Cofinity Commercial |
$487.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.66
|
| Rate for Payer: Healthscope Commercial |
$510.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$396.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$425.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.31
|
| Rate for Payer: PHP Commercial |
$482.02
|
| Rate for Payer: Priority Health SBD |
$357.26
|
| Rate for Payer: UMR Bronson Commercial |
$249.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$425.31
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$567.08
|
|
|
Service Code
|
NDC 00054005746
|
| Hospital Charge Code |
43556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$510.37 |
| Rate for Payer: Aetna American Axle |
$368.60
|
| Rate for Payer: Aetna Commercial |
$482.02
|
| Rate for Payer: Aetna Medicare |
$283.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.60
|
| Rate for Payer: BCBS Complete |
$226.83
|
| Rate for Payer: Cash Price |
$453.66
|
| Rate for Payer: Cofinity Advantage |
$396.96
|
| Rate for Payer: Cofinity Commercial |
$487.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.66
|
| Rate for Payer: Healthscope Commercial |
$510.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$396.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$425.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$453.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.31
|
| Rate for Payer: PHP Commercial |
$482.02
|
| Rate for Payer: Priority Health SBD |
$357.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.60
|
| Rate for Payer: UHC Core |
$295.45
|
| Rate for Payer: UHC Exchange |
$222.86
|
| Rate for Payer: UMR Bronson Commercial |
$209.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$425.31
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,027.14
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,291.94 |
| Max. Negotiated Rate |
$10,824.43 |
| Rate for Payer: Aetna American Axle |
$7,817.64
|
| Rate for Payer: Aetna Commercial |
$10,223.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,817.64
|
| Rate for Payer: Cash Price |
$9,621.71
|
| Rate for Payer: Cofinity Advantage |
$8,419.00
|
| Rate for Payer: Cofinity Commercial |
$10,343.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,621.71
|
| Rate for Payer: Healthscope Commercial |
$10,824.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,419.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,020.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,223.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,020.35
|
| Rate for Payer: PHP Commercial |
$10,223.07
|
| Rate for Payer: Priority Health SBD |
$7,577.10
|
| Rate for Payer: UMR Bronson Commercial |
$5,291.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,020.35
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,027.14
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,702.34 |
| Max. Negotiated Rate |
$16,754.73 |
| Rate for Payer: Aetna American Axle |
$7,817.64
|
| Rate for Payer: Aetna Commercial |
$10,223.07
|
| Rate for Payer: Aetna Medicare |
$5,373.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,817.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,458.74
|
| Rate for Payer: BCBS Complete |
$2,837.71
|
| Rate for Payer: BCBS MAPPO |
$5,166.99
|
| Rate for Payer: BCBS Trust/PPO |
$16,754.73
|
| Rate for Payer: BCN Commercial |
$16,754.73
|
| Rate for Payer: BCN Medicare Advantage |
$5,166.99
|
| Rate for Payer: Cash Price |
$9,621.71
|
| Rate for Payer: Cash Price |
$9,621.71
|
| Rate for Payer: Cofinity Advantage |
$8,419.00
|
| Rate for Payer: Cofinity Commercial |
$10,343.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,621.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,166.99
|
| Rate for Payer: Healthscope Commercial |
$10,824.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,419.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,020.35
|
| Rate for Payer: Mclaren Medicaid |
$5,166.99
|
| Rate for Payer: Mclaren Medicare |
$5,166.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,425.34
|
| Rate for Payer: Meridian Medicaid |
$5,425.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,942.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,683.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,223.07
|
| Rate for Payer: Nomi Health Commercial |
$15,500.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,020.35
|
| Rate for Payer: PACE Medicare |
$4,908.64
|
| Rate for Payer: PACE SWMI |
$5,166.99
|
| Rate for Payer: PHP Commercial |
$10,223.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,166.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,702.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,300.43
|
| Rate for Payer: Priority Health Medicare |
$5,166.99
|
| Rate for Payer: Priority Health SBD |
$7,577.10
|
| Rate for Payer: Priority Health Tiered Network |
$13,040.34
|
| Rate for Payer: Railroad Medicare Medicare |
$5,166.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,525.53
|
| Rate for Payer: UHC Core |
$8,525.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,166.99
|
| Rate for Payer: UHC Exchange |
$8,525.53
|
| Rate for Payer: UHC Medicaid |
$2,702.34
|
| Rate for Payer: UHCCP Medicaid |
$2,702.34
|
| Rate for Payer: UMR Bronson Commercial |
$4,450.04
|
| Rate for Payer: VA VA |
$5,166.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,020.35
|
|
|
DIGOXIN IV NEONATE 10 MCG/ML INJECTION
|
Facility
|
IP
|
$323.12
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
163536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.17 |
| Max. Negotiated Rate |
$290.81 |
| Rate for Payer: Aetna American Axle |
$210.03
|
| Rate for Payer: Aetna Commercial |
$274.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.03
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cofinity Advantage |
$226.18
|
| Rate for Payer: Cofinity Commercial |
$277.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.50
|
| Rate for Payer: Healthscope Commercial |
$290.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.34
|
| Rate for Payer: PHP Commercial |
$274.65
|
| Rate for Payer: Priority Health SBD |
$203.57
|
| Rate for Payer: UMR Bronson Commercial |
$142.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.34
|
|
|
DIGOXIN IV NEONATE 10 MCG/ML INJECTION
|
Facility
|
OP
|
$323.12
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
163536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$290.81 |
| Rate for Payer: Aetna American Axle |
$210.03
|
| Rate for Payer: Aetna Commercial |
$274.65
|
| Rate for Payer: Aetna Medicare |
$161.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.03
|
| Rate for Payer: BCBS Complete |
$129.25
|
| Rate for Payer: BCBS Trust/PPO |
$31.03
|
| Rate for Payer: BCN Commercial |
$31.03
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cofinity Advantage |
$226.18
|
| Rate for Payer: Cofinity Commercial |
$277.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.50
|
| Rate for Payer: Healthscope Commercial |
$290.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.34
|
| Rate for Payer: PHP Commercial |
$274.65
|
| Rate for Payer: Priority Health SBD |
$203.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.79
|
| Rate for Payer: UHC Core |
$15.79
|
| Rate for Payer: UHC Exchange |
$15.79
|
| Rate for Payer: UMR Bronson Commercial |
$119.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.34
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$200.73
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$180.66 |
| Rate for Payer: Aetna American Axle |
$130.47
|
| Rate for Payer: Aetna American Axle |
$118.09
|
| Rate for Payer: Aetna American Axle |
$269.34
|
| Rate for Payer: Aetna American Axle |
$117.42
|
| Rate for Payer: Aetna American Axle |
$108.95
|
| Rate for Payer: Aetna Commercial |
$142.47
|
| Rate for Payer: Aetna Commercial |
$154.43
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: Aetna Commercial |
$352.21
|
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.34
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cash Price |
$144.52
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cash Price |
$134.09
|
| Rate for Payer: Cofinity Advantage |
$117.33
|
| Rate for Payer: Cofinity Advantage |
$290.06
|
| Rate for Payer: Cofinity Advantage |
$126.45
|
| Rate for Payer: Cofinity Advantage |
$140.51
|
| Rate for Payer: Cofinity Advantage |
$127.18
|
| Rate for Payer: Cofinity Commercial |
$356.36
|
| Rate for Payer: Cofinity Commercial |
$144.14
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Healthscope Commercial |
$150.85
|
| Rate for Payer: Healthscope Commercial |
$162.59
|
| Rate for Payer: Healthscope Commercial |
$163.51
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$372.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.55
|
| Rate for Payer: PHP Commercial |
$154.43
|
| Rate for Payer: PHP Commercial |
$142.47
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: PHP Commercial |
$352.21
|
| Rate for Payer: PHP Commercial |
$153.55
|
| Rate for Payer: Priority Health SBD |
$126.46
|
| Rate for Payer: Priority Health SBD |
$261.05
|
| Rate for Payer: Priority Health SBD |
$113.81
|
| Rate for Payer: Priority Health SBD |
$105.59
|
| Rate for Payer: Priority Health SBD |
$114.46
|
| Rate for Payer: UMR Bronson Commercial |
$79.49
|
| Rate for Payer: UMR Bronson Commercial |
$182.32
|
| Rate for Payer: UMR Bronson Commercial |
$79.94
|
| Rate for Payer: UMR Bronson Commercial |
$73.75
|
| Rate for Payer: UMR Bronson Commercial |
$88.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.49
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$180.65
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.84 |
| Max. Negotiated Rate |
$185.07 |
| Rate for Payer: Aetna American Axle |
$117.42
|
| Rate for Payer: Aetna American Axle |
$130.47
|
| Rate for Payer: Aetna American Axle |
$269.34
|
| Rate for Payer: Aetna American Axle |
$108.95
|
| Rate for Payer: Aetna American Axle |
$283.51
|
| Rate for Payer: Aetna American Axle |
$118.09
|
| Rate for Payer: Aetna Commercial |
$370.74
|
| Rate for Payer: Aetna Commercial |
$352.21
|
| Rate for Payer: Aetna Commercial |
$154.43
|
| Rate for Payer: Aetna Commercial |
$142.47
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Aetna Medicare |
$83.81
|
| Rate for Payer: Aetna Medicare |
$90.33
|
| Rate for Payer: Aetna Medicare |
$90.84
|
| Rate for Payer: Aetna Medicare |
$218.09
|
| Rate for Payer: Aetna Medicare |
$207.19
|
| Rate for Payer: Aetna Medicare |
$100.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.47
|
| Rate for Payer: BCBS Complete |
$72.67
|
| Rate for Payer: BCBS Complete |
$72.26
|
| Rate for Payer: BCBS Complete |
$67.04
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS Complete |
$165.75
|
| Rate for Payer: BCBS Complete |
$174.47
|
| Rate for Payer: BCBS Trust/PPO |
$185.07
|
| Rate for Payer: BCBS Trust/PPO |
$185.07
|
| Rate for Payer: BCBS Trust/PPO |
$185.07
|
| Rate for Payer: BCBS Trust/PPO |
$185.07
|
| Rate for Payer: BCBS Trust/PPO |
$185.07
|
| Rate for Payer: BCBS Trust/PPO |
$185.07
|
| Rate for Payer: BCN Commercial |
$185.07
|
| Rate for Payer: BCN Commercial |
$185.07
|
| Rate for Payer: BCN Commercial |
$185.07
|
| Rate for Payer: BCN Commercial |
$185.07
|
| Rate for Payer: BCN Commercial |
$185.07
|
| Rate for Payer: BCN Commercial |
$185.07
|
| Rate for Payer: Cash Price |
$348.94
|
| Rate for Payer: Cash Price |
$134.09
|
| Rate for Payer: Cash Price |
$134.09
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cash Price |
$144.52
|
| Rate for Payer: Cash Price |
$144.52
|
| Rate for Payer: Cash Price |
$348.94
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cofinity Advantage |
$140.51
|
| Rate for Payer: Cofinity Advantage |
$127.18
|
| Rate for Payer: Cofinity Advantage |
$305.32
|
| Rate for Payer: Cofinity Advantage |
$117.33
|
| Rate for Payer: Cofinity Advantage |
$126.45
|
| Rate for Payer: Cofinity Advantage |
$290.06
|
| Rate for Payer: Cofinity Commercial |
$356.36
|
| Rate for Payer: Cofinity Commercial |
$144.14
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$375.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Healthscope Commercial |
$150.85
|
| Rate for Payer: Healthscope Commercial |
$372.93
|
| Rate for Payer: Healthscope Commercial |
$163.51
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$392.55
|
| Rate for Payer: Healthscope Commercial |
$162.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$348.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.26
|
| Rate for Payer: PHP Commercial |
$153.55
|
| Rate for Payer: PHP Commercial |
$154.43
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: PHP Commercial |
$142.47
|
| Rate for Payer: PHP Commercial |
$352.21
|
| Rate for Payer: PHP Commercial |
$370.74
|
| Rate for Payer: Priority Health SBD |
$126.46
|
| Rate for Payer: Priority Health SBD |
$105.59
|
| Rate for Payer: Priority Health SBD |
$113.81
|
| Rate for Payer: Priority Health SBD |
$274.79
|
| Rate for Payer: Priority Health SBD |
$114.46
|
| Rate for Payer: Priority Health SBD |
$261.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.18
|
| Rate for Payer: UHC Core |
$94.18
|
| Rate for Payer: UHC Core |
$94.18
|
| Rate for Payer: UHC Core |
$94.18
|
| Rate for Payer: UHC Core |
$94.18
|
| Rate for Payer: UHC Core |
$94.18
|
| Rate for Payer: UHC Core |
$94.18
|
| Rate for Payer: UHC Exchange |
$94.18
|
| Rate for Payer: UHC Exchange |
$94.18
|
| Rate for Payer: UHC Exchange |
$94.18
|
| Rate for Payer: UHC Exchange |
$94.18
|
| Rate for Payer: UHC Exchange |
$94.18
|
| Rate for Payer: UHC Exchange |
$94.18
|
| Rate for Payer: UMR Bronson Commercial |
$74.27
|
| Rate for Payer: UMR Bronson Commercial |
$153.32
|
| Rate for Payer: UMR Bronson Commercial |
$66.84
|
| Rate for Payer: UMR Bronson Commercial |
$62.02
|
| Rate for Payer: UMR Bronson Commercial |
$161.38
|
| Rate for Payer: UMR Bronson Commercial |
$67.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.49
|
|
|
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,956.04
|
| Rate for Payer: BCN Commercial |
$2,956.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$5,685.82
|
|
|
Service Code
|
APR-DRG 5171
|
| Min. Negotiated Rate |
$5,415.06 |
| Max. Negotiated Rate |
$5,685.82 |
| Rate for Payer: BCBS Complete |
$5,685.82
|
| Rate for Payer: Mclaren Medicaid |
$5,415.06
|
| Rate for Payer: Meridian Medicaid |
$5,685.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,415.06
|
| Rate for Payer: UHC Medicaid |
$5,415.06
|
| Rate for Payer: UHCCP Medicaid |
$5,415.06
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$7,062.93
|
|
|
Service Code
|
APR-DRG 5172
|
| Min. Negotiated Rate |
$6,726.60 |
| Max. Negotiated Rate |
$7,062.93 |
| Rate for Payer: BCBS Complete |
$7,062.93
|
| Rate for Payer: Mclaren Medicaid |
$6,726.60
|
| Rate for Payer: Meridian Medicaid |
$7,062.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.60
|
| Rate for Payer: UHC Medicaid |
$6,726.60
|
| Rate for Payer: UHCCP Medicaid |
$6,726.60
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$15,906.73
|
|
|
Service Code
|
APR-DRG 5174
|
| Min. Negotiated Rate |
$15,149.27 |
| Max. Negotiated Rate |
$15,906.73 |
| Rate for Payer: BCBS Complete |
$15,906.73
|
| Rate for Payer: Mclaren Medicaid |
$15,149.27
|
| Rate for Payer: Meridian Medicaid |
$15,906.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,149.27
|
| Rate for Payer: UHC Medicaid |
$15,149.27
|
| Rate for Payer: UHCCP Medicaid |
$15,149.27
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$11,144.03
|
|
|
Service Code
|
APR-DRG 5173
|
| Min. Negotiated Rate |
$10,613.36 |
| Max. Negotiated Rate |
$11,144.03 |
| Rate for Payer: BCBS Complete |
$11,144.03
|
| Rate for Payer: Mclaren Medicaid |
$10,613.36
|
| Rate for Payer: Meridian Medicaid |
$11,144.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,613.36
|
| Rate for Payer: UHC Medicaid |
$10,613.36
|
| Rate for Payer: UHCCP Medicaid |
$10,613.36
|
|
|
DILATION OF CERVICAL CANAL, INSTRUMENTAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$48.77 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$48.77
|
| Rate for Payer: BCN Commercial |
$48.77
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
