|
ABDOMINAL PAIN
|
Facility
|
IP
|
$4,170.69
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$3,972.09 |
| Max. Negotiated Rate |
$4,170.69 |
| Rate for Payer: BCBS Complete |
$4,170.69
|
| Rate for Payer: Mclaren Medicaid |
$3,972.09
|
| Rate for Payer: Meridian Medicaid |
$4,170.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,972.09
|
| Rate for Payer: UHC Medicaid |
$3,972.09
|
| Rate for Payer: UHCCP Medicaid |
$3,972.09
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 49082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$937.02
|
| Rate for Payer: BCN Commercial |
$937.02
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
|
OP
|
$4,999.64
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$808.56 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,408.01
|
| Rate for Payer: BCN Commercial |
$1,408.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Mclaren Medicaid |
$1,546.00
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); SUPERFICIAL
|
Facility
|
OP
|
$4,999.64
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$808.56 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,056.01
|
| Rate for Payer: BCN Commercial |
$1,056.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Mclaren Medicaid |
$1,546.00
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
ABLATION THERAPY FOR REDUCTION OR ERADICATION OF 1 OR MORE BONE TUMORS (EG, METASTASIS) INCLUDING ADJACENT SOFT TISSUE WHEN INVOLVED BY TUMOR EXTENSION, PERCUTANEOUS, INCLUDING IMAGING GUIDANCE WHEN PERFORMED; RADIOFREQUENCY
|
Facility
|
OP
|
$56,498.90
|
|
|
Service Code
|
CPT 20982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,985.59 |
| Max. Negotiated Rate |
$56,498.90 |
| Rate for Payer: Aetna Medicare |
$18,169.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,838.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,838.46
|
| Rate for Payer: BCBS Complete |
$9,594.95
|
| Rate for Payer: BCBS MAPPO |
$17,470.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,985.59
|
| Rate for Payer: BCN Commercial |
$4,985.59
|
| Rate for Payer: BCN Medicare Advantage |
$17,470.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,470.77
|
| Rate for Payer: Mclaren Medicaid |
$17,470.77
|
| Rate for Payer: Mclaren Medicare |
$17,470.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,344.31
|
| Rate for Payer: Meridian Medicaid |
$18,344.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,091.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,217.85
|
| Rate for Payer: Nomi Health Commercial |
$52,412.31
|
| Rate for Payer: PACE Medicare |
$16,597.23
|
| Rate for Payer: PACE SWMI |
$17,470.77
|
| Rate for Payer: PHP Medicare Advantage |
$17,470.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,137.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56,498.90
|
| Rate for Payer: Priority Health Medicare |
$17,470.77
|
| Rate for Payer: Priority Health Tiered Network |
$45,199.12
|
| Rate for Payer: Railroad Medicare Medicare |
$17,470.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,470.77
|
| Rate for Payer: UHC Medicaid |
$9,137.21
|
| Rate for Payer: UHCCP Medicaid |
$9,137.21
|
| Rate for Payer: VA VA |
$17,470.77
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$14,475.14
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$13,785.84 |
| Max. Negotiated Rate |
$14,475.14 |
| Rate for Payer: BCBS Complete |
$14,475.14
|
| Rate for Payer: Mclaren Medicaid |
$13,785.84
|
| Rate for Payer: Meridian Medicaid |
$14,475.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,785.84
|
| Rate for Payer: UHC Medicaid |
$13,785.84
|
| Rate for Payer: UHCCP Medicaid |
$13,785.84
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$6,047.80
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$5,759.81 |
| Max. Negotiated Rate |
$6,047.80 |
| Rate for Payer: BCBS Complete |
$6,047.80
|
| Rate for Payer: Mclaren Medicaid |
$5,759.81
|
| Rate for Payer: Meridian Medicaid |
$6,047.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,759.81
|
| Rate for Payer: UHC Medicaid |
$5,759.81
|
| Rate for Payer: UHCCP Medicaid |
$5,759.81
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$3,100.47
|
|
|
Service Code
|
APR-DRG 5431
|
| Min. Negotiated Rate |
$2,952.83 |
| Max. Negotiated Rate |
$3,100.47 |
| Rate for Payer: BCBS Complete |
$3,100.47
|
| Rate for Payer: Mclaren Medicaid |
$2,952.83
|
| Rate for Payer: Meridian Medicaid |
$3,100.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,952.83
|
| Rate for Payer: UHC Medicaid |
$2,952.83
|
| Rate for Payer: UHCCP Medicaid |
$2,952.83
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$16,533.74
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$7,089.87 |
| Max. Negotiated Rate |
$16,533.74 |
| Rate for Payer: Aetna Medicare |
$9,337.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,222.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,222.81
|
| Rate for Payer: BCBS MAPPO |
$8,978.25
|
| Rate for Payer: BCBS Trust/PPO |
$16,533.74
|
| Rate for Payer: BCN Commercial |
$16,533.74
|
| Rate for Payer: BCN Medicare Advantage |
$8,978.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,978.25
|
| Rate for Payer: Mclaren Medicare |
$8,978.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,427.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,324.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,876.08
|
| Rate for Payer: Nomi Health Commercial |
$12,934.83
|
| Rate for Payer: PACE Medicare |
$8,529.34
|
| Rate for Payer: PACE SWMI |
$8,978.25
|
| Rate for Payer: PHP Medicare Advantage |
$8,978.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,862.34
|
| Rate for Payer: Priority Health Medicare |
$8,978.25
|
| Rate for Payer: Priority Health Tiered Network |
$7,089.87
|
| Rate for Payer: Railroad Medicare Medicare |
$8,978.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,344.01
|
| Rate for Payer: UHC Core |
$13,673.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,978.25
|
| Rate for Payer: UHC Exchange |
$11,167.07
|
| Rate for Payer: VA VA |
$8,978.25
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$3,891.63
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$3,706.32 |
| Max. Negotiated Rate |
$3,891.63 |
| Rate for Payer: BCBS Complete |
$3,891.63
|
| Rate for Payer: Mclaren Medicaid |
$3,706.32
|
| Rate for Payer: Meridian Medicaid |
$3,891.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,706.32
|
| Rate for Payer: UHC Medicaid |
$3,706.32
|
| Rate for Payer: UHCCP Medicaid |
$3,706.32
|
|
|
ABORTION WITHOUT D&C
|
Facility
|
IP
|
$11,623.53
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$5,702.08 |
| Max. Negotiated Rate |
$11,623.53 |
| Rate for Payer: Aetna Medicare |
$7,933.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,535.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,535.64
|
| Rate for Payer: BCBS MAPPO |
$7,628.51
|
| Rate for Payer: BCBS Trust/PPO |
$10,590.60
|
| Rate for Payer: BCN Commercial |
$10,590.60
|
| Rate for Payer: BCN Medicare Advantage |
$7,628.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,628.51
|
| Rate for Payer: Mclaren Medicare |
$7,628.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,009.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,772.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,391.36
|
| Rate for Payer: Nomi Health Commercial |
$9,198.99
|
| Rate for Payer: PACE Medicare |
$7,247.08
|
| Rate for Payer: PACE SWMI |
$7,628.51
|
| Rate for Payer: PHP Medicare Advantage |
$7,628.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,127.60
|
| Rate for Payer: Priority Health Medicare |
$7,628.51
|
| Rate for Payer: Priority Health Tiered Network |
$5,702.08
|
| Rate for Payer: Railroad Medicare Medicare |
$7,628.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,623.53
|
| Rate for Payer: UHC Core |
$9,724.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,628.51
|
| Rate for Payer: UHC Exchange |
$7,941.79
|
| Rate for Payer: VA VA |
$7,628.51
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$2,373.48
|
|
|
Service Code
|
APR-DRG 5641
|
| Min. Negotiated Rate |
$2,260.46 |
| Max. Negotiated Rate |
$2,373.48 |
| Rate for Payer: BCBS Complete |
$2,373.48
|
| Rate for Payer: Mclaren Medicaid |
$2,260.46
|
| Rate for Payer: Meridian Medicaid |
$2,373.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,260.46
|
| Rate for Payer: UHC Medicaid |
$2,260.46
|
| Rate for Payer: UHCCP Medicaid |
$2,260.46
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$9,657.96
|
|
|
Service Code
|
APR-DRG 5644
|
| Min. Negotiated Rate |
$9,198.06 |
| Max. Negotiated Rate |
$9,657.96 |
| Rate for Payer: BCBS Complete |
$9,657.96
|
| Rate for Payer: Mclaren Medicaid |
$9,198.06
|
| Rate for Payer: Meridian Medicaid |
$9,657.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,198.06
|
| Rate for Payer: UHC Medicaid |
$9,198.06
|
| Rate for Payer: UHCCP Medicaid |
$9,198.06
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$5,001.80
|
|
|
Service Code
|
APR-DRG 5643
|
| Min. Negotiated Rate |
$4,763.62 |
| Max. Negotiated Rate |
$5,001.80 |
| Rate for Payer: BCBS Complete |
$5,001.80
|
| Rate for Payer: Mclaren Medicaid |
$4,763.62
|
| Rate for Payer: Meridian Medicaid |
$5,001.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,763.62
|
| Rate for Payer: UHC Medicaid |
$4,763.62
|
| Rate for Payer: UHCCP Medicaid |
$4,763.62
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$3,451.56
|
|
|
Service Code
|
APR-DRG 5642
|
| Min. Negotiated Rate |
$3,287.20 |
| Max. Negotiated Rate |
$3,451.56 |
| Rate for Payer: BCBS Complete |
$3,451.56
|
| Rate for Payer: Mclaren Medicaid |
$3,287.20
|
| Rate for Payer: Meridian Medicaid |
$3,451.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,287.20
|
| Rate for Payer: UHC Medicaid |
$3,287.20
|
| Rate for Payer: UHCCP Medicaid |
$3,287.20
|
|
|
ACEBUTOLOL 200 MG CAPSULE
|
Facility
|
IP
|
$245.28
|
|
|
Service Code
|
NDC 53746066901
|
| Hospital Charge Code |
8939
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.92 |
| Max. Negotiated Rate |
$220.75 |
| Rate for Payer: Aetna American Axle |
$159.43
|
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.43
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Advantage |
$171.70
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$220.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.96
|
| Rate for Payer: PHP Commercial |
$208.49
|
| Rate for Payer: Priority Health SBD |
$154.53
|
| Rate for Payer: UMR Bronson Commercial |
$107.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.96
|
|
|
ACEBUTOLOL 200 MG CAPSULE
|
Facility
|
OP
|
$245.28
|
|
|
Service Code
|
NDC 53746066901
|
| Hospital Charge Code |
8939
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$220.75 |
| Rate for Payer: Aetna American Axle |
$159.43
|
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: Aetna Medicare |
$122.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.43
|
| Rate for Payer: BCBS Complete |
$98.11
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Advantage |
$171.70
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$220.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.96
|
| Rate for Payer: PHP Commercial |
$208.49
|
| Rate for Payer: Priority Health SBD |
$154.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.43
|
| Rate for Payer: UHC Core |
$127.79
|
| Rate for Payer: UHC Exchange |
$96.40
|
| Rate for Payer: UMR Bronson Commercial |
$90.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.96
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39.16
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$35.24 |
| Rate for Payer: Aetna American Axle |
$25.45
|
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna American Axle |
$32.40
|
| Rate for Payer: Aetna American Axle |
$12.73
|
| Rate for Payer: Aetna Commercial |
$42.36
|
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$39.87
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$31.33
|
| Rate for Payer: Cofinity Advantage |
$16.20
|
| Rate for Payer: Cofinity Advantage |
$13.71
|
| Rate for Payer: Cofinity Advantage |
$27.41
|
| Rate for Payer: Cofinity Advantage |
$34.89
|
| Rate for Payer: Cofinity Commercial |
$33.68
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Commercial |
$42.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$44.86
|
| Rate for Payer: Healthscope Commercial |
$35.24
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$42.36
|
| Rate for Payer: Priority Health SBD |
$31.40
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$24.67
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: UMR Bronson Commercial |
$17.23
|
| Rate for Payer: UMR Bronson Commercial |
$8.62
|
| Rate for Payer: UMR Bronson Commercial |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.38
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$49.84
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$44.86 |
| Rate for Payer: Aetna American Axle |
$32.40
|
| Rate for Payer: Aetna American Axle |
$12.73
|
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna American Axle |
$25.45
|
| Rate for Payer: Aetna Commercial |
$42.36
|
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$19.58
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna Medicare |
$24.92
|
| Rate for Payer: Aetna Medicare |
$9.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.45
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS Complete |
$19.94
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$31.33
|
| Rate for Payer: Cash Price |
$39.87
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$39.87
|
| Rate for Payer: Cash Price |
$31.33
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Advantage |
$34.89
|
| Rate for Payer: Cofinity Advantage |
$27.41
|
| Rate for Payer: Cofinity Advantage |
$16.20
|
| Rate for Payer: Cofinity Advantage |
$13.71
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Commercial |
$33.68
|
| Rate for Payer: Cofinity Commercial |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$35.24
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$44.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.38
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: PHP Commercial |
$42.36
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health SBD |
$24.67
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: Priority Health SBD |
$31.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UMR Bronson Commercial |
$18.44
|
| Rate for Payer: UMR Bronson Commercial |
$7.24
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.38
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.15
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Advantage |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.36
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$11.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.15
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Advantage |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.36
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18.99
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna American Axle |
$12.34
|
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Advantage |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.24
|
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health SBD |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.24
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18.99
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna American Axle |
$12.34
|
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna Medicare |
$9.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Advantage |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.24
|
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health SBD |
$11.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.34
|
| Rate for Payer: UHC Core |
$9.89
|
| Rate for Payer: UHC Exchange |
$7.46
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.24
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 45802073200
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna American Axle |
$1.03
|
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.03
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cofinity Advantage |
$1.11
|
| Rate for Payer: Cofinity Commercial |
$1.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.27
|
| Rate for Payer: Healthscope Commercial |
$1.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.19
|
| Rate for Payer: PHP Commercial |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.00
|
| Rate for Payer: UMR Bronson Commercial |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.19
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 45802073200
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna American Axle |
$1.03
|
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.03
|
| Rate for Payer: BCBS Complete |
$0.64
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cofinity Advantage |
$1.11
|
| Rate for Payer: Cofinity Commercial |
$1.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.27
|
| Rate for Payer: Healthscope Commercial |
$1.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.19
|
| Rate for Payer: PHP Commercial |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.03
|
| Rate for Payer: UHC Core |
$0.83
|
| Rate for Payer: UHC Exchange |
$0.62
|
| Rate for Payer: UMR Bronson Commercial |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.19
|
|
