|
DIPYRIDAMOLE 25 MG TABLET
|
Facility
|
OP
|
$528.48
|
|
|
Service Code
|
NDC 64980013301
|
| Hospital Charge Code |
2528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.54 |
| Max. Negotiated Rate |
$475.63 |
| Rate for Payer: Aetna American Axle |
$343.51
|
| Rate for Payer: Aetna Commercial |
$449.21
|
| Rate for Payer: Aetna Medicare |
$264.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.51
|
| Rate for Payer: BCBS Complete |
$211.39
|
| Rate for Payer: Cash Price |
$422.78
|
| Rate for Payer: Cofinity Advantage |
$369.94
|
| Rate for Payer: Cofinity Commercial |
$454.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.78
|
| Rate for Payer: Healthscope Commercial |
$475.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.36
|
| Rate for Payer: PHP Commercial |
$449.21
|
| Rate for Payer: Priority Health SBD |
$332.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.51
|
| Rate for Payer: UHC Core |
$275.34
|
| Rate for Payer: UHC Exchange |
$207.69
|
| Rate for Payer: UMR Bronson Commercial |
$195.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.36
|
|
|
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND GRAFT INSERTION, WITH OR WITHOUT PATCH GRAFT; FOR ANEURYSM, PSEUDOANEURYSM, AND ASSOCIATED OCCLUSIVE DISEASE, RADIAL OR ULNAR ARTERY
|
Facility
|
OP
|
$17,930.33
|
|
|
Service Code
|
CPT 35045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,427.94
|
| Rate for Payer: BCN Commercial |
$4,427.94
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
DISOPYRAMIDE PHOSPHATE ER 100 MG CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$1,485.92
|
|
|
Service Code
|
NDC 00025273231
|
| Hospital Charge Code |
2537
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$653.80 |
| Max. Negotiated Rate |
$1,337.33 |
| Rate for Payer: Aetna American Axle |
$965.85
|
| Rate for Payer: Aetna Commercial |
$1,263.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.85
|
| Rate for Payer: Cash Price |
$1,188.74
|
| Rate for Payer: Cofinity Advantage |
$1,040.14
|
| Rate for Payer: Cofinity Commercial |
$1,277.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.74
|
| Rate for Payer: Healthscope Commercial |
$1,337.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,040.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,114.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,263.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,114.44
|
| Rate for Payer: PHP Commercial |
$1,263.03
|
| Rate for Payer: Priority Health SBD |
$936.13
|
| Rate for Payer: UMR Bronson Commercial |
$653.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,114.44
|
|
|
DISOPYRAMIDE PHOSPHATE ER 100 MG CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$1,485.92
|
|
|
Service Code
|
NDC 00025273231
|
| Hospital Charge Code |
2537
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$549.79 |
| Max. Negotiated Rate |
$1,337.33 |
| Rate for Payer: Aetna American Axle |
$965.85
|
| Rate for Payer: Aetna Commercial |
$1,263.03
|
| Rate for Payer: Aetna Medicare |
$742.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.85
|
| Rate for Payer: BCBS Complete |
$594.37
|
| Rate for Payer: Cash Price |
$1,188.74
|
| Rate for Payer: Cofinity Advantage |
$1,040.14
|
| Rate for Payer: Cofinity Commercial |
$1,277.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.74
|
| Rate for Payer: Healthscope Commercial |
$1,337.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,040.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,114.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,188.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,263.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,114.44
|
| Rate for Payer: PHP Commercial |
$1,263.03
|
| Rate for Payer: Priority Health SBD |
$936.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$965.85
|
| Rate for Payer: UHC Core |
$774.16
|
| Rate for Payer: UHC Exchange |
$583.97
|
| Rate for Payer: UMR Bronson Commercial |
$549.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,114.44
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
APR-DRG 2842
|
| Min. Negotiated Rate |
$5,673.34 |
| Max. Negotiated Rate |
$5,957.00 |
| Rate for Payer: BCBS Complete |
$5,957.00
|
| Rate for Payer: Mclaren Medicaid |
$5,673.34
|
| Rate for Payer: Meridian Medicaid |
$5,957.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,673.34
|
| Rate for Payer: UHC Medicaid |
$5,673.34
|
| Rate for Payer: UHCCP Medicaid |
$5,673.34
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$9,992.10
|
|
|
Service Code
|
APR-DRG 2844
|
| Min. Negotiated Rate |
$9,516.29 |
| Max. Negotiated Rate |
$9,992.10 |
| Rate for Payer: BCBS Complete |
$9,992.10
|
| Rate for Payer: Mclaren Medicaid |
$9,516.29
|
| Rate for Payer: Meridian Medicaid |
$9,992.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,516.29
|
| Rate for Payer: UHC Medicaid |
$9,516.29
|
| Rate for Payer: UHCCP Medicaid |
$9,516.29
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$7,581.70
|
|
|
Service Code
|
APR-DRG 2843
|
| Min. Negotiated Rate |
$7,220.66 |
| Max. Negotiated Rate |
$7,581.70 |
| Rate for Payer: BCBS Complete |
$7,581.70
|
| Rate for Payer: Mclaren Medicaid |
$7,220.66
|
| Rate for Payer: Meridian Medicaid |
$7,581.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,220.66
|
| Rate for Payer: UHC Medicaid |
$7,220.66
|
| Rate for Payer: UHCCP Medicaid |
$7,220.66
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$3,881.95
|
|
|
Service Code
|
APR-DRG 2841
|
| Min. Negotiated Rate |
$3,697.09 |
| Max. Negotiated Rate |
$3,881.95 |
| Rate for Payer: BCBS Complete |
$3,881.95
|
| Rate for Payer: Mclaren Medicaid |
$3,697.09
|
| Rate for Payer: Meridian Medicaid |
$3,881.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,697.09
|
| Rate for Payer: UHC Medicaid |
$3,697.09
|
| Rate for Payer: UHCCP Medicaid |
$3,697.09
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$20,612.96
|
|
|
Service Code
|
MSDRG 442
|
| Min. Negotiated Rate |
$8,232.20 |
| Max. Negotiated Rate |
$20,612.96 |
| Rate for Payer: Aetna Medicare |
$9,012.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,831.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,831.84
|
| Rate for Payer: BCBS MAPPO |
$8,665.47
|
| Rate for Payer: BCBS Trust/PPO |
$20,612.96
|
| Rate for Payer: BCN Commercial |
$20,612.96
|
| Rate for Payer: BCN Medicare Advantage |
$8,665.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,665.47
|
| Rate for Payer: Mclaren Medicare |
$8,665.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,098.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,965.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,532.02
|
| Rate for Payer: Nomi Health Commercial |
$12,452.37
|
| Rate for Payer: PACE Medicare |
$8,232.20
|
| Rate for Payer: PACE SWMI |
$8,665.47
|
| Rate for Payer: PHP Medicare Advantage |
$8,665.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,562.70
|
| Rate for Payer: Priority Health Medicare |
$8,665.47
|
| Rate for Payer: Priority Health Tiered Network |
$12,450.16
|
| Rate for Payer: Railroad Medicare Medicare |
$8,665.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,734.39
|
| Rate for Payer: UHC Core |
$13,163.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,665.47
|
| Rate for Payer: UHC Exchange |
$10,750.55
|
| Rate for Payer: VA VA |
$8,665.47
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$55,069.45
|
|
|
Service Code
|
MSDRG 441
|
| Min. Negotiated Rate |
$14,821.42 |
| Max. Negotiated Rate |
$55,069.45 |
| Rate for Payer: Aetna Medicare |
$16,225.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,501.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,501.86
|
| Rate for Payer: BCBS MAPPO |
$15,601.49
|
| Rate for Payer: BCBS Trust/PPO |
$55,069.45
|
| Rate for Payer: BCN Commercial |
$55,069.45
|
| Rate for Payer: BCN Medicare Advantage |
$15,601.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,601.49
|
| Rate for Payer: Mclaren Medicare |
$15,601.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,381.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,941.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,161.64
|
| Rate for Payer: Nomi Health Commercial |
$23,151.63
|
| Rate for Payer: PACE Medicare |
$14,821.42
|
| Rate for Payer: PACE SWMI |
$15,601.49
|
| Rate for Payer: PHP Medicare Advantage |
$15,601.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,934.40
|
| Rate for Payer: Priority Health Medicare |
$15,601.49
|
| Rate for Payer: Priority Health Tiered Network |
$23,147.52
|
| Rate for Payer: Railroad Medicare Medicare |
$15,601.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,253.61
|
| Rate for Payer: UHC Core |
$24,474.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,601.49
|
| Rate for Payer: UHC Exchange |
$19,987.57
|
| Rate for Payer: VA VA |
$15,601.49
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,380.01
|
|
|
Service Code
|
MSDRG 443
|
| Min. Negotiated Rate |
$6,122.14 |
| Max. Negotiated Rate |
$16,380.01 |
| Rate for Payer: Aetna Medicare |
$6,702.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,055.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,055.45
|
| Rate for Payer: BCBS MAPPO |
$6,444.36
|
| Rate for Payer: BCBS Trust/PPO |
$16,380.01
|
| Rate for Payer: BCN Commercial |
$16,380.01
|
| Rate for Payer: BCN Medicare Advantage |
$6,444.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,444.36
|
| Rate for Payer: Mclaren Medicare |
$6,444.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,766.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,411.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,088.80
|
| Rate for Payer: Nomi Health Commercial |
$9,026.13
|
| Rate for Payer: PACE Medicare |
$6,122.14
|
| Rate for Payer: PACE SWMI |
$6,444.36
|
| Rate for Payer: PHP Medicare Advantage |
$6,444.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,280.66
|
| Rate for Payer: Priority Health Medicare |
$6,444.36
|
| Rate for Payer: Priority Health Tiered Network |
$9,024.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,444.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,405.11
|
| Rate for Payer: UHC Core |
$9,541.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,444.36
|
| Rate for Payer: UHC Exchange |
$7,792.56
|
| Rate for Payer: VA VA |
$6,444.36
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$7,059.91
|
|
|
Service Code
|
APR-DRG 2823
|
| Min. Negotiated Rate |
$6,723.72 |
| Max. Negotiated Rate |
$7,059.91 |
| Rate for Payer: BCBS Complete |
$7,059.91
|
| Rate for Payer: Mclaren Medicaid |
$6,723.72
|
| Rate for Payer: Meridian Medicaid |
$7,059.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,723.72
|
| Rate for Payer: UHC Medicaid |
$6,723.72
|
| Rate for Payer: UHCCP Medicaid |
$6,723.72
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$3,458.83
|
|
|
Service Code
|
APR-DRG 2821
|
| Min. Negotiated Rate |
$3,294.12 |
| Max. Negotiated Rate |
$3,458.83 |
| Rate for Payer: BCBS Complete |
$3,458.83
|
| Rate for Payer: Mclaren Medicaid |
$3,294.12
|
| Rate for Payer: Meridian Medicaid |
$3,458.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,294.12
|
| Rate for Payer: UHC Medicaid |
$3,294.12
|
| Rate for Payer: UHCCP Medicaid |
$3,294.12
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$4,694.30
|
|
|
Service Code
|
APR-DRG 2822
|
| Min. Negotiated Rate |
$4,470.76 |
| Max. Negotiated Rate |
$4,694.30 |
| Rate for Payer: BCBS Complete |
$4,694.30
|
| Rate for Payer: Mclaren Medicaid |
$4,470.76
|
| Rate for Payer: Meridian Medicaid |
$4,694.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,470.76
|
| Rate for Payer: UHC Medicaid |
$4,470.76
|
| Rate for Payer: UHCCP Medicaid |
$4,470.76
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$14,173.08
|
|
|
Service Code
|
APR-DRG 2824
|
| Min. Negotiated Rate |
$13,498.17 |
| Max. Negotiated Rate |
$14,173.08 |
| Rate for Payer: BCBS Complete |
$14,173.08
|
| Rate for Payer: Mclaren Medicaid |
$13,498.17
|
| Rate for Payer: Meridian Medicaid |
$14,173.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,498.17
|
| Rate for Payer: UHC Medicaid |
$13,498.17
|
| Rate for Payer: UHCCP Medicaid |
$13,498.17
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC
|
Facility
|
IP
|
$18,334.52
|
|
|
Service Code
|
MSDRG 439
|
| Min. Negotiated Rate |
$7,246.29 |
| Max. Negotiated Rate |
$18,334.52 |
| Rate for Payer: Aetna Medicare |
$7,932.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,534.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,534.59
|
| Rate for Payer: BCBS MAPPO |
$7,627.67
|
| Rate for Payer: BCBS Trust/PPO |
$18,334.52
|
| Rate for Payer: BCN Commercial |
$18,334.52
|
| Rate for Payer: BCN Medicare Advantage |
$7,627.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,627.67
|
| Rate for Payer: Mclaren Medicare |
$7,627.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,009.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,771.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,390.44
|
| Rate for Payer: Nomi Health Commercial |
$10,851.48
|
| Rate for Payer: PACE Medicare |
$7,246.29
|
| Rate for Payer: PACE SWMI |
$7,627.67
|
| Rate for Payer: PHP Medicare Advantage |
$7,627.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,561.94
|
| Rate for Payer: Priority Health Medicare |
$7,627.67
|
| Rate for Payer: Priority Health Tiered Network |
$10,849.55
|
| Rate for Payer: Railroad Medicare Medicare |
$7,627.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,711.56
|
| Rate for Payer: UHC Core |
$11,471.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,627.67
|
| Rate for Payer: UHC Exchange |
$9,368.44
|
| Rate for Payer: VA VA |
$7,627.67
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$35,620.42
|
|
|
Service Code
|
MSDRG 438
|
| Min. Negotiated Rate |
$13,514.54 |
| Max. Negotiated Rate |
$35,620.42 |
| Rate for Payer: Aetna Medicare |
$14,794.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,782.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,782.29
|
| Rate for Payer: BCBS MAPPO |
$14,225.83
|
| Rate for Payer: BCBS Trust/PPO |
$35,620.42
|
| Rate for Payer: BCN Commercial |
$35,620.42
|
| Rate for Payer: BCN Medicare Advantage |
$14,225.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,225.83
|
| Rate for Payer: Mclaren Medicare |
$14,225.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,937.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,359.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,648.41
|
| Rate for Payer: Nomi Health Commercial |
$21,029.58
|
| Rate for Payer: PACE Medicare |
$13,514.54
|
| Rate for Payer: PACE SWMI |
$14,225.83
|
| Rate for Payer: PHP Medicare Advantage |
$14,225.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,282.31
|
| Rate for Payer: Priority Health Medicare |
$14,225.83
|
| Rate for Payer: Priority Health Tiered Network |
$21,025.85
|
| Rate for Payer: Railroad Medicare Medicare |
$14,225.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,572.26
|
| Rate for Payer: UHC Core |
$22,231.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,225.83
|
| Rate for Payer: UHC Exchange |
$18,155.54
|
| Rate for Payer: VA VA |
$14,225.83
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$13,434.52
|
|
|
Service Code
|
MSDRG 440
|
| Min. Negotiated Rate |
$5,500.07 |
| Max. Negotiated Rate |
$13,434.52 |
| Rate for Payer: Aetna Medicare |
$6,021.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,236.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,236.94
|
| Rate for Payer: BCBS MAPPO |
$5,789.55
|
| Rate for Payer: BCBS Trust/PPO |
$13,434.52
|
| Rate for Payer: BCN Commercial |
$13,434.52
|
| Rate for Payer: BCN Medicare Advantage |
$5,789.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,789.55
|
| Rate for Payer: Mclaren Medicare |
$5,789.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,079.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,657.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,368.51
|
| Rate for Payer: Nomi Health Commercial |
$8,016.06
|
| Rate for Payer: PACE Medicare |
$5,500.07
|
| Rate for Payer: PACE SWMI |
$5,789.55
|
| Rate for Payer: PHP Medicare Advantage |
$5,789.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,018.30
|
| Rate for Payer: Priority Health Medicare |
$5,789.55
|
| Rate for Payer: Priority Health Tiered Network |
$8,014.64
|
| Rate for Payer: Railroad Medicare Medicare |
$5,789.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,128.82
|
| Rate for Payer: UHC Core |
$8,474.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,789.55
|
| Rate for Payer: UHC Exchange |
$6,920.53
|
| Rate for Payer: VA VA |
$5,789.55
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$32,050.69
|
|
|
Service Code
|
MSDRG 883
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$32,050.69 |
| Rate for Payer: Aetna Medicare |
$17,717.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,295.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,295.66
|
| Rate for Payer: BCBS MAPPO |
$17,036.53
|
| Rate for Payer: BCBS Trust/PPO |
$22,246.29
|
| Rate for Payer: BCN Commercial |
$22,246.29
|
| Rate for Payer: BCN Medicare Advantage |
$17,036.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,036.53
|
| Rate for Payer: Mclaren Medicare |
$17,036.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,888.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,592.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,740.18
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$16,184.70
|
| Rate for Payer: PACE SWMI |
$17,036.53
|
| Rate for Payer: PHP Medicare Advantage |
$17,036.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,700.96
|
| Rate for Payer: Priority Health Medicare |
$17,036.53
|
| Rate for Payer: Priority Health Tiered Network |
$25,360.77
|
| Rate for Payer: Railroad Medicare Medicare |
$17,036.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,050.69
|
| Rate for Payer: UHC Core |
$26,814.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,036.53
|
| Rate for Payer: UHC Exchange |
$21,898.68
|
| Rate for Payer: VA VA |
$17,036.53
|
|
|
DISORDERS OF THE BILIARY TRACT WITH CC
|
Facility
|
IP
|
$21,636.88
|
|
|
Service Code
|
MSDRG 445
|
| Min. Negotiated Rate |
$9,257.84 |
| Max. Negotiated Rate |
$21,636.88 |
| Rate for Payer: Aetna Medicare |
$10,134.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,181.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,181.38
|
| Rate for Payer: BCBS MAPPO |
$9,745.10
|
| Rate for Payer: BCBS Trust/PPO |
$21,636.88
|
| Rate for Payer: BCN Commercial |
$21,636.88
|
| Rate for Payer: BCN Medicare Advantage |
$9,745.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,745.10
|
| Rate for Payer: Mclaren Medicare |
$9,745.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,232.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,206.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,719.61
|
| Rate for Payer: Nomi Health Commercial |
$14,117.76
|
| Rate for Payer: PACE Medicare |
$9,257.84
|
| Rate for Payer: PACE SWMI |
$9,745.10
|
| Rate for Payer: PHP Medicare Advantage |
$9,745.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,644.07
|
| Rate for Payer: Priority Health Medicare |
$9,745.10
|
| Rate for Payer: Priority Health Tiered Network |
$14,115.25
|
| Rate for Payer: Railroad Medicare Medicare |
$9,745.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,838.72
|
| Rate for Payer: UHC Core |
$14,924.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,745.10
|
| Rate for Payer: UHC Exchange |
$12,188.33
|
| Rate for Payer: VA VA |
$9,745.10
|
|
|
DISORDERS OF THE BILIARY TRACT WITH MCC
|
Facility
|
IP
|
$36,773.36
|
|
|
Service Code
|
MSDRG 444
|
| Min. Negotiated Rate |
$13,837.88 |
| Max. Negotiated Rate |
$36,773.36 |
| Rate for Payer: Aetna Medicare |
$15,148.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,207.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,207.74
|
| Rate for Payer: BCBS MAPPO |
$14,566.19
|
| Rate for Payer: BCBS Trust/PPO |
$36,773.36
|
| Rate for Payer: BCN Commercial |
$36,773.36
|
| Rate for Payer: BCN Medicare Advantage |
$14,566.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,566.19
|
| Rate for Payer: Mclaren Medicare |
$14,566.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,294.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,751.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,022.81
|
| Rate for Payer: Nomi Health Commercial |
$21,554.61
|
| Rate for Payer: PACE Medicare |
$13,837.88
|
| Rate for Payer: PACE SWMI |
$14,566.19
|
| Rate for Payer: PHP Medicare Advantage |
$14,566.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,938.48
|
| Rate for Payer: Priority Health Medicare |
$14,566.19
|
| Rate for Payer: Priority Health Tiered Network |
$21,550.78
|
| Rate for Payer: Railroad Medicare Medicare |
$14,566.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,235.67
|
| Rate for Payer: UHC Core |
$22,786.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,566.19
|
| Rate for Payer: UHC Exchange |
$18,608.81
|
| Rate for Payer: VA VA |
$14,566.19
|
|
|
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC
|
Facility
|
IP
|
$18,293.35
|
|
|
Service Code
|
MSDRG 446
|
| Min. Negotiated Rate |
$7,135.85 |
| Max. Negotiated Rate |
$18,293.35 |
| Rate for Payer: Aetna Medicare |
$7,811.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,389.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,389.27
|
| Rate for Payer: BCBS MAPPO |
$7,511.42
|
| Rate for Payer: BCBS Trust/PPO |
$18,293.35
|
| Rate for Payer: BCN Commercial |
$18,293.35
|
| Rate for Payer: BCN Medicare Advantage |
$7,511.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,511.42
|
| Rate for Payer: Mclaren Medicare |
$7,511.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,886.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,638.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,262.56
|
| Rate for Payer: Nomi Health Commercial |
$10,672.17
|
| Rate for Payer: PACE Medicare |
$7,135.85
|
| Rate for Payer: PACE SWMI |
$7,511.42
|
| Rate for Payer: PHP Medicare Advantage |
$7,511.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,337.85
|
| Rate for Payer: Priority Health Medicare |
$7,511.42
|
| Rate for Payer: Priority Health Tiered Network |
$10,670.28
|
| Rate for Payer: Railroad Medicare Medicare |
$7,511.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,484.99
|
| Rate for Payer: UHC Core |
$11,281.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,511.42
|
| Rate for Payer: UHC Exchange |
$9,213.64
|
| Rate for Payer: VA VA |
$7,511.42
|
|
|
DISSECTION, DEEP JUGULAR NODE(S)
|
Facility
|
OP
|
$19,480.40
|
|
|
Service Code
|
CPT 38542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.44 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,475.86
|
| Rate for Payer: BCN Commercial |
$4,475.86
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Mclaren Medicaid |
$6,023.79
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 68382010601
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.78 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna American Axle |
$196.37
|
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare |
$151.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.37
|
| Rate for Payer: BCBS Complete |
$120.84
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Advantage |
$211.47
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.57
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: Priority Health SBD |
$190.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.37
|
| Rate for Payer: UHC Core |
$157.39
|
| Rate for Payer: UHC Exchange |
$118.73
|
| Rate for Payer: UMR Bronson Commercial |
$111.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 68084031301
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna American Axle |
$293.28
|
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Advantage |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.40
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.28
|
| Rate for Payer: UHC Core |
$235.08
|
| Rate for Payer: UHC Exchange |
$177.32
|
| Rate for Payer: UMR Bronson Commercial |
$166.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
