|
EATING DISORDERS
|
Facility
|
IP
|
$23,717.84
|
|
|
Service Code
|
APR-DRG 7594
|
| Min. Negotiated Rate |
$22,588.42 |
| Max. Negotiated Rate |
$23,717.84 |
| Rate for Payer: BCBS Complete |
$23,717.84
|
| Rate for Payer: Mclaren Medicaid |
$22,588.42
|
| Rate for Payer: Meridian Medicaid |
$23,717.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,588.42
|
| Rate for Payer: UHC Medicaid |
$22,588.42
|
| Rate for Payer: UHCCP Medicaid |
$22,588.42
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$6,036.91
|
|
|
Service Code
|
APR-DRG 7591
|
| Min. Negotiated Rate |
$5,749.43 |
| Max. Negotiated Rate |
$6,036.91 |
| Rate for Payer: BCBS Complete |
$6,036.91
|
| Rate for Payer: Mclaren Medicaid |
$5,749.43
|
| Rate for Payer: Meridian Medicaid |
$6,036.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,749.43
|
| Rate for Payer: UHC Medicaid |
$5,749.43
|
| Rate for Payer: UHCCP Medicaid |
$5,749.43
|
|
|
ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$516,317.62
|
|
|
Service Code
|
MSDRG 003
|
| Min. Negotiated Rate |
$169,188.17 |
| Max. Negotiated Rate |
$516,317.62 |
| Rate for Payer: Aetna Medicare |
$185,216.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222,616.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222,616.01
|
| Rate for Payer: BCBS MAPPO |
$178,092.81
|
| Rate for Payer: BCBS Trust/PPO |
$516,317.62
|
| Rate for Payer: BCN Commercial |
$516,317.62
|
| Rate for Payer: BCN Medicare Advantage |
$178,092.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178,092.81
|
| Rate for Payer: Mclaren Medicare |
$178,092.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186,997.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204,806.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$195,902.09
|
| Rate for Payer: Nomi Health Commercial |
$273,805.08
|
| Rate for Payer: PACE Medicare |
$169,188.17
|
| Rate for Payer: PACE SWMI |
$178,092.81
|
| Rate for Payer: PHP Medicare Advantage |
$178,092.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342,195.65
|
| Rate for Payer: Priority Health Medicare |
$178,092.81
|
| Rate for Payer: Priority Health Tiered Network |
$273,756.47
|
| Rate for Payer: Railroad Medicare Medicare |
$178,092.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345,970.76
|
| Rate for Payer: UHC Core |
$289,448.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178,092.81
|
| Rate for Payer: UHC Exchange |
$236,385.05
|
| Rate for Payer: VA VA |
$178,092.81
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29,530.20
|
|
|
Service Code
|
HCPCS J1299
|
| Hospital Charge Code |
81696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$26,577.18 |
| Rate for Payer: Aetna American Axle |
$19,194.63
|
| Rate for Payer: Aetna Commercial |
$25,100.67
|
| Rate for Payer: Aetna Medicare |
$46.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,194.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.88
|
| Rate for Payer: BCBS Complete |
$24.55
|
| Rate for Payer: BCBS MAPPO |
$44.70
|
| Rate for Payer: BCBS Trust/PPO |
$145.99
|
| Rate for Payer: BCN Commercial |
$145.99
|
| Rate for Payer: BCN Medicare Advantage |
$44.70
|
| Rate for Payer: Cash Price |
$23,624.16
|
| Rate for Payer: Cash Price |
$23,624.16
|
| Rate for Payer: Cofinity Advantage |
$20,671.14
|
| Rate for Payer: Cofinity Commercial |
$25,395.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,624.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$26,577.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,671.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,147.65
|
| Rate for Payer: Mclaren Medicaid |
$44.70
|
| Rate for Payer: Mclaren Medicare |
$44.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.94
|
| Rate for Payer: Meridian Medicaid |
$46.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,100.67
|
| Rate for Payer: Nomi Health Commercial |
$134.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,147.65
|
| Rate for Payer: PACE Medicare |
$42.47
|
| Rate for Payer: PACE SWMI |
$44.70
|
| Rate for Payer: PHP Commercial |
$25,100.67
|
| Rate for Payer: PHP Medicare Advantage |
$44.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$141.36
|
| Rate for Payer: Priority Health Medicare |
$44.70
|
| Rate for Payer: Priority Health SBD |
$18,604.03
|
| Rate for Payer: Priority Health Tiered Network |
$113.09
|
| Rate for Payer: Railroad Medicare Medicare |
$44.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.30
|
| Rate for Payer: UHC Core |
$74.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.70
|
| Rate for Payer: UHC Exchange |
$74.30
|
| Rate for Payer: UHC Medicaid |
$23.38
|
| Rate for Payer: UHCCP Medicaid |
$23.38
|
| Rate for Payer: UMR Bronson Commercial |
$10,926.17
|
| Rate for Payer: VA VA |
$44.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,147.65
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29,530.20
|
|
|
Service Code
|
HCPCS J1299
|
| Hospital Charge Code |
81696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,993.29 |
| Max. Negotiated Rate |
$26,577.18 |
| Rate for Payer: Aetna American Axle |
$19,194.63
|
| Rate for Payer: Aetna Commercial |
$25,100.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,194.63
|
| Rate for Payer: Cash Price |
$23,624.16
|
| Rate for Payer: Cofinity Advantage |
$20,671.14
|
| Rate for Payer: Cofinity Commercial |
$25,395.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,624.16
|
| Rate for Payer: Healthscope Commercial |
$26,577.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,671.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,147.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,100.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,147.65
|
| Rate for Payer: PHP Commercial |
$25,100.67
|
| Rate for Payer: Priority Health SBD |
$18,604.03
|
| Rate for Payer: UMR Bronson Commercial |
$12,993.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,147.65
|
|
|
EDARAVONE 30 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,737.60
|
|
|
Service Code
|
HCPCS J1301
|
| Hospital Charge Code |
183348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$764.54 |
| Max. Negotiated Rate |
$1,563.84 |
| Rate for Payer: Aetna American Axle |
$1,129.44
|
| Rate for Payer: Aetna Commercial |
$1,476.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.44
|
| Rate for Payer: Cash Price |
$1,390.08
|
| Rate for Payer: Cofinity Advantage |
$1,216.32
|
| Rate for Payer: Cofinity Commercial |
$1,494.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.08
|
| Rate for Payer: Healthscope Commercial |
$1,563.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,303.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,303.20
|
| Rate for Payer: PHP Commercial |
$1,476.96
|
| Rate for Payer: Priority Health SBD |
$1,094.69
|
| Rate for Payer: UMR Bronson Commercial |
$764.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,303.20
|
|
|
EDARAVONE 30 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,737.60
|
|
|
Service Code
|
HCPCS J1301
|
| Hospital Charge Code |
183348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$1,563.84 |
| Rate for Payer: Aetna American Axle |
$1,129.44
|
| Rate for Payer: Aetna Commercial |
$1,476.96
|
| Rate for Payer: Aetna Medicare |
$15.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.98
|
| Rate for Payer: BCBS Complete |
$8.34
|
| Rate for Payer: BCBS MAPPO |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$56.62
|
| Rate for Payer: BCN Commercial |
$56.62
|
| Rate for Payer: BCN Medicare Advantage |
$15.18
|
| Rate for Payer: Cash Price |
$1,390.08
|
| Rate for Payer: Cash Price |
$1,390.08
|
| Rate for Payer: Cofinity Advantage |
$1,216.32
|
| Rate for Payer: Cofinity Commercial |
$1,494.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$1,563.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,303.20
|
| Rate for Payer: Mclaren Medicaid |
$15.18
|
| Rate for Payer: Mclaren Medicare |
$15.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.94
|
| Rate for Payer: Meridian Medicaid |
$15.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.96
|
| Rate for Payer: Nomi Health Commercial |
$45.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,303.20
|
| Rate for Payer: PACE Medicare |
$14.42
|
| Rate for Payer: PACE SWMI |
$15.18
|
| Rate for Payer: PHP Commercial |
$1,476.96
|
| Rate for Payer: PHP Medicare Advantage |
$15.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$66.20
|
| Rate for Payer: Priority Health Medicare |
$15.18
|
| Rate for Payer: Priority Health SBD |
$1,094.69
|
| Rate for Payer: Priority Health Tiered Network |
$52.96
|
| Rate for Payer: Railroad Medicare Medicare |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.83
|
| Rate for Payer: UHC Core |
$28.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.18
|
| Rate for Payer: UHC Exchange |
$28.83
|
| Rate for Payer: UHC Medicaid |
$7.94
|
| Rate for Payer: UHCCP Medicaid |
$7.94
|
| Rate for Payer: UMR Bronson Commercial |
$642.91
|
| Rate for Payer: VA VA |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,303.20
|
|
|
EFGARTIGIMOD ALFA 1008 MG-HYALURON-QVFC 11,200 UNIT/5.6 ML SUBCUT SOLN
|
Facility
|
IP
|
$42,666.60
|
|
|
Service Code
|
HCPCS J9334
|
| Hospital Charge Code |
204386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,773.30 |
| Max. Negotiated Rate |
$38,399.94 |
| Rate for Payer: Aetna American Axle |
$27,733.29
|
| Rate for Payer: Aetna Commercial |
$36,266.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,733.29
|
| Rate for Payer: Cash Price |
$34,133.28
|
| Rate for Payer: Cofinity Advantage |
$29,866.62
|
| Rate for Payer: Cofinity Commercial |
$36,693.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,133.28
|
| Rate for Payer: Healthscope Commercial |
$38,399.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,866.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,999.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,266.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,999.95
|
| Rate for Payer: PHP Commercial |
$36,266.61
|
| Rate for Payer: Priority Health SBD |
$26,879.96
|
| Rate for Payer: UMR Bronson Commercial |
$18,773.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,999.95
|
|
|
EFGARTIGIMOD ALFA 1008 MG-HYALURON-QVFC 11,200 UNIT/5.6 ML SUBCUT SOLN
|
Facility
|
OP
|
$42,666.60
|
|
|
Service Code
|
HCPCS J9334
|
| Hospital Charge Code |
204386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$38,399.94 |
| Rate for Payer: Aetna American Axle |
$27,733.29
|
| Rate for Payer: Aetna Commercial |
$36,266.61
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,733.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.91
|
| Rate for Payer: BCBS Complete |
$18.85
|
| Rate for Payer: BCBS MAPPO |
$34.33
|
| Rate for Payer: BCBS Trust/PPO |
$110.63
|
| Rate for Payer: BCN Commercial |
$110.63
|
| Rate for Payer: BCN Medicare Advantage |
$34.33
|
| Rate for Payer: Cash Price |
$34,133.28
|
| Rate for Payer: Cash Price |
$34,133.28
|
| Rate for Payer: Cofinity Advantage |
$29,866.62
|
| Rate for Payer: Cofinity Commercial |
$36,693.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,133.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$38,399.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,866.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,999.95
|
| Rate for Payer: Mclaren Medicaid |
$34.33
|
| Rate for Payer: Mclaren Medicare |
$34.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.05
|
| Rate for Payer: Meridian Medicaid |
$36.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,266.61
|
| Rate for Payer: Nomi Health Commercial |
$102.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,999.95
|
| Rate for Payer: PACE Medicare |
$32.61
|
| Rate for Payer: PACE SWMI |
$34.33
|
| Rate for Payer: PHP Commercial |
$36,266.61
|
| Rate for Payer: PHP Medicare Advantage |
$34.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$106.88
|
| Rate for Payer: Priority Health Medicare |
$34.33
|
| Rate for Payer: Priority Health SBD |
$26,879.96
|
| Rate for Payer: Priority Health Tiered Network |
$85.50
|
| Rate for Payer: Railroad Medicare Medicare |
$34.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.30
|
| Rate for Payer: UHC Core |
$56.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.33
|
| Rate for Payer: UHC Exchange |
$56.30
|
| Rate for Payer: UHC Medicaid |
$17.95
|
| Rate for Payer: UHCCP Medicaid |
$17.95
|
| Rate for Payer: UMR Bronson Commercial |
$15,786.64
|
| Rate for Payer: VA VA |
$34.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,999.95
|
|
|
EFGARTIGIMOD ALFA-FCAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,416.92
|
|
|
Service Code
|
HCPCS J9332
|
| Hospital Charge Code |
198972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,223.44 |
| Max. Negotiated Rate |
$14,775.23 |
| Rate for Payer: Aetna American Axle |
$10,671.00
|
| Rate for Payer: Aetna Commercial |
$13,954.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,671.00
|
| Rate for Payer: Cash Price |
$13,133.54
|
| Rate for Payer: Cofinity Advantage |
$11,491.84
|
| Rate for Payer: Cofinity Commercial |
$14,118.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,133.54
|
| Rate for Payer: Healthscope Commercial |
$14,775.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,491.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,312.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,954.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,312.69
|
| Rate for Payer: PHP Commercial |
$13,954.38
|
| Rate for Payer: Priority Health SBD |
$10,342.66
|
| Rate for Payer: UMR Bronson Commercial |
$7,223.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,312.69
|
|
|
EFGARTIGIMOD ALFA-FCAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,416.92
|
|
|
Service Code
|
HCPCS J9332
|
| Hospital Charge Code |
198972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$14,775.23 |
| Rate for Payer: Aetna American Axle |
$10,671.00
|
| Rate for Payer: Aetna Commercial |
$13,954.38
|
| Rate for Payer: Aetna Medicare |
$33.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,671.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.76
|
| Rate for Payer: BCBS Complete |
$17.91
|
| Rate for Payer: BCBS MAPPO |
$32.61
|
| Rate for Payer: BCBS Trust/PPO |
$104.48
|
| Rate for Payer: BCN Commercial |
$104.48
|
| Rate for Payer: BCN Medicare Advantage |
$32.61
|
| Rate for Payer: Cash Price |
$13,133.54
|
| Rate for Payer: Cash Price |
$13,133.54
|
| Rate for Payer: Cofinity Advantage |
$11,491.84
|
| Rate for Payer: Cofinity Commercial |
$14,118.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,133.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.61
|
| Rate for Payer: Healthscope Commercial |
$14,775.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,491.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,312.69
|
| Rate for Payer: Mclaren Medicaid |
$32.61
|
| Rate for Payer: Mclaren Medicare |
$32.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.24
|
| Rate for Payer: Meridian Medicaid |
$34.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,954.38
|
| Rate for Payer: Nomi Health Commercial |
$97.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,312.69
|
| Rate for Payer: PACE Medicare |
$30.98
|
| Rate for Payer: PACE SWMI |
$32.61
|
| Rate for Payer: PHP Commercial |
$13,954.38
|
| Rate for Payer: PHP Medicare Advantage |
$32.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$32.61
|
| Rate for Payer: Priority Health SBD |
$10,342.66
|
| Rate for Payer: Priority Health Tiered Network |
$81.12
|
| Rate for Payer: Railroad Medicare Medicare |
$32.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.16
|
| Rate for Payer: UHC Core |
$53.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.61
|
| Rate for Payer: UHC Exchange |
$53.16
|
| Rate for Payer: UHC Medicaid |
$17.06
|
| Rate for Payer: UHCCP Medicaid |
$17.06
|
| Rate for Payer: UMR Bronson Commercial |
$6,074.26
|
| Rate for Payer: VA VA |
$32.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,312.69
|
|
|
ELECARE INFANT UNFLAVORED INFANT CONTINUOUS FEED
|
Facility
|
IP
|
$113.96
|
|
|
Service Code
|
NDC 70074053511
|
| Hospital Charge Code |
168951
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$102.56 |
| Rate for Payer: Aetna American Axle |
$74.07
|
| Rate for Payer: Aetna Commercial |
$96.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.07
|
| Rate for Payer: Cash Price |
$91.17
|
| Rate for Payer: Cofinity Advantage |
$79.77
|
| Rate for Payer: Cofinity Commercial |
$98.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$102.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.47
|
| Rate for Payer: PHP Commercial |
$96.87
|
| Rate for Payer: Priority Health SBD |
$71.79
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.47
|
|
|
ELECARE INFANT UNFLAVORED INFANT CONTINUOUS FEED
|
Facility
|
OP
|
$113.96
|
|
|
Service Code
|
NDC 70074053511
|
| Hospital Charge Code |
168951
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$102.56 |
| Rate for Payer: Aetna American Axle |
$74.07
|
| Rate for Payer: Aetna Commercial |
$96.87
|
| Rate for Payer: Aetna Medicare |
$56.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.07
|
| Rate for Payer: BCBS Complete |
$45.58
|
| Rate for Payer: Cash Price |
$91.17
|
| Rate for Payer: Cofinity Advantage |
$79.77
|
| Rate for Payer: Cofinity Commercial |
$98.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$102.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.47
|
| Rate for Payer: PHP Commercial |
$96.87
|
| Rate for Payer: Priority Health SBD |
$71.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.07
|
| Rate for Payer: UHC Core |
$59.37
|
| Rate for Payer: UHC Exchange |
$44.79
|
| Rate for Payer: UMR Bronson Commercial |
$42.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.47
|
|
|
ELECARE INFANT UNFLAVORED ORAL POWDER CUSTOM
|
Facility
|
OP
|
$113.96
|
|
|
Service Code
|
NDC 70074053511
|
| Hospital Charge Code |
150852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$102.56 |
| Rate for Payer: Aetna American Axle |
$74.07
|
| Rate for Payer: Aetna Commercial |
$96.87
|
| Rate for Payer: Aetna Medicare |
$56.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.07
|
| Rate for Payer: BCBS Complete |
$45.58
|
| Rate for Payer: Cash Price |
$91.17
|
| Rate for Payer: Cofinity Advantage |
$79.77
|
| Rate for Payer: Cofinity Commercial |
$98.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$102.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.47
|
| Rate for Payer: PHP Commercial |
$96.87
|
| Rate for Payer: Priority Health SBD |
$71.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.07
|
| Rate for Payer: UHC Core |
$59.37
|
| Rate for Payer: UHC Exchange |
$44.79
|
| Rate for Payer: UMR Bronson Commercial |
$42.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.47
|
|
|
ELECARE INFANT UNFLAVORED ORAL POWDER CUSTOM
|
Facility
|
IP
|
$113.96
|
|
|
Service Code
|
NDC 70074053511
|
| Hospital Charge Code |
150852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$102.56 |
| Rate for Payer: Aetna American Axle |
$74.07
|
| Rate for Payer: Aetna Commercial |
$96.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.07
|
| Rate for Payer: Cash Price |
$91.17
|
| Rate for Payer: Cofinity Advantage |
$79.77
|
| Rate for Payer: Cofinity Commercial |
$98.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$102.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.47
|
| Rate for Payer: PHP Commercial |
$96.87
|
| Rate for Payer: Priority Health SBD |
$71.79
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.47
|
|
|
ELECARE JR (VANILLA) ORAL POWDER CUSTOM
|
Facility
|
IP
|
$109.52
|
|
|
Service Code
|
NDC 70074056586
|
| Hospital Charge Code |
163630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.19 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Advantage |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.14
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$48.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE JR (VANILLA) ORAL POWDER CUSTOM
|
Facility
|
OP
|
$109.52
|
|
|
Service Code
|
NDC 70074056586
|
| Hospital Charge Code |
163630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: BCBS Complete |
$43.81
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Advantage |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.14
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.19
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: UHC Exchange |
$43.04
|
| Rate for Payer: UMR Bronson Commercial |
$40.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE JUNIOR VANILLA CONTINUOUS FEED
|
Facility
|
IP
|
$113.96
|
|
|
Service Code
|
NDC 09900000581
|
| Hospital Charge Code |
168952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$102.56 |
| Rate for Payer: Aetna American Axle |
$74.07
|
| Rate for Payer: Aetna Commercial |
$96.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.07
|
| Rate for Payer: Cash Price |
$91.17
|
| Rate for Payer: Cofinity Advantage |
$79.77
|
| Rate for Payer: Cofinity Commercial |
$98.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$102.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.47
|
| Rate for Payer: PHP Commercial |
$96.87
|
| Rate for Payer: Priority Health SBD |
$71.79
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.47
|
|
|
ELECARE JUNIOR VANILLA CONTINUOUS FEED
|
Facility
|
OP
|
$109.52
|
|
|
Service Code
|
NDC 70074056586
|
| Hospital Charge Code |
168952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: BCBS Complete |
$43.81
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Advantage |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.14
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.19
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: UHC Exchange |
$43.04
|
| Rate for Payer: UMR Bronson Commercial |
$40.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE JUNIOR VANILLA CONTINUOUS FEED
|
Facility
|
IP
|
$109.52
|
|
|
Service Code
|
NDC 70074056586
|
| Hospital Charge Code |
168952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.19 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Advantage |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.14
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$48.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE JUNIOR VANILLA CONTINUOUS FEED
|
Facility
|
OP
|
$113.96
|
|
|
Service Code
|
NDC 09900000581
|
| Hospital Charge Code |
168952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$102.56 |
| Rate for Payer: Aetna American Axle |
$74.07
|
| Rate for Payer: Aetna Commercial |
$96.87
|
| Rate for Payer: Aetna Medicare |
$56.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.07
|
| Rate for Payer: BCBS Complete |
$45.58
|
| Rate for Payer: Cash Price |
$91.17
|
| Rate for Payer: Cofinity Advantage |
$79.77
|
| Rate for Payer: Cofinity Commercial |
$98.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$102.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.47
|
| Rate for Payer: PHP Commercial |
$96.87
|
| Rate for Payer: Priority Health SBD |
$71.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.07
|
| Rate for Payer: UHC Core |
$59.37
|
| Rate for Payer: UHC Exchange |
$44.79
|
| Rate for Payer: UMR Bronson Commercial |
$42.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.47
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$9,072.61
|
|
|
Service Code
|
APR-DRG 3241
|
| Min. Negotiated Rate |
$8,640.58 |
| Max. Negotiated Rate |
$9,072.61 |
| Rate for Payer: BCBS Complete |
$9,072.61
|
| Rate for Payer: Mclaren Medicaid |
$8,640.58
|
| Rate for Payer: Meridian Medicaid |
$9,072.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,640.58
|
| Rate for Payer: UHC Medicaid |
$8,640.58
|
| Rate for Payer: UHCCP Medicaid |
$8,640.58
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$24,378.86
|
|
|
Service Code
|
APR-DRG 3244
|
| Min. Negotiated Rate |
$23,217.96 |
| Max. Negotiated Rate |
$24,378.86 |
| Rate for Payer: BCBS Complete |
$24,378.86
|
| Rate for Payer: Mclaren Medicaid |
$23,217.96
|
| Rate for Payer: Meridian Medicaid |
$24,378.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,217.96
|
| Rate for Payer: UHC Medicaid |
$23,217.96
|
| Rate for Payer: UHCCP Medicaid |
$23,217.96
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$15,940.63
|
|
|
Service Code
|
APR-DRG 3243
|
| Min. Negotiated Rate |
$15,181.55 |
| Max. Negotiated Rate |
$15,940.63 |
| Rate for Payer: BCBS Complete |
$15,940.63
|
| Rate for Payer: Mclaren Medicaid |
$15,181.55
|
| Rate for Payer: Meridian Medicaid |
$15,940.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,181.55
|
| Rate for Payer: UHC Medicaid |
$15,181.55
|
| Rate for Payer: UHCCP Medicaid |
$15,181.55
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$11,166.43
|
|
|
Service Code
|
APR-DRG 3242
|
| Min. Negotiated Rate |
$10,634.70 |
| Max. Negotiated Rate |
$11,166.43 |
| Rate for Payer: BCBS Complete |
$11,166.43
|
| Rate for Payer: Mclaren Medicaid |
$10,634.70
|
| Rate for Payer: Meridian Medicaid |
$11,166.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,634.70
|
| Rate for Payer: UHC Medicaid |
$10,634.70
|
| Rate for Payer: UHCCP Medicaid |
$10,634.70
|
|
