|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$21,450.30
|
|
|
Service Code
|
APR-DRG 2334
|
| Min. Negotiated Rate |
$20,428.85 |
| Max. Negotiated Rate |
$21,450.30 |
| Rate for Payer: BCBS Complete |
$21,450.30
|
| Rate for Payer: Mclaren Medicaid |
$20,428.85
|
| Rate for Payer: Meridian Medicaid |
$21,450.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,428.85
|
| Rate for Payer: UHC Medicaid |
$20,428.85
|
| Rate for Payer: UHCCP Medicaid |
$20,428.85
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$17,025.37
|
|
|
Service Code
|
APR-DRG 2344
|
| Min. Negotiated Rate |
$16,214.64 |
| Max. Negotiated Rate |
$17,025.37 |
| Rate for Payer: BCBS Complete |
$17,025.37
|
| Rate for Payer: Mclaren Medicaid |
$16,214.64
|
| Rate for Payer: Meridian Medicaid |
$17,025.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,214.64
|
| Rate for Payer: UHC Medicaid |
$16,214.64
|
| Rate for Payer: UHCCP Medicaid |
$16,214.64
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$6,556.28
|
|
|
Service Code
|
APR-DRG 2341
|
| Min. Negotiated Rate |
$6,244.07 |
| Max. Negotiated Rate |
$6,556.28 |
| Rate for Payer: BCBS Complete |
$6,556.28
|
| Rate for Payer: Mclaren Medicaid |
$6,244.07
|
| Rate for Payer: Meridian Medicaid |
$6,556.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,244.07
|
| Rate for Payer: UHC Medicaid |
$6,244.07
|
| Rate for Payer: UHCCP Medicaid |
$6,244.07
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$12,428.53
|
|
|
Service Code
|
APR-DRG 2343
|
| Min. Negotiated Rate |
$11,836.70 |
| Max. Negotiated Rate |
$12,428.53 |
| Rate for Payer: BCBS Complete |
$12,428.53
|
| Rate for Payer: Mclaren Medicaid |
$11,836.70
|
| Rate for Payer: Meridian Medicaid |
$12,428.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,836.70
|
| Rate for Payer: UHC Medicaid |
$11,836.70
|
| Rate for Payer: UHCCP Medicaid |
$11,836.70
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$7,998.76
|
|
|
Service Code
|
APR-DRG 2342
|
| Min. Negotiated Rate |
$7,617.87 |
| Max. Negotiated Rate |
$7,998.76 |
| Rate for Payer: BCBS Complete |
$7,998.76
|
| Rate for Payer: Mclaren Medicaid |
$7,617.87
|
| Rate for Payer: Meridian Medicaid |
$7,998.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,617.87
|
| Rate for Payer: UHC Medicaid |
$7,617.87
|
| Rate for Payer: UHCCP Medicaid |
$7,617.87
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
|
IP
|
$31,576.89
|
|
|
Service Code
|
MSDRG 398
|
| Min. Negotiated Rate |
$12,588.20 |
| Max. Negotiated Rate |
$31,576.89 |
| Rate for Payer: Aetna Medicare |
$13,780.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,563.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,563.42
|
| Rate for Payer: BCBS MAPPO |
$13,250.74
|
| Rate for Payer: BCBS Trust/PPO |
$31,576.89
|
| Rate for Payer: BCN Commercial |
$31,576.89
|
| Rate for Payer: BCN Medicare Advantage |
$13,250.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,250.74
|
| Rate for Payer: Mclaren Medicare |
$13,250.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,913.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,238.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,575.81
|
| Rate for Payer: Nomi Health Commercial |
$19,525.44
|
| Rate for Payer: PACE Medicare |
$12,588.20
|
| Rate for Payer: PACE SWMI |
$13,250.74
|
| Rate for Payer: PHP Medicare Advantage |
$13,250.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,402.47
|
| Rate for Payer: Priority Health Medicare |
$13,250.74
|
| Rate for Payer: Priority Health Tiered Network |
$19,521.97
|
| Rate for Payer: Railroad Medicare Medicare |
$13,250.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,671.68
|
| Rate for Payer: UHC Core |
$20,640.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,250.74
|
| Rate for Payer: UHC Exchange |
$16,856.96
|
| Rate for Payer: VA VA |
$13,250.74
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
|
IP
|
$39,036.87
|
|
|
Service Code
|
MSDRG 397
|
| Min. Negotiated Rate |
$19,589.75 |
| Max. Negotiated Rate |
$39,036.87 |
| Rate for Payer: Aetna Medicare |
$21,445.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,775.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,775.99
|
| Rate for Payer: BCBS MAPPO |
$20,620.79
|
| Rate for Payer: BCBS Trust/PPO |
$36,087.08
|
| Rate for Payer: BCN Commercial |
$36,087.08
|
| Rate for Payer: BCN Medicare Advantage |
$20,620.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,620.79
|
| Rate for Payer: Mclaren Medicare |
$20,620.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,651.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,713.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,682.87
|
| Rate for Payer: Nomi Health Commercial |
$30,894.21
|
| Rate for Payer: PACE Medicare |
$19,589.75
|
| Rate for Payer: PACE SWMI |
$20,620.79
|
| Rate for Payer: PHP Medicare Advantage |
$20,620.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38,610.91
|
| Rate for Payer: Priority Health Medicare |
$20,620.79
|
| Rate for Payer: Priority Health Tiered Network |
$30,888.73
|
| Rate for Payer: Railroad Medicare Medicare |
$20,620.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,036.87
|
| Rate for Payer: UHC Core |
$32,659.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,620.79
|
| Rate for Payer: UHC Exchange |
$26,672.00
|
| Rate for Payer: VA VA |
$20,620.79
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,575.31
|
|
|
Service Code
|
MSDRG 399
|
| Min. Negotiated Rate |
$9,657.45 |
| Max. Negotiated Rate |
$26,575.31 |
| Rate for Payer: Aetna Medicare |
$10,572.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,707.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,707.17
|
| Rate for Payer: BCBS MAPPO |
$10,165.74
|
| Rate for Payer: BCBS Trust/PPO |
$26,575.31
|
| Rate for Payer: BCN Commercial |
$26,575.31
|
| Rate for Payer: BCN Medicare Advantage |
$10,165.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,165.74
|
| Rate for Payer: Mclaren Medicare |
$10,165.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,674.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,690.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,182.31
|
| Rate for Payer: Nomi Health Commercial |
$14,766.63
|
| Rate for Payer: PACE Medicare |
$9,657.45
|
| Rate for Payer: PACE SWMI |
$10,165.74
|
| Rate for Payer: PHP Medicare Advantage |
$10,165.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,455.01
|
| Rate for Payer: Priority Health Medicare |
$10,165.74
|
| Rate for Payer: Priority Health Tiered Network |
$14,764.01
|
| Rate for Payer: Railroad Medicare Medicare |
$10,165.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,658.61
|
| Rate for Payer: UHC Core |
$15,610.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,165.74
|
| Rate for Payer: UHC Exchange |
$12,748.52
|
| Rate for Payer: VA VA |
$10,165.74
|
|
|
APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN 1 PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM (EG, ILIZAROV, MONTICELLI TYPE)
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 20692
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$12,119.82
|
| Rate for Payer: BCN Commercial |
$12,119.82
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
APPLICATION OF A UNIPLANE (PINS OR WIRES IN 1 PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 20690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,985.59
|
| Rate for Payer: BCN Commercial |
$4,985.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
APRACLONIDINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$148.75
|
|
|
Service Code
|
NDC 61314066505
|
| Hospital Charge Code |
9119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna Medicare |
$74.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: BCBS Complete |
$59.50
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Advantage |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.56
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.69
|
| Rate for Payer: UHC Core |
$77.50
|
| Rate for Payer: UHC Exchange |
$58.46
|
| Rate for Payer: UMR Bronson Commercial |
$55.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
APRACLONIDINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$148.75
|
|
|
Service Code
|
NDC 61314066505
|
| Hospital Charge Code |
9119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Advantage |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.56
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UMR Bronson Commercial |
$65.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
APRACLONIDINE 1 % EYE DROPS IN A DROPPERETTE
|
Facility
|
OP
|
$95.42
|
|
|
Service Code
|
NDC 82667020001
|
| Hospital Charge Code |
9120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.31 |
| Max. Negotiated Rate |
$85.88 |
| Rate for Payer: Aetna American Axle |
$62.02
|
| Rate for Payer: Aetna Commercial |
$81.11
|
| Rate for Payer: Aetna Medicare |
$47.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.02
|
| Rate for Payer: BCBS Complete |
$38.17
|
| Rate for Payer: Cash Price |
$76.34
|
| Rate for Payer: Cofinity Advantage |
$66.79
|
| Rate for Payer: Cofinity Commercial |
$82.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.34
|
| Rate for Payer: Healthscope Commercial |
$85.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.56
|
| Rate for Payer: PHP Commercial |
$81.11
|
| Rate for Payer: Priority Health SBD |
$60.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.02
|
| Rate for Payer: UHC Core |
$49.71
|
| Rate for Payer: UHC Exchange |
$37.50
|
| Rate for Payer: UMR Bronson Commercial |
$35.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.56
|
|
|
APRACLONIDINE 1 % EYE DROPS IN A DROPPERETTE
|
Facility
|
OP
|
$95.42
|
|
|
Service Code
|
NDC 00065066010
|
| Hospital Charge Code |
9120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.31 |
| Max. Negotiated Rate |
$85.88 |
| Rate for Payer: Aetna American Axle |
$62.02
|
| Rate for Payer: Aetna Commercial |
$81.11
|
| Rate for Payer: Aetna Medicare |
$47.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.02
|
| Rate for Payer: BCBS Complete |
$38.17
|
| Rate for Payer: Cash Price |
$76.34
|
| Rate for Payer: Cofinity Advantage |
$66.79
|
| Rate for Payer: Cofinity Commercial |
$82.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.34
|
| Rate for Payer: Healthscope Commercial |
$85.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.56
|
| Rate for Payer: PHP Commercial |
$81.11
|
| Rate for Payer: Priority Health SBD |
$60.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.02
|
| Rate for Payer: UHC Core |
$49.71
|
| Rate for Payer: UHC Exchange |
$37.50
|
| Rate for Payer: UMR Bronson Commercial |
$35.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.56
|
|
|
APRACLONIDINE 1 % EYE DROPS IN A DROPPERETTE
|
Facility
|
IP
|
$95.42
|
|
|
Service Code
|
NDC 82667020001
|
| Hospital Charge Code |
9120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$85.88 |
| Rate for Payer: Aetna American Axle |
$62.02
|
| Rate for Payer: Aetna Commercial |
$81.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.02
|
| Rate for Payer: Cash Price |
$76.34
|
| Rate for Payer: Cofinity Advantage |
$66.79
|
| Rate for Payer: Cofinity Commercial |
$82.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.34
|
| Rate for Payer: Healthscope Commercial |
$85.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.56
|
| Rate for Payer: PHP Commercial |
$81.11
|
| Rate for Payer: Priority Health SBD |
$60.11
|
| Rate for Payer: UMR Bronson Commercial |
$41.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.56
|
|
|
APRACLONIDINE 1 % EYE DROPS IN A DROPPERETTE
|
Facility
|
IP
|
$95.42
|
|
|
Service Code
|
NDC 00065066010
|
| Hospital Charge Code |
9120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$85.88 |
| Rate for Payer: Aetna American Axle |
$62.02
|
| Rate for Payer: Aetna Commercial |
$81.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.02
|
| Rate for Payer: Cash Price |
$76.34
|
| Rate for Payer: Cofinity Advantage |
$66.79
|
| Rate for Payer: Cofinity Commercial |
$82.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.34
|
| Rate for Payer: Healthscope Commercial |
$85.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.56
|
| Rate for Payer: PHP Commercial |
$81.11
|
| Rate for Payer: Priority Health SBD |
$60.11
|
| Rate for Payer: UMR Bronson Commercial |
$41.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.56
|
|
|
APREPITANT 125 MG (25 MG/ML FINAL CONCENTRATION) ORAL SUSPENSION
|
Facility
|
OP
|
$1,176.23
|
|
|
Service Code
|
NDC 00006306601
|
| Hospital Charge Code |
179507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$435.21 |
| Max. Negotiated Rate |
$1,058.61 |
| Rate for Payer: Aetna American Axle |
$764.55
|
| Rate for Payer: Aetna Commercial |
$999.80
|
| Rate for Payer: Aetna Medicare |
$588.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.55
|
| Rate for Payer: BCBS Complete |
$470.49
|
| Rate for Payer: Cash Price |
$940.98
|
| Rate for Payer: Cofinity Advantage |
$823.36
|
| Rate for Payer: Cofinity Commercial |
$1,011.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.98
|
| Rate for Payer: Healthscope Commercial |
$1,058.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$823.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$882.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$940.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$882.17
|
| Rate for Payer: PHP Commercial |
$999.80
|
| Rate for Payer: Priority Health SBD |
$741.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.55
|
| Rate for Payer: UHC Core |
$612.82
|
| Rate for Payer: UHC Exchange |
$462.26
|
| Rate for Payer: UMR Bronson Commercial |
$435.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$882.17
|
|
|
APREPITANT 125 MG (25 MG/ML FINAL CONCENTRATION) ORAL SUSPENSION
|
Facility
|
IP
|
$1,176.23
|
|
|
Service Code
|
NDC 00006306601
|
| Hospital Charge Code |
179507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$517.54 |
| Max. Negotiated Rate |
$1,058.61 |
| Rate for Payer: Aetna American Axle |
$764.55
|
| Rate for Payer: Aetna Commercial |
$999.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.55
|
| Rate for Payer: Cash Price |
$940.98
|
| Rate for Payer: Cofinity Advantage |
$823.36
|
| Rate for Payer: Cofinity Commercial |
$1,011.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.98
|
| Rate for Payer: Healthscope Commercial |
$1,058.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$823.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$882.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$882.17
|
| Rate for Payer: PHP Commercial |
$999.80
|
| Rate for Payer: Priority Health SBD |
$741.02
|
| Rate for Payer: UMR Bronson Commercial |
$517.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$882.17
|
|
|
APREPITANT 125 MG (25 MG/ML FINAL CONCENTRATION) ORAL SUSPENSION
|
Facility
|
IP
|
$1,176.23
|
|
|
Service Code
|
NDC 00006306603
|
| Hospital Charge Code |
179507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$517.54 |
| Max. Negotiated Rate |
$1,058.61 |
| Rate for Payer: Aetna American Axle |
$764.55
|
| Rate for Payer: Aetna Commercial |
$999.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.55
|
| Rate for Payer: Cash Price |
$940.98
|
| Rate for Payer: Cofinity Advantage |
$823.36
|
| Rate for Payer: Cofinity Commercial |
$1,011.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.98
|
| Rate for Payer: Healthscope Commercial |
$1,058.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$823.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$882.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$882.17
|
| Rate for Payer: PHP Commercial |
$999.80
|
| Rate for Payer: Priority Health SBD |
$741.02
|
| Rate for Payer: UMR Bronson Commercial |
$517.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$882.17
|
|
|
APREPITANT 125 MG (25 MG/ML FINAL CONCENTRATION) ORAL SUSPENSION
|
Facility
|
OP
|
$1,176.23
|
|
|
Service Code
|
NDC 00006306603
|
| Hospital Charge Code |
179507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$435.21 |
| Max. Negotiated Rate |
$1,058.61 |
| Rate for Payer: Aetna American Axle |
$764.55
|
| Rate for Payer: Aetna Commercial |
$999.80
|
| Rate for Payer: Aetna Medicare |
$588.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.55
|
| Rate for Payer: BCBS Complete |
$470.49
|
| Rate for Payer: Cash Price |
$940.98
|
| Rate for Payer: Cofinity Advantage |
$823.36
|
| Rate for Payer: Cofinity Commercial |
$1,011.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.98
|
| Rate for Payer: Healthscope Commercial |
$1,058.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$823.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$882.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$940.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$882.17
|
| Rate for Payer: PHP Commercial |
$999.80
|
| Rate for Payer: Priority Health SBD |
$741.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.55
|
| Rate for Payer: UHC Core |
$612.82
|
| Rate for Payer: UHC Exchange |
$462.26
|
| Rate for Payer: UMR Bronson Commercial |
$435.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$882.17
|
|
|
APREPITANT 125 MG CAPSULE
|
Facility
|
IP
|
$739.51
|
|
|
Service Code
|
NDC 00781232306
|
| Hospital Charge Code |
35489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.38 |
| Max. Negotiated Rate |
$665.56 |
| Rate for Payer: Aetna American Axle |
$480.68
|
| Rate for Payer: Aetna Commercial |
$628.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.68
|
| Rate for Payer: Cash Price |
$591.61
|
| Rate for Payer: Cofinity Advantage |
$517.66
|
| Rate for Payer: Cofinity Commercial |
$635.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$591.61
|
| Rate for Payer: Healthscope Commercial |
$665.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$517.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$554.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$628.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$554.63
|
| Rate for Payer: PHP Commercial |
$628.58
|
| Rate for Payer: Priority Health SBD |
$465.89
|
| Rate for Payer: UMR Bronson Commercial |
$325.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$554.63
|
|
|
APREPITANT 125 MG CAPSULE
|
Facility
|
OP
|
$4,437.05
|
|
|
Service Code
|
NDC 00781232368
|
| Hospital Charge Code |
35489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,641.71 |
| Max. Negotiated Rate |
$3,993.34 |
| Rate for Payer: Aetna American Axle |
$2,884.08
|
| Rate for Payer: Aetna Commercial |
$3,771.49
|
| Rate for Payer: Aetna Medicare |
$2,218.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,884.08
|
| Rate for Payer: BCBS Complete |
$1,774.82
|
| Rate for Payer: Cash Price |
$3,549.64
|
| Rate for Payer: Cofinity Advantage |
$3,105.93
|
| Rate for Payer: Cofinity Commercial |
$3,815.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.64
|
| Rate for Payer: Healthscope Commercial |
$3,993.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,105.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,327.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,549.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,327.79
|
| Rate for Payer: PHP Commercial |
$3,771.49
|
| Rate for Payer: Priority Health SBD |
$2,795.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,884.08
|
| Rate for Payer: UHC Core |
$2,311.70
|
| Rate for Payer: UHC Exchange |
$1,743.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,641.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,327.79
|
|
|
APREPITANT 125 MG CAPSULE
|
Facility
|
OP
|
$739.51
|
|
|
Service Code
|
NDC 00781232306
|
| Hospital Charge Code |
35489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.62 |
| Max. Negotiated Rate |
$665.56 |
| Rate for Payer: Aetna American Axle |
$480.68
|
| Rate for Payer: Aetna Commercial |
$628.58
|
| Rate for Payer: Aetna Medicare |
$369.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.68
|
| Rate for Payer: BCBS Complete |
$295.80
|
| Rate for Payer: Cash Price |
$591.61
|
| Rate for Payer: Cofinity Advantage |
$517.66
|
| Rate for Payer: Cofinity Commercial |
$635.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$591.61
|
| Rate for Payer: Healthscope Commercial |
$665.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$517.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$554.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$591.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$628.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$554.63
|
| Rate for Payer: PHP Commercial |
$628.58
|
| Rate for Payer: Priority Health SBD |
$465.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.68
|
| Rate for Payer: UHC Core |
$385.28
|
| Rate for Payer: UHC Exchange |
$290.63
|
| Rate for Payer: UMR Bronson Commercial |
$273.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$554.63
|
|
|
APREPITANT 125 MG CAPSULE
|
Facility
|
IP
|
$4,437.05
|
|
|
Service Code
|
NDC 00781232368
|
| Hospital Charge Code |
35489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,952.30 |
| Max. Negotiated Rate |
$3,993.34 |
| Rate for Payer: Aetna American Axle |
$2,884.08
|
| Rate for Payer: Aetna Commercial |
$3,771.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,884.08
|
| Rate for Payer: Cash Price |
$3,549.64
|
| Rate for Payer: Cofinity Advantage |
$3,105.93
|
| Rate for Payer: Cofinity Commercial |
$3,815.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.64
|
| Rate for Payer: Healthscope Commercial |
$3,993.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,105.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,327.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,327.79
|
| Rate for Payer: PHP Commercial |
$3,771.49
|
| Rate for Payer: Priority Health SBD |
$2,795.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,952.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,327.79
|
|
|
APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION
|
Facility
|
OP
|
$890.20
|
|
|
Service Code
|
HCPCS J0185
|
| Hospital Charge Code |
185153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$801.18 |
| Rate for Payer: Aetna American Axle |
$578.63
|
| Rate for Payer: Aetna Commercial |
$756.67
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.11
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: BCBS MAPPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$5.54
|
| Rate for Payer: BCN Commercial |
$5.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.69
|
| Rate for Payer: Cash Price |
$712.16
|
| Rate for Payer: Cash Price |
$712.16
|
| Rate for Payer: Cofinity Advantage |
$623.14
|
| Rate for Payer: Cofinity Commercial |
$765.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.69
|
| Rate for Payer: Healthscope Commercial |
$801.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$623.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.65
|
| Rate for Payer: Mclaren Medicaid |
$1.69
|
| Rate for Payer: Mclaren Medicare |
$1.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.77
|
| Rate for Payer: Meridian Medicaid |
$1.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.67
|
| Rate for Payer: Nomi Health Commercial |
$5.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$667.65
|
| Rate for Payer: PACE Medicare |
$1.61
|
| Rate for Payer: PACE SWMI |
$1.69
|
| Rate for Payer: PHP Commercial |
$756.67
|
| Rate for Payer: PHP Medicare Advantage |
$1.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.19
|
| Rate for Payer: Priority Health Medicare |
$1.69
|
| Rate for Payer: Priority Health SBD |
$560.83
|
| Rate for Payer: Priority Health Tiered Network |
$4.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.82
|
| Rate for Payer: UHC Core |
$2.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.69
|
| Rate for Payer: UHC Exchange |
$2.82
|
| Rate for Payer: UHC Medicaid |
$0.88
|
| Rate for Payer: UHCCP Medicaid |
$0.88
|
| Rate for Payer: UMR Bronson Commercial |
$329.37
|
| Rate for Payer: VA VA |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.65
|
|
