|
ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION
|
Facility
IP
|
$101.42
|
|
|
Service Code
|
HCPCS J1120
|
| Hospital Charge Code |
114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$91.28 |
| Rate for Payer: Aetna American Axle |
$65.92
|
| Rate for Payer: Aetna American Axle |
$85.31
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna American Axle |
$107.58
|
| Rate for Payer: Aetna American Axle |
$74.74
|
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$97.74
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$111.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$91.99
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$98.89
|
| Rate for Payer: Cofinity Commercial |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$80.49
|
| Rate for Payer: Cofinity Commercial |
$112.87
|
| Rate for Payer: Cofinity Commercial |
$91.87
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$118.12
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Commercial |
$103.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.55
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Commercial |
$97.74
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$111.55
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.63
|
| Rate for Payer: Priority Health SBD |
$72.44
|
| Rate for Payer: Priority Health SBD |
$82.68
|
| Rate for Payer: Priority Health SBD |
$63.89
|
| Rate for Payer: Priority Health SBD |
$104.26
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$72.82
|
| Rate for Payer: UMR Bronson Commercial |
$57.75
|
| Rate for Payer: UMR Bronson Commercial |
$50.60
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.24
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE
|
Facility
IP
|
$555.84
|
|
|
Service Code
|
NDC 23155-120-01
|
| Hospital Charge Code |
8962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.57 |
| Max. Negotiated Rate |
$500.26 |
| Rate for Payer: Aetna American Axle |
$361.30
|
| Rate for Payer: Aetna Commercial |
$472.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.30
|
| Rate for Payer: Cash Price |
$444.67
|
| Rate for Payer: Cofinity Commercial |
$389.09
|
| Rate for Payer: Cofinity Commercial |
$478.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.67
|
| Rate for Payer: Healthscope Commercial |
$500.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$389.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.46
|
| Rate for Payer: PHP Commercial |
$472.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.09
|
| Rate for Payer: Priority Health SBD |
$350.18
|
| Rate for Payer: UMR Bronson Commercial |
$244.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.88
|
|
|
ACETIC ACID 0.25 % IRRIGATION SOLUTION
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
NDC 0264-2304-10
|
| Hospital Charge Code |
8963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna American Axle |
$19.50
|
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: UMR Bronson Commercial |
$13.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
ACETONE LIQUID
|
Facility
IP
|
$100.80
|
|
|
Service Code
|
NDC 395001994
|
| Hospital Charge Code |
121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna American Axle |
$65.52
|
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.52
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.68
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.56
|
| Rate for Payer: Priority Health SBD |
$63.50
|
| Rate for Payer: UMR Bronson Commercial |
$44.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT
|
Facility
IP
|
$270.17
|
|
|
Service Code
|
NDC 24208-539-20
|
| Hospital Charge Code |
32559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$243.15 |
| Rate for Payer: Aetna American Axle |
$175.61
|
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.61
|
| Rate for Payer: Cash Price |
$216.14
|
| Rate for Payer: Cofinity Commercial |
$189.12
|
| Rate for Payer: Cofinity Commercial |
$232.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.14
|
| Rate for Payer: Healthscope Commercial |
$243.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.64
|
| Rate for Payer: PHP Commercial |
$229.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.12
|
| Rate for Payer: Priority Health SBD |
$170.21
|
| Rate for Payer: UMR Bronson Commercial |
$118.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.63
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$130.43
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$117.39 |
| Rate for Payer: Aetna American Axle |
$84.78
|
| Rate for Payer: Aetna American Axle |
$116.79
|
| Rate for Payer: Aetna American Axle |
$440.07
|
| Rate for Payer: Aetna American Axle |
$236.06
|
| Rate for Payer: Aetna American Axle |
$133.90
|
| Rate for Payer: Aetna American Axle |
$111.68
|
| Rate for Payer: Aetna Commercial |
$152.72
|
| Rate for Payer: Aetna Commercial |
$110.87
|
| Rate for Payer: Aetna Commercial |
$146.05
|
| Rate for Payer: Aetna Commercial |
$175.10
|
| Rate for Payer: Aetna Commercial |
$308.69
|
| Rate for Payer: Aetna Commercial |
$575.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.78
|
| Rate for Payer: Cash Price |
$143.74
|
| Rate for Payer: Cash Price |
$104.34
|
| Rate for Payer: Cash Price |
$137.46
|
| Rate for Payer: Cash Price |
$541.62
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cofinity Commercial |
$177.16
|
| Rate for Payer: Cofinity Commercial |
$120.27
|
| Rate for Payer: Cofinity Commercial |
$147.77
|
| Rate for Payer: Cofinity Commercial |
$582.25
|
| Rate for Payer: Cofinity Commercial |
$473.92
|
| Rate for Payer: Cofinity Commercial |
$91.30
|
| Rate for Payer: Cofinity Commercial |
$125.77
|
| Rate for Payer: Cofinity Commercial |
$154.52
|
| Rate for Payer: Cofinity Commercial |
$312.33
|
| Rate for Payer: Cofinity Commercial |
$254.22
|
| Rate for Payer: Cofinity Commercial |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$144.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.80
|
| Rate for Payer: Healthscope Commercial |
$609.33
|
| Rate for Payer: Healthscope Commercial |
$117.39
|
| Rate for Payer: Healthscope Commercial |
$326.85
|
| Rate for Payer: Healthscope Commercial |
$161.70
|
| Rate for Payer: Healthscope Commercial |
$185.40
|
| Rate for Payer: Healthscope Commercial |
$154.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$575.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.72
|
| Rate for Payer: PHP Commercial |
$308.69
|
| Rate for Payer: PHP Commercial |
$110.87
|
| Rate for Payer: PHP Commercial |
$146.05
|
| Rate for Payer: PHP Commercial |
$575.48
|
| Rate for Payer: PHP Commercial |
$175.10
|
| Rate for Payer: PHP Commercial |
$152.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.92
|
| Rate for Payer: Priority Health SBD |
$426.53
|
| Rate for Payer: Priority Health SBD |
$108.25
|
| Rate for Payer: Priority Health SBD |
$129.78
|
| Rate for Payer: Priority Health SBD |
$228.80
|
| Rate for Payer: Priority Health SBD |
$82.17
|
| Rate for Payer: Priority Health SBD |
$113.19
|
| Rate for Payer: UMR Bronson Commercial |
$159.79
|
| Rate for Payer: UMR Bronson Commercial |
$79.05
|
| Rate for Payer: UMR Bronson Commercial |
$90.64
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: UMR Bronson Commercial |
$75.60
|
| Rate for Payer: UMR Bronson Commercial |
$297.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.82
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
IP
|
$88.35
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna American Axle |
$57.43
|
| Rate for Payer: Aetna American Axle |
$28.11
|
| Rate for Payer: Aetna American Axle |
$66.18
|
| Rate for Payer: Aetna American Axle |
$38.56
|
| Rate for Payer: Aetna Commercial |
$50.43
|
| Rate for Payer: Aetna Commercial |
$86.54
|
| Rate for Payer: Aetna Commercial |
$36.76
|
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.11
|
| Rate for Payer: Cash Price |
$47.46
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cash Price |
$34.60
|
| Rate for Payer: Cofinity Commercial |
$51.02
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Cofinity Commercial |
$71.27
|
| Rate for Payer: Cofinity Commercial |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Cofinity Commercial |
$87.56
|
| Rate for Payer: Cofinity Commercial |
$41.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$38.92
|
| Rate for Payer: Healthscope Commercial |
$91.63
|
| Rate for Payer: Healthscope Commercial |
$53.40
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.76
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: PHP Commercial |
$50.43
|
| Rate for Payer: PHP Commercial |
$86.54
|
| Rate for Payer: PHP Commercial |
$36.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.28
|
| Rate for Payer: Priority Health SBD |
$64.14
|
| Rate for Payer: Priority Health SBD |
$27.25
|
| Rate for Payer: Priority Health SBD |
$37.38
|
| Rate for Payer: Priority Health SBD |
$55.66
|
| Rate for Payer: UMR Bronson Commercial |
$38.87
|
| Rate for Payer: UMR Bronson Commercial |
$44.80
|
| Rate for Payer: UMR Bronson Commercial |
$26.11
|
| Rate for Payer: UMR Bronson Commercial |
$19.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
ACETYLCYSTEINE 600 MG CAPSULE
|
Facility
IP
|
$176.25
|
|
|
Service Code
|
NDC 7985404097
|
| Hospital Charge Code |
116999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.81
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UMR Bronson Commercial |
$77.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
ACETYLCYSTEINE 600 MG CAPSULE
|
Facility
IP
|
$249.57
|
|
|
Service Code
|
NDC 2743400211
|
| Hospital Charge Code |
116999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$224.61 |
| Rate for Payer: Aetna American Axle |
$162.22
|
| Rate for Payer: Aetna Commercial |
$212.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: Cash Price |
$199.66
|
| Rate for Payer: Cofinity Commercial |
$174.70
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.66
|
| Rate for Payer: Healthscope Commercial |
$224.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.13
|
| Rate for Payer: PHP Commercial |
$212.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.70
|
| Rate for Payer: Priority Health SBD |
$157.23
|
| Rate for Payer: UMR Bronson Commercial |
$109.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.18
|
|
|
ACIDOPHILUS 25 MILLION CELL-PECTIN, CITRUS 100 MG TABLET
|
Facility
IP
|
$61.10
|
|
|
Service Code
|
NDC 536718001
|
| Hospital Charge Code |
134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna American Axle |
$39.72
|
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.94
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| Rate for Payer: UMR Bronson Commercial |
$26.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.82
|
|
|
ACIDOPHILUS-SPOROGENES 35 MILLION-25 MILLION CELL TABLET
|
Facility
IP
|
$58.75
|
|
|
Service Code
|
NDC 536718101
|
| Hospital Charge Code |
115719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna American Axle |
$38.19
|
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: UMR Bronson Commercial |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
IP
|
$97.44
|
|
|
Service Code
|
NDC 66689-201-08
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.87 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna American Axle |
$63.34
|
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.34
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$68.21
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.82
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.21
|
| Rate for Payer: Priority Health SBD |
$61.39
|
| Rate for Payer: UMR Bronson Commercial |
$42.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.08
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
IP
|
$18,296.42
|
|
|
Service Code
|
MS-DRG 880
|
| Min. Negotiated Rate |
$7,475.10 |
| Max. Negotiated Rate |
$18,296.42 |
| Rate for Payer: Aetna Medicare |
$8,183.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,835.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,835.66
|
| Rate for Payer: BCBS MAPPO |
$7,868.53
|
| Rate for Payer: BCBS Trust/PPO |
$18,296.42
|
| Rate for Payer: BCN Medicare Advantage |
$7,868.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,868.53
|
| Rate for Payer: Mclaren Medicare |
$7,868.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,261.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,048.81
|
| Rate for Payer: PACE Medicare |
$7,475.10
|
| Rate for Payer: PACE SWMI |
$7,868.53
|
| Rate for Payer: PHP Medicare Advantage |
$7,868.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,698.43
|
| Rate for Payer: Priority Health Medicare |
$7,868.53
|
| Rate for Payer: Priority Health Narrow Network |
$10,958.74
|
| Rate for Payer: Railroad Medicare Medicare |
$7,868.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,561.47
|
| Rate for Payer: UHC Core |
$11,940.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,868.53
|
| Rate for Payer: UHC Exchange |
$9,492.54
|
| Rate for Payer: UHC Medicare Advantage |
$8,104.59
|
| Rate for Payer: VA VA |
$7,868.53
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
IP
|
$24,103.74
|
|
|
Service Code
|
MS-DRG 289
|
| Min. Negotiated Rate |
$11,304.58 |
| Max. Negotiated Rate |
$24,103.74 |
| Rate for Payer: Aetna Medicare |
$12,375.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,874.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,874.45
|
| Rate for Payer: BCBS MAPPO |
$11,899.56
|
| Rate for Payer: BCBS Trust/PPO |
$24,103.74
|
| Rate for Payer: BCN Medicare Advantage |
$11,899.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,899.56
|
| Rate for Payer: Mclaren Medicare |
$11,899.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,494.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,684.49
|
| Rate for Payer: PACE Medicare |
$11,304.58
|
| Rate for Payer: PACE SWMI |
$11,899.56
|
| Rate for Payer: PHP Medicare Advantage |
$11,899.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,204.88
|
| Rate for Payer: Priority Health Medicare |
$11,899.56
|
| Rate for Payer: Priority Health Narrow Network |
$16,963.90
|
| Rate for Payer: Railroad Medicare Medicare |
$11,899.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,540.84
|
| Rate for Payer: UHC Core |
$18,483.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,899.56
|
| Rate for Payer: UHC Exchange |
$14,694.25
|
| Rate for Payer: UHC Medicare Advantage |
$12,256.55
|
| Rate for Payer: VA VA |
$11,899.56
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
IP
|
$67,943.79
|
|
|
Service Code
|
MS-DRG 288
|
| Min. Negotiated Rate |
$19,469.40 |
| Max. Negotiated Rate |
$67,943.79 |
| Rate for Payer: Aetna Medicare |
$21,313.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,617.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,617.62
|
| Rate for Payer: BCBS MAPPO |
$20,494.10
|
| Rate for Payer: BCBS Trust/PPO |
$67,943.79
|
| Rate for Payer: BCN Medicare Advantage |
$20,494.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,494.10
|
| Rate for Payer: Mclaren Medicare |
$20,494.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,518.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,568.22
|
| Rate for Payer: PACE Medicare |
$19,469.40
|
| Rate for Payer: PACE SWMI |
$20,494.10
|
| Rate for Payer: PHP Medicare Advantage |
$20,494.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,209.34
|
| Rate for Payer: Priority Health Medicare |
$20,494.10
|
| Rate for Payer: Priority Health Narrow Network |
$29,767.47
|
| Rate for Payer: Railroad Medicare Medicare |
$20,494.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,553.62
|
| Rate for Payer: UHC Core |
$32,433.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,494.10
|
| Rate for Payer: UHC Exchange |
$25,784.79
|
| Rate for Payer: UHC Medicare Advantage |
$21,108.92
|
| Rate for Payer: VA VA |
$20,494.10
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
IP
|
$20,661.06
|
|
|
Service Code
|
MS-DRG 290
|
| Min. Negotiated Rate |
$8,430.47 |
| Max. Negotiated Rate |
$20,661.06 |
| Rate for Payer: Aetna Medicare |
$9,229.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,092.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,092.72
|
| Rate for Payer: BCBS MAPPO |
$8,874.18
|
| Rate for Payer: BCBS Trust/PPO |
$20,661.06
|
| Rate for Payer: BCN Medicare Advantage |
$8,874.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,874.18
|
| Rate for Payer: Mclaren Medicare |
$8,874.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,317.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,205.31
|
| Rate for Payer: PACE Medicare |
$8,430.47
|
| Rate for Payer: PACE SWMI |
$8,874.18
|
| Rate for Payer: PHP Medicare Advantage |
$8,874.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,711.54
|
| Rate for Payer: Priority Health Medicare |
$8,874.18
|
| Rate for Payer: Priority Health Narrow Network |
$11,769.23
|
| Rate for Payer: Railroad Medicare Medicare |
$8,874.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,638.40
|
| Rate for Payer: UHC Core |
$12,823.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,874.18
|
| Rate for Payer: UHC Exchange |
$10,194.59
|
| Rate for Payer: UHC Medicare Advantage |
$9,140.41
|
| Rate for Payer: VA VA |
$8,874.18
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC
|
Facility
IP
|
$99,551.05
|
|
|
Service Code
|
MS-DRG 835
|
| Min. Negotiated Rate |
$16,852.22 |
| Max. Negotiated Rate |
$99,551.05 |
| Rate for Payer: Aetna Medicare |
$18,448.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,173.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,173.98
|
| Rate for Payer: BCBS MAPPO |
$17,739.18
|
| Rate for Payer: BCBS Trust/PPO |
$99,551.05
|
| Rate for Payer: BCN Medicare Advantage |
$17,739.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,739.18
|
| Rate for Payer: Mclaren Medicare |
$17,739.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,626.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,400.06
|
| Rate for Payer: PACE Medicare |
$16,852.22
|
| Rate for Payer: PACE SWMI |
$17,739.18
|
| Rate for Payer: PHP Medicare Advantage |
$17,739.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,079.25
|
| Rate for Payer: Priority Health Medicare |
$17,739.18
|
| Rate for Payer: Priority Health Narrow Network |
$25,663.40
|
| Rate for Payer: Railroad Medicare Medicare |
$17,739.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,100.32
|
| Rate for Payer: UHC Core |
$27,961.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,739.18
|
| Rate for Payer: UHC Exchange |
$22,229.81
|
| Rate for Payer: UHC Medicare Advantage |
$18,271.36
|
| Rate for Payer: VA VA |
$17,739.18
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$183,125.07
|
|
|
Service Code
|
MS-DRG 834
|
| Min. Negotiated Rate |
$41,475.51 |
| Max. Negotiated Rate |
$183,125.07 |
| Rate for Payer: Aetna Medicare |
$45,404.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54,573.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54,573.04
|
| Rate for Payer: BCBS MAPPO |
$43,658.43
|
| Rate for Payer: BCBS Trust/PPO |
$183,125.07
|
| Rate for Payer: BCN Medicare Advantage |
$43,658.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43,658.43
|
| Rate for Payer: Mclaren Medicare |
$43,658.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45,841.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,207.19
|
| Rate for Payer: PACE Medicare |
$41,475.51
|
| Rate for Payer: PACE SWMI |
$43,658.43
|
| Rate for Payer: PHP Medicare Advantage |
$43,658.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80,345.20
|
| Rate for Payer: Priority Health Medicare |
$43,658.43
|
| Rate for Payer: Priority Health Narrow Network |
$64,276.16
|
| Rate for Payer: Railroad Medicare Medicare |
$43,658.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85,407.15
|
| Rate for Payer: UHC Core |
$70,032.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$43,658.43
|
| Rate for Payer: UHC Exchange |
$55,676.46
|
| Rate for Payer: UHC Medicare Advantage |
$44,968.18
|
| Rate for Payer: VA VA |
$43,658.43
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$25,629.07
|
|
|
Service Code
|
MS-DRG 836
|
| Min. Negotiated Rate |
$10,822.88 |
| Max. Negotiated Rate |
$25,629.07 |
| Rate for Payer: Aetna Medicare |
$11,848.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,240.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,240.64
|
| Rate for Payer: BCBS MAPPO |
$11,392.51
|
| Rate for Payer: BCBS Trust/PPO |
$25,629.07
|
| Rate for Payer: BCN Medicare Advantage |
$11,392.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,392.51
|
| Rate for Payer: Mclaren Medicare |
$11,392.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,962.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,101.39
|
| Rate for Payer: PACE Medicare |
$10,822.88
|
| Rate for Payer: PACE SWMI |
$11,392.51
|
| Rate for Payer: PHP Medicare Advantage |
$11,392.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,181.16
|
| Rate for Payer: Priority Health Medicare |
$11,392.51
|
| Rate for Payer: Priority Health Narrow Network |
$13,744.93
|
| Rate for Payer: Railroad Medicare Medicare |
$11,392.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,263.61
|
| Rate for Payer: UHC Core |
$14,975.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,392.51
|
| Rate for Payer: UHC Exchange |
$11,905.95
|
| Rate for Payer: UHC Medicare Advantage |
$11,734.29
|
| Rate for Payer: VA VA |
$11,392.51
|
|
|
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
IP
|
$19,543.42
|
|
|
Service Code
|
MS-DRG 121
|
| Min. Negotiated Rate |
$9,866.05 |
| Max. Negotiated Rate |
$19,543.42 |
| Rate for Payer: Aetna Medicare |
$10,800.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,981.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,981.65
|
| Rate for Payer: BCBS MAPPO |
$10,385.32
|
| Rate for Payer: BCBS Trust/PPO |
$11,579.44
|
| Rate for Payer: BCN Medicare Advantage |
$10,385.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,385.32
|
| Rate for Payer: Mclaren Medicare |
$10,385.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,904.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,943.12
|
| Rate for Payer: PACE Medicare |
$9,866.05
|
| Rate for Payer: PACE SWMI |
$10,385.32
|
| Rate for Payer: PHP Medicare Advantage |
$10,385.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,385.12
|
| Rate for Payer: Priority Health Medicare |
$10,385.32
|
| Rate for Payer: Priority Health Narrow Network |
$14,708.10
|
| Rate for Payer: Railroad Medicare Medicare |
$10,385.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,543.42
|
| Rate for Payer: UHC Core |
$16,025.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,385.32
|
| Rate for Payer: UHC Exchange |
$12,740.25
|
| Rate for Payer: UHC Medicare Advantage |
$10,696.88
|
| Rate for Payer: VA VA |
$10,385.32
|
|
|
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
IP
|
$11,356.60
|
|
|
Service Code
|
MS-DRG 122
|
| Min. Negotiated Rate |
$5,937.02 |
| Max. Negotiated Rate |
$11,356.60 |
| Rate for Payer: Aetna Medicare |
$6,499.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,811.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,811.86
|
| Rate for Payer: BCBS MAPPO |
$6,249.49
|
| Rate for Payer: BCBS Trust/PPO |
$10,272.74
|
| Rate for Payer: BCN Medicare Advantage |
$6,249.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,249.49
|
| Rate for Payer: Mclaren Medicare |
$6,249.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,561.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,186.91
|
| Rate for Payer: PACE Medicare |
$5,937.02
|
| Rate for Payer: PACE SWMI |
$6,249.49
|
| Rate for Payer: PHP Medicare Advantage |
$6,249.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,683.52
|
| Rate for Payer: Priority Health Medicare |
$6,249.49
|
| Rate for Payer: Priority Health Narrow Network |
$8,546.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,249.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,356.60
|
| Rate for Payer: UHC Core |
$9,312.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,249.49
|
| Rate for Payer: UHC Exchange |
$7,403.31
|
| Rate for Payer: UHC Medicare Advantage |
$6,436.97
|
| Rate for Payer: VA VA |
$6,249.49
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
IP
|
$19,789.09
|
|
|
Service Code
|
MS-DRG 281
|
| Min. Negotiated Rate |
$7,170.55 |
| Max. Negotiated Rate |
$19,789.09 |
| Rate for Payer: Aetna Medicare |
$7,849.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,434.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,434.94
|
| Rate for Payer: BCBS MAPPO |
$7,547.95
|
| Rate for Payer: BCBS Trust/PPO |
$19,789.09
|
| Rate for Payer: BCN Medicare Advantage |
$7,547.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,547.95
|
| Rate for Payer: Mclaren Medicare |
$7,547.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,680.14
|
| Rate for Payer: PACE Medicare |
$7,170.55
|
| Rate for Payer: PACE SWMI |
$7,547.95
|
| Rate for Payer: PHP Medicare Advantage |
$7,547.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,101.48
|
| Rate for Payer: Priority Health Medicare |
$7,547.95
|
| Rate for Payer: Priority Health Narrow Network |
$10,481.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7,547.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,926.90
|
| Rate for Payer: UHC Core |
$11,419.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,547.95
|
| Rate for Payer: UHC Exchange |
$9,078.87
|
| Rate for Payer: UHC Medicare Advantage |
$7,774.39
|
| Rate for Payer: VA VA |
$7,547.95
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
IP
|
$28,453.57
|
|
|
Service Code
|
MS-DRG 280
|
| Min. Negotiated Rate |
$12,101.07 |
| Max. Negotiated Rate |
$28,453.57 |
| Rate for Payer: Aetna Medicare |
$13,247.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,922.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,922.46
|
| Rate for Payer: BCBS MAPPO |
$12,737.97
|
| Rate for Payer: BCBS Trust/PPO |
$28,453.57
|
| Rate for Payer: BCN Medicare Advantage |
$12,737.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,737.97
|
| Rate for Payer: Mclaren Medicare |
$12,737.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,374.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,648.67
|
| Rate for Payer: PACE Medicare |
$12,101.07
|
| Rate for Payer: PACE SWMI |
$12,737.97
|
| Rate for Payer: PHP Medicare Advantage |
$12,737.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,766.15
|
| Rate for Payer: Priority Health Medicare |
$12,737.97
|
| Rate for Payer: Priority Health Narrow Network |
$18,212.92
|
| Rate for Payer: Railroad Medicare Medicare |
$12,737.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,200.47
|
| Rate for Payer: UHC Core |
$19,843.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,737.97
|
| Rate for Payer: UHC Exchange |
$15,776.16
|
| Rate for Payer: UHC Medicare Advantage |
$13,120.11
|
| Rate for Payer: VA VA |
$12,737.97
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
IP
|
$17,170.65
|
|
|
Service Code
|
MS-DRG 282
|
| Min. Negotiated Rate |
$5,743.75 |
| Max. Negotiated Rate |
$17,170.65 |
| Rate for Payer: Aetna Medicare |
$6,287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,557.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,557.56
|
| Rate for Payer: BCBS MAPPO |
$6,046.05
|
| Rate for Payer: BCBS Trust/PPO |
$17,170.65
|
| Rate for Payer: BCN Medicare Advantage |
$6,046.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,046.05
|
| Rate for Payer: Mclaren Medicare |
$6,046.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,348.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,952.96
|
| Rate for Payer: PACE Medicare |
$5,743.75
|
| Rate for Payer: PACE SWMI |
$6,046.05
|
| Rate for Payer: PHP Medicare Advantage |
$6,046.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,304.68
|
| Rate for Payer: Priority Health Medicare |
$6,046.05
|
| Rate for Payer: Priority Health Narrow Network |
$8,243.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,046.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,953.90
|
| Rate for Payer: UHC Core |
$8,981.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,046.05
|
| Rate for Payer: UHC Exchange |
$7,140.79
|
| Rate for Payer: UHC Medicare Advantage |
$6,227.43
|
| Rate for Payer: VA VA |
$6,046.05
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
IP
|
$16,464.52
|
|
|
Service Code
|
MS-DRG 284
|
| Min. Negotiated Rate |
$5,901.88 |
| Max. Negotiated Rate |
$16,464.52 |
| Rate for Payer: Aetna Medicare |
$6,461.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,765.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,765.64
|
| Rate for Payer: BCBS MAPPO |
$6,212.51
|
| Rate for Payer: BCBS Trust/PPO |
$16,464.52
|
| Rate for Payer: BCN Medicare Advantage |
$6,212.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,212.51
|
| Rate for Payer: Mclaren Medicare |
$6,212.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,523.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,144.39
|
| Rate for Payer: PACE Medicare |
$5,901.88
|
| Rate for Payer: PACE SWMI |
$6,212.51
|
| Rate for Payer: PHP Medicare Advantage |
$6,212.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,614.64
|
| Rate for Payer: Priority Health Medicare |
$6,212.51
|
| Rate for Payer: Priority Health Narrow Network |
$8,491.71
|
| Rate for Payer: Railroad Medicare Medicare |
$6,212.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,283.38
|
| Rate for Payer: UHC Core |
$9,252.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,212.51
|
| Rate for Payer: UHC Exchange |
$7,355.58
|
| Rate for Payer: UHC Medicare Advantage |
$6,398.89
|
| Rate for Payer: VA VA |
$6,212.51
|
|
