|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$64,219.67
|
|
|
Service Code
|
MS-DRG 584
|
| Min. Negotiated Rate |
$14,825.12 |
| Max. Negotiated Rate |
$64,219.67 |
| Rate for Payer: Aetna Medicare |
$16,229.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,506.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,506.74
|
| Rate for Payer: BCBS MAPPO |
$15,605.39
|
| Rate for Payer: BCBS Trust/PPO |
$64,219.67
|
| Rate for Payer: BCN Medicare Advantage |
$15,605.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,605.39
|
| Rate for Payer: Mclaren Medicare |
$15,605.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,385.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,946.20
|
| Rate for Payer: PACE Medicare |
$14,825.12
|
| Rate for Payer: PACE SWMI |
$15,605.39
|
| Rate for Payer: PHP Medicare Advantage |
$15,605.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,105.75
|
| Rate for Payer: Priority Health Medicare |
$15,605.39
|
| Rate for Payer: Priority Health Narrow Network |
$22,484.60
|
| Rate for Payer: Railroad Medicare Medicare |
$15,605.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,876.48
|
| Rate for Payer: UHC Core |
$24,498.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,605.39
|
| Rate for Payer: UHC Exchange |
$19,476.32
|
| Rate for Payer: UHC Medicare Advantage |
$16,073.55
|
| Rate for Payer: VA VA |
$15,605.39
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$56,032.64
|
|
|
Service Code
|
MS-DRG 585
|
| Min. Negotiated Rate |
$12,814.84 |
| Max. Negotiated Rate |
$56,032.64 |
| Rate for Payer: Aetna Medicare |
$14,028.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,861.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,861.64
|
| Rate for Payer: BCBS MAPPO |
$13,489.31
|
| Rate for Payer: BCBS Trust/PPO |
$56,032.64
|
| Rate for Payer: BCN Medicare Advantage |
$13,489.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,489.31
|
| Rate for Payer: Mclaren Medicare |
$13,489.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,163.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,512.71
|
| Rate for Payer: PACE Medicare |
$12,814.84
|
| Rate for Payer: PACE SWMI |
$13,489.31
|
| Rate for Payer: PHP Medicare Advantage |
$13,489.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,165.27
|
| Rate for Payer: Priority Health Medicare |
$13,489.31
|
| Rate for Payer: Priority Health Narrow Network |
$19,332.22
|
| Rate for Payer: Railroad Medicare Medicare |
$13,489.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,687.74
|
| Rate for Payer: UHC Core |
$21,063.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,489.31
|
| Rate for Payer: UHC Exchange |
$16,745.70
|
| Rate for Payer: UHC Medicare Advantage |
$13,893.99
|
| Rate for Payer: VA VA |
$13,489.31
|
|
|
BREAST REDUCTION
|
Facility
|
OP
|
$18,247.50
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,074.99 |
| Max. Negotiated Rate |
$18,247.50 |
| Rate for Payer: Aetna Medicare |
$6,028.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.58
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$6,499.86
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.46
|
| Rate for Payer: Mclaren Medicaid |
$3,170.66
|
| Rate for Payer: Mclaren Medicare |
$5,796.46
|
| Rate for Payer: Meridian Medicaid |
$3,329.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,086.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.93
|
| Rate for Payer: PACE Medicare |
$5,506.64
|
| Rate for Payer: PACE SWMI |
$5,796.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,170.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,247.50
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$14,598.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,182.49
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.46
|
| Rate for Payer: UHC Exchange |
$1,074.99
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: VA VA |
$5,796.46
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50,745.98
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22,328.23 |
| Max. Negotiated Rate |
$45,671.38 |
| Rate for Payer: Aetna American Axle |
$32,984.89
|
| Rate for Payer: Aetna Commercial |
$43,134.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,984.89
|
| Rate for Payer: Cash Price |
$40,596.78
|
| Rate for Payer: Cofinity Commercial |
$35,522.19
|
| Rate for Payer: Cofinity Commercial |
$43,641.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,596.78
|
| Rate for Payer: Healthscope Commercial |
$45,671.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,522.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,059.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43,134.08
|
| Rate for Payer: PHP Commercial |
$43,134.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,522.19
|
| Rate for Payer: Priority Health SBD |
$31,969.97
|
| Rate for Payer: UMR Bronson Commercial |
$22,328.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38,059.48
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50,745.98
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.15 |
| Max. Negotiated Rate |
$45,671.38 |
| Rate for Payer: Aetna American Axle |
$32,984.89
|
| Rate for Payer: Aetna Commercial |
$43,134.08
|
| Rate for Payer: Aetna Medicare |
$239.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,984.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.27
|
| Rate for Payer: BCBS Complete |
$132.46
|
| Rate for Payer: BCBS MAPPO |
$230.61
|
| Rate for Payer: BCBS Trust/PPO |
$745.22
|
| Rate for Payer: BCN Medicare Advantage |
$230.61
|
| Rate for Payer: Cash Price |
$40,596.78
|
| Rate for Payer: Cash Price |
$40,596.78
|
| Rate for Payer: Cofinity Commercial |
$35,522.19
|
| Rate for Payer: Cofinity Commercial |
$43,641.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,596.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.61
|
| Rate for Payer: Healthscope Commercial |
$45,671.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,522.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,059.48
|
| Rate for Payer: Mclaren Medicaid |
$126.15
|
| Rate for Payer: Mclaren Medicare |
$230.61
|
| Rate for Payer: Meridian Medicaid |
$132.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43,134.08
|
| Rate for Payer: PACE Medicare |
$219.08
|
| Rate for Payer: PACE SWMI |
$230.61
|
| Rate for Payer: PHP Commercial |
$43,134.08
|
| Rate for Payer: PHP Medicare Advantage |
$230.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,522.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$652.33
|
| Rate for Payer: Priority Health Medicare |
$230.61
|
| Rate for Payer: Priority Health Narrow Network |
$521.86
|
| Rate for Payer: Priority Health SBD |
$31,969.97
|
| Rate for Payer: Railroad Medicare Medicare |
$230.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.61
|
| Rate for Payer: UHC Medicare Advantage |
$237.53
|
| Rate for Payer: UMR Bronson Commercial |
$18,776.01
|
| Rate for Payer: VA VA |
$230.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38,059.48
|
|
|
BREXPIPRAZOLE 0.25 MG TABLET
|
Facility
|
IP
|
$4,882.89
|
|
|
Service Code
|
NDC 59148-035-13
|
| Hospital Charge Code |
174663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,148.47 |
| Max. Negotiated Rate |
$4,394.60 |
| Rate for Payer: Aetna American Axle |
$3,173.88
|
| Rate for Payer: Aetna Commercial |
$4,150.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,173.88
|
| Rate for Payer: Cash Price |
$3,906.31
|
| Rate for Payer: Cofinity Commercial |
$3,418.02
|
| Rate for Payer: Cofinity Commercial |
$4,199.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,906.31
|
| Rate for Payer: Healthscope Commercial |
$4,394.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,418.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,662.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,150.46
|
| Rate for Payer: PHP Commercial |
$4,150.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,418.02
|
| Rate for Payer: Priority Health SBD |
$3,076.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,148.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,662.17
|
|
|
BREXPIPRAZOLE 1 MG TABLET
|
Facility
|
IP
|
$4,882.89
|
|
|
Service Code
|
NDC 59148-037-13
|
| Hospital Charge Code |
174666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,148.47 |
| Max. Negotiated Rate |
$4,394.60 |
| Rate for Payer: Aetna American Axle |
$3,173.88
|
| Rate for Payer: Aetna Commercial |
$4,150.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,173.88
|
| Rate for Payer: Cash Price |
$3,906.31
|
| Rate for Payer: Cofinity Commercial |
$3,418.02
|
| Rate for Payer: Cofinity Commercial |
$4,199.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,906.31
|
| Rate for Payer: Healthscope Commercial |
$4,394.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,418.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,662.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,150.46
|
| Rate for Payer: PHP Commercial |
$4,150.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,418.02
|
| Rate for Payer: Priority Health SBD |
$3,076.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,148.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,662.17
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$499.17
|
|
|
Service Code
|
NDC 61314-144-05
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.63 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna American Axle |
$324.46
|
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.29
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.42
|
| Rate for Payer: Priority Health SBD |
$314.48
|
| Rate for Payer: UMR Bronson Commercial |
$219.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.38
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$674.73
|
|
|
Service Code
|
NDC 0023-9177-05
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.88 |
| Max. Negotiated Rate |
$607.26 |
| Rate for Payer: Aetna American Axle |
$438.57
|
| Rate for Payer: Aetna Commercial |
$573.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.57
|
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Cofinity Commercial |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.78
|
| Rate for Payer: Healthscope Commercial |
$607.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.52
|
| Rate for Payer: PHP Commercial |
$573.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.31
|
| Rate for Payer: Priority Health SBD |
$425.08
|
| Rate for Payer: UMR Bronson Commercial |
$296.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.05
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 0023-9321-05
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.34 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna American Axle |
$411.18
|
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.18
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$442.81
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$537.70
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.81
|
| Rate for Payer: Priority Health SBD |
$398.53
|
| Rate for Payer: UMR Bronson Commercial |
$278.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$10.29
|
|
|
Service Code
|
NDC 70069-231-01
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna American Axle |
$6.69
|
| Rate for Payer: Aetna Commercial |
$8.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.69
|
| Rate for Payer: Cash Price |
$8.23
|
| Rate for Payer: Cofinity Commercial |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$8.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$9.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.75
|
| Rate for Payer: PHP Commercial |
$8.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.20
|
| Rate for Payer: Priority Health SBD |
$6.48
|
| Rate for Payer: UMR Bronson Commercial |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.72
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
NDC 61314-143-05
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.91
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$50.99
|
|
|
Service Code
|
NDC 24208-411-05
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$45.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.34
|
| Rate for Payer: PHP Commercial |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.69
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$8.77
|
|
|
Service Code
|
NDC 17478-715-10
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$5.70
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.70
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.45
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health SBD |
$5.53
|
| Rate for Payer: UMR Bronson Commercial |
$3.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.58
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,114.61
|
|
|
Service Code
|
NDC 0065-0275-10
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$490.43 |
| Max. Negotiated Rate |
$1,003.15 |
| Rate for Payer: Aetna American Axle |
$724.50
|
| Rate for Payer: Aetna Commercial |
$947.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.50
|
| Rate for Payer: Cash Price |
$891.69
|
| Rate for Payer: Cofinity Commercial |
$958.56
|
| Rate for Payer: Cofinity Commercial |
$780.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.69
|
| Rate for Payer: Healthscope Commercial |
$1,003.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$947.42
|
| Rate for Payer: PHP Commercial |
$947.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.23
|
| Rate for Payer: Priority Health SBD |
$702.20
|
| Rate for Payer: UMR Bronson Commercial |
$490.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.96
|
|
|
BRIVARACETAM 100 MG TABLET
|
Facility
|
IP
|
$4,944.83
|
|
|
Service Code
|
NDC 50474-770-66
|
| Hospital Charge Code |
178919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,175.73 |
| Max. Negotiated Rate |
$4,450.35 |
| Rate for Payer: Aetna American Axle |
$3,214.14
|
| Rate for Payer: Aetna Commercial |
$4,203.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,214.14
|
| Rate for Payer: Cash Price |
$3,955.86
|
| Rate for Payer: Cofinity Commercial |
$3,461.38
|
| Rate for Payer: Cofinity Commercial |
$4,252.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,955.86
|
| Rate for Payer: Healthscope Commercial |
$4,450.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,461.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,708.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,203.11
|
| Rate for Payer: PHP Commercial |
$4,203.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.38
|
| Rate for Payer: Priority Health SBD |
$3,115.24
|
| Rate for Payer: UMR Bronson Commercial |
$2,175.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,708.62
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$602.40
|
|
|
Service Code
|
NDC 0574-0106-01
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.06 |
| Max. Negotiated Rate |
$542.16 |
| Rate for Payer: Aetna American Axle |
$391.56
|
| Rate for Payer: Aetna Commercial |
$512.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.56
|
| Rate for Payer: Cash Price |
$481.92
|
| Rate for Payer: Cofinity Commercial |
$421.68
|
| Rate for Payer: Cofinity Commercial |
$518.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.92
|
| Rate for Payer: Healthscope Commercial |
$542.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$512.04
|
| Rate for Payer: PHP Commercial |
$512.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.68
|
| Rate for Payer: Priority Health SBD |
$379.51
|
| Rate for Payer: UMR Bronson Commercial |
$265.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.80
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$198.44
|
|
|
Service Code
|
NDC 0574-0106-03
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna American Axle |
$128.99
|
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.99
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Cofinity Commercial |
$170.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.75
|
| Rate for Payer: Healthscope Commercial |
$178.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.67
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.91
|
| Rate for Payer: Priority Health SBD |
$125.02
|
| Rate for Payer: UMR Bronson Commercial |
$87.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.83
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$2,562.99
|
|
|
Service Code
|
NDC 0378-7096-01
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,127.72 |
| Max. Negotiated Rate |
$2,306.69 |
| Rate for Payer: Aetna American Axle |
$1,665.94
|
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.94
|
| Rate for Payer: Cash Price |
$2,050.39
|
| Rate for Payer: Cofinity Commercial |
$1,794.09
|
| Rate for Payer: Cofinity Commercial |
$2,204.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.39
|
| Rate for Payer: Healthscope Commercial |
$2,306.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,794.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,922.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,178.54
|
| Rate for Payer: PHP Commercial |
$2,178.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,794.09
|
| Rate for Payer: Priority Health SBD |
$1,614.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,922.24
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$1,211.01
|
|
|
Service Code
|
NDC 63304-158-01
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$532.84 |
| Max. Negotiated Rate |
$1,089.91 |
| Rate for Payer: Aetna American Axle |
$787.16
|
| Rate for Payer: Aetna Commercial |
$1,029.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.16
|
| Rate for Payer: Cash Price |
$968.81
|
| Rate for Payer: Cofinity Commercial |
$1,041.47
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.81
|
| Rate for Payer: Healthscope Commercial |
$1,089.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$847.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,029.36
|
| Rate for Payer: PHP Commercial |
$1,029.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.71
|
| Rate for Payer: Priority Health SBD |
$762.94
|
| Rate for Payer: UMR Bronson Commercial |
$532.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.26
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$464.10
|
|
|
Service Code
|
NDC 68382-110-06
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$417.69 |
| Rate for Payer: Aetna American Axle |
$301.66
|
| Rate for Payer: Aetna Commercial |
$394.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.66
|
| Rate for Payer: Cash Price |
$371.28
|
| Rate for Payer: Cofinity Commercial |
$324.87
|
| Rate for Payer: Cofinity Commercial |
$399.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.28
|
| Rate for Payer: Healthscope Commercial |
$417.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.48
|
| Rate for Payer: PHP Commercial |
$394.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.87
|
| Rate for Payer: Priority Health SBD |
$292.38
|
| Rate for Payer: UMR Bronson Commercial |
$204.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.08
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$14,605.71
|
|
|
Service Code
|
MS-DRG 202
|
| Min. Negotiated Rate |
$7,496.34 |
| Max. Negotiated Rate |
$14,605.71 |
| Rate for Payer: Aetna Medicare |
$8,206.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,863.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,863.60
|
| Rate for Payer: BCBS MAPPO |
$7,890.88
|
| Rate for Payer: BCBS Trust/PPO |
$12,461.47
|
| Rate for Payer: BCN Medicare Advantage |
$7,890.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,890.88
|
| Rate for Payer: Mclaren Medicare |
$7,890.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,285.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,074.51
|
| Rate for Payer: PACE Medicare |
$7,496.34
|
| Rate for Payer: PACE SWMI |
$7,890.88
|
| Rate for Payer: PHP Medicare Advantage |
$7,890.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,740.05
|
| Rate for Payer: Priority Health Medicare |
$7,890.88
|
| Rate for Payer: Priority Health Narrow Network |
$10,992.04
|
| Rate for Payer: Railroad Medicare Medicare |
$7,890.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,605.71
|
| Rate for Payer: UHC Core |
$11,976.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,890.88
|
| Rate for Payer: UHC Exchange |
$9,521.38
|
| Rate for Payer: UHC Medicare Advantage |
$8,127.61
|
| Rate for Payer: VA VA |
$7,890.88
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
MS-DRG 203
|
| Min. Negotiated Rate |
$5,573.92 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna Medicare |
$6,101.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,334.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,334.10
|
| Rate for Payer: BCBS MAPPO |
$5,867.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,835.09
|
| Rate for Payer: BCN Medicare Advantage |
$5,867.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,867.28
|
| Rate for Payer: Mclaren Medicare |
$5,867.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,160.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,747.37
|
| Rate for Payer: PACE Medicare |
$5,573.92
|
| Rate for Payer: PACE SWMI |
$5,867.28
|
| Rate for Payer: PHP Medicare Advantage |
$5,867.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,971.76
|
| Rate for Payer: Priority Health Medicare |
$5,867.28
|
| Rate for Payer: Priority Health Narrow Network |
$7,977.41
|
| Rate for Payer: Railroad Medicare Medicare |
$5,867.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,600.00
|
| Rate for Payer: UHC Core |
$8,691.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,867.28
|
| Rate for Payer: UHC Exchange |
$6,910.09
|
| Rate for Payer: UHC Medicare Advantage |
$6,043.30
|
| Rate for Payer: VA VA |
$5,867.28
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31622
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.70 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,439.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.47
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$127.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.36 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.20
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$128.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
