|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 0093-3147-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.00
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$127.30
|
|
|
Service Code
|
NDC 50268-152-15
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.01 |
| Max. Negotiated Rate |
$114.57 |
| Rate for Payer: Aetna American Axle |
$82.74
|
| Rate for Payer: Aetna Commercial |
$108.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.74
|
| Rate for Payer: Cash Price |
$101.84
|
| Rate for Payer: Cofinity Commercial |
$109.48
|
| Rate for Payer: Cofinity Commercial |
$89.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.84
|
| Rate for Payer: Healthscope Commercial |
$114.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.20
|
| Rate for Payer: PHP Commercial |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.11
|
| Rate for Payer: Priority Health SBD |
$80.20
|
| Rate for Payer: UMR Bronson Commercial |
$56.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.48
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 50268-152-11
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$254.60
|
|
|
Service Code
|
NDC 68180-122-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.41
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.22
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 67877-219-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.24
|
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.24
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.70
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.11
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UMR Bronson Commercial |
$122.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.98
|
|
|
CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 59320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,157.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.24
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$149.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
IP
|
$25,679.17
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,298.83 |
| Max. Negotiated Rate |
$23,111.25 |
| Rate for Payer: Aetna American Axle |
$16,691.46
|
| Rate for Payer: Aetna Commercial |
$21,827.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,691.46
|
| Rate for Payer: Cash Price |
$20,543.34
|
| Rate for Payer: Cofinity Commercial |
$17,975.42
|
| Rate for Payer: Cofinity Commercial |
$22,084.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,543.34
|
| Rate for Payer: Healthscope Commercial |
$23,111.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,975.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,259.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,827.29
|
| Rate for Payer: PHP Commercial |
$21,827.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,975.42
|
| Rate for Payer: Priority Health SBD |
$16,177.88
|
| Rate for Payer: UMR Bronson Commercial |
$11,298.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,259.38
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
OP
|
$25,679.17
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$23,111.25 |
| Rate for Payer: Aetna American Axle |
$16,691.46
|
| Rate for Payer: Aetna Commercial |
$21,827.29
|
| Rate for Payer: Aetna Medicare |
$5.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,691.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.02
|
| Rate for Payer: BCBS Complete |
$2.77
|
| Rate for Payer: BCBS MAPPO |
$4.82
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCN Medicare Advantage |
$4.82
|
| Rate for Payer: Cash Price |
$20,543.34
|
| Rate for Payer: Cash Price |
$20,543.34
|
| Rate for Payer: Cofinity Commercial |
$22,084.09
|
| Rate for Payer: Cofinity Commercial |
$17,975.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,543.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$23,111.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,975.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,259.38
|
| Rate for Payer: Mclaren Medicaid |
$2.63
|
| Rate for Payer: Mclaren Medicare |
$4.82
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,827.29
|
| Rate for Payer: PACE Medicare |
$4.58
|
| Rate for Payer: PACE SWMI |
$4.82
|
| Rate for Payer: PHP Commercial |
$21,827.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,975.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.40
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow Network |
$11.52
|
| Rate for Payer: Priority Health SBD |
$16,177.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.82
|
| Rate for Payer: UHC Medicare Advantage |
$4.96
|
| Rate for Payer: UMR Bronson Commercial |
$9,501.29
|
| Rate for Payer: VA VA |
$4.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,259.38
|
|
|
CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION)
|
Facility
|
OP
|
$7,596.85
|
|
|
Service Code
|
CPT 38724
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,427.65 |
| Max. Negotiated Rate |
$7,596.85 |
| Rate for Payer: BCBS Trust/PPO |
$7,596.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,570.42
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Exchange |
$1,427.65
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$49,036.73
|
|
|
Service Code
|
MS-DRG 472
|
| Min. Negotiated Rate |
$22,122.42 |
| Max. Negotiated Rate |
$49,036.73 |
| Rate for Payer: Aetna Medicare |
$24,218.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,108.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,108.45
|
| Rate for Payer: BCBS MAPPO |
$23,286.76
|
| Rate for Payer: BCBS Trust/PPO |
$49,036.73
|
| Rate for Payer: BCN Medicare Advantage |
$23,286.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,286.76
|
| Rate for Payer: Mclaren Medicare |
$23,286.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,451.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,779.77
|
| Rate for Payer: PACE Medicare |
$22,122.42
|
| Rate for Payer: PACE SWMI |
$23,286.76
|
| Rate for Payer: PHP Medicare Advantage |
$23,286.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42,409.75
|
| Rate for Payer: Priority Health Medicare |
$23,286.76
|
| Rate for Payer: Priority Health Narrow Network |
$33,927.80
|
| Rate for Payer: Railroad Medicare Medicare |
$23,286.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,081.67
|
| Rate for Payer: UHC Core |
$36,966.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,286.76
|
| Rate for Payer: UHC Exchange |
$29,388.50
|
| Rate for Payer: UHC Medicare Advantage |
$23,985.36
|
| Rate for Payer: VA VA |
$23,286.76
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$75,034.43
|
|
|
Service Code
|
MS-DRG 471
|
| Min. Negotiated Rate |
$36,497.42 |
| Max. Negotiated Rate |
$75,034.43 |
| Rate for Payer: Aetna Medicare |
$39,955.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,022.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,022.92
|
| Rate for Payer: BCBS MAPPO |
$38,418.34
|
| Rate for Payer: BCBS Trust/PPO |
$64,945.90
|
| Rate for Payer: BCN Medicare Advantage |
$38,418.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,418.34
|
| Rate for Payer: Mclaren Medicare |
$38,418.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40,339.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,181.09
|
| Rate for Payer: PACE Medicare |
$36,497.42
|
| Rate for Payer: PACE SWMI |
$38,418.34
|
| Rate for Payer: PHP Medicare Advantage |
$38,418.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70,587.26
|
| Rate for Payer: Priority Health Medicare |
$38,418.34
|
| Rate for Payer: Priority Health Narrow Network |
$56,469.81
|
| Rate for Payer: Railroad Medicare Medicare |
$38,418.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75,034.43
|
| Rate for Payer: UHC Core |
$61,526.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$38,418.34
|
| Rate for Payer: UHC Exchange |
$48,914.54
|
| Rate for Payer: UHC Medicare Advantage |
$39,570.89
|
| Rate for Payer: VA VA |
$38,418.34
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$40,095.83
|
|
|
Service Code
|
MS-DRG 473
|
| Min. Negotiated Rate |
$18,500.14 |
| Max. Negotiated Rate |
$40,095.83 |
| Rate for Payer: Aetna Medicare |
$20,252.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,342.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,342.29
|
| Rate for Payer: BCBS MAPPO |
$19,473.83
|
| Rate for Payer: BCBS Trust/PPO |
$40,095.83
|
| Rate for Payer: BCN Medicare Advantage |
$19,473.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,473.83
|
| Rate for Payer: Mclaren Medicare |
$19,473.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,447.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,394.90
|
| Rate for Payer: PACE Medicare |
$18,500.14
|
| Rate for Payer: PACE SWMI |
$19,473.83
|
| Rate for Payer: PHP Medicare Advantage |
$19,473.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,309.41
|
| Rate for Payer: Priority Health Medicare |
$19,473.83
|
| Rate for Payer: Priority Health Narrow Network |
$28,247.53
|
| Rate for Payer: Railroad Medicare Medicare |
$19,473.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,533.99
|
| Rate for Payer: UHC Core |
$30,777.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,473.83
|
| Rate for Payer: UHC Exchange |
$24,468.21
|
| Rate for Payer: UHC Medicare Advantage |
$20,058.04
|
| Rate for Payer: VA VA |
$19,473.83
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$16,033.48
|
|
|
Service Code
|
MS-DRG 787
|
| Min. Negotiated Rate |
$8,181.55 |
| Max. Negotiated Rate |
$16,033.48 |
| Rate for Payer: Aetna Medicare |
$8,956.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,765.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,765.20
|
| Rate for Payer: BCBS MAPPO |
$8,612.16
|
| Rate for Payer: BCBS Trust/PPO |
$15,959.43
|
| Rate for Payer: BCN Medicare Advantage |
$8,612.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,612.16
|
| Rate for Payer: Mclaren Medicare |
$8,612.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,042.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,903.98
|
| Rate for Payer: PACE Medicare |
$8,181.55
|
| Rate for Payer: PACE SWMI |
$8,612.16
|
| Rate for Payer: PHP Medicare Advantage |
$8,612.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,083.20
|
| Rate for Payer: Priority Health Medicare |
$8,612.16
|
| Rate for Payer: Priority Health Narrow Network |
$12,066.56
|
| Rate for Payer: Railroad Medicare Medicare |
$8,612.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,033.48
|
| Rate for Payer: UHC Core |
$13,147.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,612.16
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$8,870.52
|
| Rate for Payer: VA VA |
$8,612.16
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$26,686.87
|
|
|
Service Code
|
MS-DRG 786
|
| Min. Negotiated Rate |
$9,193.00 |
| Max. Negotiated Rate |
$26,686.87 |
| Rate for Payer: Aetna Medicare |
$14,553.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,492.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,492.56
|
| Rate for Payer: BCBS MAPPO |
$13,994.05
|
| Rate for Payer: BCBS Trust/PPO |
$22,005.47
|
| Rate for Payer: BCN Medicare Advantage |
$13,994.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,994.05
|
| Rate for Payer: Mclaren Medicare |
$13,994.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,693.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,093.16
|
| Rate for Payer: PACE Medicare |
$13,294.35
|
| Rate for Payer: PACE SWMI |
$13,994.05
|
| Rate for Payer: PHP Medicare Advantage |
$13,994.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,105.19
|
| Rate for Payer: Priority Health Medicare |
$13,994.05
|
| Rate for Payer: Priority Health Narrow Network |
$20,084.15
|
| Rate for Payer: Railroad Medicare Medicare |
$13,994.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,686.87
|
| Rate for Payer: UHC Core |
$21,882.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,994.05
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$14,413.87
|
| Rate for Payer: VA VA |
$13,994.05
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$14,589.90
|
|
|
Service Code
|
MS-DRG 788
|
| Min. Negotiated Rate |
$6,745.97 |
| Max. Negotiated Rate |
$14,589.90 |
| Rate for Payer: Aetna Medicare |
$7,385.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,876.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,876.28
|
| Rate for Payer: BCBS MAPPO |
$7,101.02
|
| Rate for Payer: BCBS Trust/PPO |
$14,589.90
|
| Rate for Payer: BCN Medicare Advantage |
$7,101.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,101.02
|
| Rate for Payer: Mclaren Medicare |
$7,101.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,456.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,166.17
|
| Rate for Payer: PACE Medicare |
$6,745.97
|
| Rate for Payer: PACE SWMI |
$7,101.02
|
| Rate for Payer: PHP Medicare Advantage |
$7,101.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,269.18
|
| Rate for Payer: Priority Health Medicare |
$7,101.02
|
| Rate for Payer: Priority Health Narrow Network |
$9,815.34
|
| Rate for Payer: Railroad Medicare Medicare |
$7,101.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,042.17
|
| Rate for Payer: UHC Core |
$10,694.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,101.02
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,314.05
|
| Rate for Payer: VA VA |
$7,101.02
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$16,761.04
|
|
|
Service Code
|
MS-DRG 784
|
| Min. Negotiated Rate |
$7,983.90 |
| Max. Negotiated Rate |
$16,761.04 |
| Rate for Payer: Aetna Medicare |
$8,740.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,505.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,505.12
|
| Rate for Payer: BCBS MAPPO |
$8,404.10
|
| Rate for Payer: BCBS Trust/PPO |
$16,761.04
|
| Rate for Payer: BCN Medicare Advantage |
$8,404.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,404.10
|
| Rate for Payer: Mclaren Medicare |
$8,404.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,824.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,664.72
|
| Rate for Payer: PACE Medicare |
$7,983.90
|
| Rate for Payer: PACE SWMI |
$8,404.10
|
| Rate for Payer: PHP Medicare Advantage |
$8,404.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,695.75
|
| Rate for Payer: Priority Health Medicare |
$8,404.10
|
| Rate for Payer: Priority Health Narrow Network |
$11,756.60
|
| Rate for Payer: Railroad Medicare Medicare |
$8,404.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,621.62
|
| Rate for Payer: UHC Core |
$12,809.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,404.10
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$8,656.22
|
| Rate for Payer: VA VA |
$8,404.10
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$27,027.04
|
|
|
Service Code
|
MS-DRG 783
|
| Min. Negotiated Rate |
$9,193.00 |
| Max. Negotiated Rate |
$27,027.04 |
| Rate for Payer: Aetna Medicare |
$14,732.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,707.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,707.39
|
| Rate for Payer: BCBS MAPPO |
$14,165.91
|
| Rate for Payer: BCBS Trust/PPO |
$24,327.38
|
| Rate for Payer: BCN Medicare Advantage |
$14,165.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,165.91
|
| Rate for Payer: Mclaren Medicare |
$14,165.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,874.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,290.80
|
| Rate for Payer: PACE Medicare |
$13,457.61
|
| Rate for Payer: PACE SWMI |
$14,165.91
|
| Rate for Payer: PHP Medicare Advantage |
$14,165.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,425.19
|
| Rate for Payer: Priority Health Medicare |
$14,165.91
|
| Rate for Payer: Priority Health Narrow Network |
$20,340.15
|
| Rate for Payer: Railroad Medicare Medicare |
$14,165.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,027.04
|
| Rate for Payer: UHC Core |
$22,161.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,165.91
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$14,590.89
|
| Rate for Payer: VA VA |
$14,165.91
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$14,328.56
|
|
|
Service Code
|
MS-DRG 785
|
| Min. Negotiated Rate |
$6,828.69 |
| Max. Negotiated Rate |
$14,328.56 |
| Rate for Payer: Aetna Medicare |
$7,475.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,985.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,985.11
|
| Rate for Payer: BCBS MAPPO |
$7,188.09
|
| Rate for Payer: BCBS Trust/PPO |
$14,328.56
|
| Rate for Payer: BCN Medicare Advantage |
$7,188.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,188.09
|
| Rate for Payer: Mclaren Medicare |
$7,188.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,547.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,266.30
|
| Rate for Payer: PACE Medicare |
$6,828.69
|
| Rate for Payer: PACE SWMI |
$7,188.09
|
| Rate for Payer: PHP Medicare Advantage |
$7,188.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,431.34
|
| Rate for Payer: Priority Health Medicare |
$7,188.09
|
| Rate for Payer: Priority Health Narrow Network |
$9,945.07
|
| Rate for Payer: Railroad Medicare Medicare |
$7,188.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,214.54
|
| Rate for Payer: UHC Core |
$10,835.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,188.09
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,403.73
|
| Rate for Payer: VA VA |
$7,188.09
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$242.05
|
|
|
Service Code
|
NDC 0904-6717-61
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.56 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna American Axle |
$157.33
|
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.33
|
| Rate for Payer: BCBS Complete |
$96.82
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$169.44
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.74
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.44
|
| Rate for Payer: Priority Health SBD |
$152.49
|
| Rate for Payer: UMR Bronson Commercial |
$89.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.54
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 51079-597-20
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna American Axle |
$210.80
|
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.80
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$227.01
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.66
|
| Rate for Payer: PHP Commercial |
$275.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.01
|
| Rate for Payer: Priority Health SBD |
$204.31
|
| Rate for Payer: UMR Bronson Commercial |
$142.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 51079-597-20
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna American Axle |
$210.80
|
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.80
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$227.01
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.66
|
| Rate for Payer: PHP Commercial |
$275.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.01
|
| Rate for Payer: Priority Health SBD |
$204.31
|
| Rate for Payer: UMR Bronson Commercial |
$119.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$191.76
|
|
|
Service Code
|
NDC 51991-837-16
|
| Hospital Charge Code |
70838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$172.58 |
| Rate for Payer: Aetna American Axle |
$124.64
|
| Rate for Payer: Aetna Commercial |
$163.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.64
|
| Rate for Payer: BCBS Complete |
$76.70
|
| Rate for Payer: Cash Price |
$153.41
|
| Rate for Payer: Cofinity Commercial |
$134.23
|
| Rate for Payer: Cofinity Commercial |
$164.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.41
|
| Rate for Payer: Healthscope Commercial |
$172.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.00
|
| Rate for Payer: PHP Commercial |
$163.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.23
|
| Rate for Payer: Priority Health SBD |
$120.81
|
| Rate for Payer: UMR Bronson Commercial |
$70.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.82
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,451.02
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$3,105.92 |
| Rate for Payer: Aetna American Axle |
$2,243.16
|
| Rate for Payer: Aetna Commercial |
$2,933.37
|
| Rate for Payer: Aetna Medicare |
$76.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,243.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.15
|
| Rate for Payer: BCBS Complete |
$42.34
|
| Rate for Payer: BCBS MAPPO |
$73.72
|
| Rate for Payer: BCBS Trust/PPO |
$238.23
|
| Rate for Payer: BCN Medicare Advantage |
$73.72
|
| Rate for Payer: Cash Price |
$2,760.82
|
| Rate for Payer: Cash Price |
$2,760.82
|
| Rate for Payer: Cofinity Commercial |
$2,967.88
|
| Rate for Payer: Cofinity Commercial |
$2,415.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,760.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.72
|
| Rate for Payer: Healthscope Commercial |
$3,105.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,415.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,588.26
|
| Rate for Payer: Mclaren Medicaid |
$40.32
|
| Rate for Payer: Mclaren Medicare |
$73.72
|
| Rate for Payer: Meridian Medicaid |
$42.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,933.37
|
| Rate for Payer: PACE Medicare |
$70.03
|
| Rate for Payer: PACE SWMI |
$73.72
|
| Rate for Payer: PHP Commercial |
$2,933.37
|
| Rate for Payer: PHP Medicare Advantage |
$73.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,415.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.26
|
| Rate for Payer: Priority Health Medicare |
$73.72
|
| Rate for Payer: Priority Health Narrow Network |
$169.81
|
| Rate for Payer: Priority Health SBD |
$2,174.14
|
| Rate for Payer: Railroad Medicare Medicare |
$73.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.72
|
| Rate for Payer: UHC Medicare Advantage |
$75.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,276.88
|
| Rate for Payer: VA VA |
$73.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,588.26
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,451.02
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,518.45 |
| Max. Negotiated Rate |
$3,105.92 |
| Rate for Payer: Aetna American Axle |
$2,243.16
|
| Rate for Payer: Aetna Commercial |
$2,933.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,243.16
|
| Rate for Payer: Cash Price |
$2,760.82
|
| Rate for Payer: Cofinity Commercial |
$2,967.88
|
| Rate for Payer: Cofinity Commercial |
$2,415.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,760.82
|
| Rate for Payer: Healthscope Commercial |
$3,105.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,415.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,588.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,933.37
|
| Rate for Payer: PHP Commercial |
$2,933.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,415.71
|
| Rate for Payer: Priority Health SBD |
$2,174.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,518.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,588.26
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,902.03
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$6,211.83 |
| Rate for Payer: Aetna American Axle |
$4,486.32
|
| Rate for Payer: Aetna Commercial |
$5,866.73
|
| Rate for Payer: Aetna Medicare |
$76.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,486.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.15
|
| Rate for Payer: BCBS Complete |
$42.34
|
| Rate for Payer: BCBS MAPPO |
$73.72
|
| Rate for Payer: BCBS Trust/PPO |
$238.23
|
| Rate for Payer: BCN Medicare Advantage |
$73.72
|
| Rate for Payer: Cash Price |
$5,521.62
|
| Rate for Payer: Cash Price |
$5,521.62
|
| Rate for Payer: Cofinity Commercial |
$4,831.42
|
| Rate for Payer: Cofinity Commercial |
$5,935.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,521.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.72
|
| Rate for Payer: Healthscope Commercial |
$6,211.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,831.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,176.52
|
| Rate for Payer: Mclaren Medicaid |
$40.32
|
| Rate for Payer: Mclaren Medicare |
$73.72
|
| Rate for Payer: Meridian Medicaid |
$42.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,866.73
|
| Rate for Payer: PACE Medicare |
$70.03
|
| Rate for Payer: PACE SWMI |
$73.72
|
| Rate for Payer: PHP Commercial |
$5,866.73
|
| Rate for Payer: PHP Medicare Advantage |
$73.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,831.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.26
|
| Rate for Payer: Priority Health Medicare |
$73.72
|
| Rate for Payer: Priority Health Narrow Network |
$169.81
|
| Rate for Payer: Priority Health SBD |
$4,348.28
|
| Rate for Payer: Railroad Medicare Medicare |
$73.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.72
|
| Rate for Payer: UHC Medicare Advantage |
$75.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,553.75
|
| Rate for Payer: VA VA |
$73.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,176.52
|
|
