|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$294.50
|
|
|
Service Code
|
NDC 0054-0021-25
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.58 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna American Axle |
$191.42
|
| Rate for Payer: Aetna Commercial |
$250.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.42
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$206.15
|
| Rate for Payer: Cofinity Commercial |
$253.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$265.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.32
|
| Rate for Payer: PHP Commercial |
$250.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.15
|
| Rate for Payer: Priority Health SBD |
$185.54
|
| Rate for Payer: UMR Bronson Commercial |
$129.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.88
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 51079-142-01
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.61
|
| Rate for Payer: Priority Health SBD |
$2.35
|
| Rate for Payer: UMR Bronson Commercial |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$372.40
|
|
|
Service Code
|
NDC 51079-142-20
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$335.16 |
| Rate for Payer: Aetna American Axle |
$242.06
|
| Rate for Payer: Aetna Commercial |
$316.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.06
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$320.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Healthscope Commercial |
$335.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.54
|
| Rate for Payer: PHP Commercial |
$316.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.68
|
| Rate for Payer: Priority Health SBD |
$234.61
|
| Rate for Payer: UMR Bronson Commercial |
$163.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.30
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$379.05
|
|
|
Service Code
|
NDC 0054-0020-25
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.78 |
| Max. Negotiated Rate |
$341.14 |
| Rate for Payer: Aetna American Axle |
$246.38
|
| Rate for Payer: Aetna Commercial |
$322.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.38
|
| Rate for Payer: Cash Price |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$265.34
|
| Rate for Payer: Cofinity Commercial |
$325.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.24
|
| Rate for Payer: Healthscope Commercial |
$341.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$322.19
|
| Rate for Payer: PHP Commercial |
$322.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.34
|
| Rate for Payer: Priority Health SBD |
$238.80
|
| Rate for Payer: UMR Bronson Commercial |
$166.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.29
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$269.80
|
|
|
Service Code
|
NDC 0378-1450-01
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.71 |
| Max. Negotiated Rate |
$242.82 |
| Rate for Payer: Aetna American Axle |
$175.37
|
| Rate for Payer: Aetna Commercial |
$229.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.37
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$232.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$242.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.33
|
| Rate for Payer: PHP Commercial |
$229.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.86
|
| Rate for Payer: Priority Health SBD |
$169.97
|
| Rate for Payer: UMR Bronson Commercial |
$118.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.35
|
|
|
LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; COMPLICATED OR LARGE (OVER 2.5 CM)
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 52318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.45 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,925.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.10
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$456.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; SIMPLE OR SMALL (LESS THAN 2.5 CM)
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 52317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$333.99 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,185.03
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.39
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$333.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 50590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$561.56 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,782.89
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.72
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$561.56
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$232,850.34
|
|
|
Service Code
|
MS-DRG 005
|
| Min. Negotiated Rate |
$76,256.33 |
| Max. Negotiated Rate |
$232,850.34 |
| Rate for Payer: Aetna Medicare |
$83,480.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100,337.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100,337.28
|
| Rate for Payer: BCBS MAPPO |
$80,269.82
|
| Rate for Payer: BCBS Trust/PPO |
$232,850.34
|
| Rate for Payer: BCN Medicare Advantage |
$80,269.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80,269.82
|
| Rate for Payer: Mclaren Medicare |
$80,269.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84,283.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92,310.29
|
| Rate for Payer: PACE Medicare |
$76,256.33
|
| Rate for Payer: PACE SWMI |
$80,269.82
|
| Rate for Payer: PHP Medicare Advantage |
$80,269.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148,521.67
|
| Rate for Payer: Priority Health Medicare |
$80,269.82
|
| Rate for Payer: Priority Health Narrow Network |
$118,817.34
|
| Rate for Payer: Railroad Medicare Medicare |
$80,269.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157,878.90
|
| Rate for Payer: UHC Core |
$129,457.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$80,269.82
|
| Rate for Payer: UHC Exchange |
$102,920.40
|
| Rate for Payer: UHC Medicare Advantage |
$82,677.91
|
| Rate for Payer: VA VA |
$80,269.82
|
|
|
LIVER TRANSPLANT WITHOUT MCC
|
Facility
|
IP
|
$89,577.35
|
|
|
Service Code
|
MS-DRG 006
|
| Min. Negotiated Rate |
$35,896.39 |
| Max. Negotiated Rate |
$89,577.35 |
| Rate for Payer: Aetna Medicare |
$39,297.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,232.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,232.09
|
| Rate for Payer: BCBS MAPPO |
$37,785.67
|
| Rate for Payer: BCBS Trust/PPO |
$89,577.35
|
| Rate for Payer: BCN Medicare Advantage |
$37,785.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,785.67
|
| Rate for Payer: Mclaren Medicare |
$37,785.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39,674.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43,453.52
|
| Rate for Payer: PACE Medicare |
$35,896.39
|
| Rate for Payer: PACE SWMI |
$37,785.67
|
| Rate for Payer: PHP Medicare Advantage |
$37,785.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69,409.13
|
| Rate for Payer: Priority Health Medicare |
$37,785.67
|
| Rate for Payer: Priority Health Narrow Network |
$55,527.30
|
| Rate for Payer: Railroad Medicare Medicare |
$37,785.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73,782.07
|
| Rate for Payer: UHC Core |
$60,499.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$37,785.67
|
| Rate for Payer: UHC Exchange |
$48,098.13
|
| Rate for Payer: UHC Medicare Advantage |
$38,919.24
|
| Rate for Payer: VA VA |
$37,785.67
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC
|
Facility
|
IP
|
$40,105.88
|
|
|
Service Code
|
MS-DRG 496
|
| Min. Negotiated Rate |
$15,036.69 |
| Max. Negotiated Rate |
$40,105.88 |
| Rate for Payer: Aetna Medicare |
$16,461.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,785.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,785.11
|
| Rate for Payer: BCBS MAPPO |
$15,828.09
|
| Rate for Payer: BCBS Trust/PPO |
$40,105.88
|
| Rate for Payer: BCN Medicare Advantage |
$15,828.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,828.09
|
| Rate for Payer: Mclaren Medicare |
$15,828.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,619.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,202.30
|
| Rate for Payer: PACE Medicare |
$15,036.69
|
| Rate for Payer: PACE SWMI |
$15,828.09
|
| Rate for Payer: PHP Medicare Advantage |
$15,828.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,520.47
|
| Rate for Payer: Priority Health Medicare |
$15,828.09
|
| Rate for Payer: Priority Health Narrow Network |
$22,816.38
|
| Rate for Payer: Railroad Medicare Medicare |
$15,828.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,317.33
|
| Rate for Payer: UHC Core |
$24,859.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,828.09
|
| Rate for Payer: UHC Exchange |
$19,763.70
|
| Rate for Payer: UHC Medicare Advantage |
$16,302.93
|
| Rate for Payer: VA VA |
$15,828.09
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC
|
Facility
|
IP
|
$91,409.25
|
|
|
Service Code
|
MS-DRG 495
|
| Min. Negotiated Rate |
$26,703.75 |
| Max. Negotiated Rate |
$91,409.25 |
| Rate for Payer: Aetna Medicare |
$29,233.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,136.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,136.51
|
| Rate for Payer: BCBS MAPPO |
$28,109.21
|
| Rate for Payer: BCBS Trust/PPO |
$91,409.25
|
| Rate for Payer: BCN Medicare Advantage |
$28,109.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,109.21
|
| Rate for Payer: Mclaren Medicare |
$28,109.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,514.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,325.59
|
| Rate for Payer: PACE Medicare |
$26,703.75
|
| Rate for Payer: PACE SWMI |
$28,109.21
|
| Rate for Payer: PHP Medicare Advantage |
$28,109.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,389.93
|
| Rate for Payer: Priority Health Medicare |
$28,109.21
|
| Rate for Payer: Priority Health Narrow Network |
$41,111.94
|
| Rate for Payer: Railroad Medicare Medicare |
$28,109.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54,627.62
|
| Rate for Payer: UHC Core |
$44,793.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,109.21
|
| Rate for Payer: UHC Exchange |
$35,611.45
|
| Rate for Payer: UHC Medicare Advantage |
$28,952.49
|
| Rate for Payer: VA VA |
$28,109.21
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$27,342.86
|
|
|
Service Code
|
MS-DRG 497
|
| Min. Negotiated Rate |
$10,936.34 |
| Max. Negotiated Rate |
$27,342.86 |
| Rate for Payer: Aetna Medicare |
$11,972.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,389.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,389.92
|
| Rate for Payer: BCBS MAPPO |
$11,511.94
|
| Rate for Payer: BCBS Trust/PPO |
$27,342.86
|
| Rate for Payer: BCN Medicare Advantage |
$11,511.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,511.94
|
| Rate for Payer: Mclaren Medicare |
$11,511.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,087.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,238.73
|
| Rate for Payer: PACE Medicare |
$10,936.34
|
| Rate for Payer: PACE SWMI |
$11,511.94
|
| Rate for Payer: PHP Medicare Advantage |
$11,511.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,483.08
|
| Rate for Payer: Priority Health Medicare |
$11,511.94
|
| Rate for Payer: Priority Health Narrow Network |
$16,386.46
|
| Rate for Payer: Railroad Medicare Medicare |
$11,511.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,773.56
|
| Rate for Payer: UHC Core |
$17,853.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,511.94
|
| Rate for Payer: UHC Exchange |
$14,194.07
|
| Rate for Payer: UHC Medicare Advantage |
$11,857.30
|
| Rate for Payer: VA VA |
$11,511.94
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC
|
Facility
|
IP
|
$50,328.36
|
|
|
Service Code
|
MS-DRG 498
|
| Min. Negotiated Rate |
$19,601.18 |
| Max. Negotiated Rate |
$50,328.36 |
| Rate for Payer: Aetna Medicare |
$21,458.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,791.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,791.02
|
| Rate for Payer: BCBS MAPPO |
$20,632.82
|
| Rate for Payer: BCBS Trust/PPO |
$50,328.36
|
| Rate for Payer: BCN Medicare Advantage |
$20,632.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,632.82
|
| Rate for Payer: Mclaren Medicare |
$20,632.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,664.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,727.74
|
| Rate for Payer: PACE Medicare |
$19,601.18
|
| Rate for Payer: PACE SWMI |
$20,632.82
|
| Rate for Payer: PHP Medicare Advantage |
$20,632.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,467.64
|
| Rate for Payer: Priority Health Medicare |
$20,632.82
|
| Rate for Payer: Priority Health Narrow Network |
$29,974.11
|
| Rate for Payer: Railroad Medicare Medicare |
$20,632.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,828.19
|
| Rate for Payer: UHC Core |
$32,658.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,632.82
|
| Rate for Payer: UHC Exchange |
$25,963.78
|
| Rate for Payer: UHC Medicare Advantage |
$21,251.80
|
| Rate for Payer: VA VA |
$20,632.82
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$22,699.03
|
|
|
Service Code
|
MS-DRG 499
|
| Min. Negotiated Rate |
$9,929.02 |
| Max. Negotiated Rate |
$22,699.03 |
| Rate for Payer: Aetna Medicare |
$10,869.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,064.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,064.50
|
| Rate for Payer: BCBS MAPPO |
$10,451.60
|
| Rate for Payer: BCBS Trust/PPO |
$22,699.03
|
| Rate for Payer: BCN Medicare Advantage |
$10,451.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,451.60
|
| Rate for Payer: Mclaren Medicare |
$10,451.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,974.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,019.34
|
| Rate for Payer: PACE Medicare |
$9,929.02
|
| Rate for Payer: PACE SWMI |
$10,451.60
|
| Rate for Payer: PHP Medicare Advantage |
$10,451.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,508.53
|
| Rate for Payer: Priority Health Medicare |
$10,451.60
|
| Rate for Payer: Priority Health Narrow Network |
$14,806.82
|
| Rate for Payer: Railroad Medicare Medicare |
$10,451.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,674.61
|
| Rate for Payer: UHC Core |
$16,132.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,451.60
|
| Rate for Payer: UHC Exchange |
$12,825.77
|
| Rate for Payer: UHC Medicare Advantage |
$10,765.15
|
| Rate for Payer: VA VA |
$10,451.60
|
|
|
LOMUSTINE 10 MG CAPSULE
|
Facility
|
IP
|
$1,878.79
|
|
|
Service Code
|
NDC 58181-3040-5
|
| Hospital Charge Code |
10459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$826.67 |
| Max. Negotiated Rate |
$1,690.91 |
| Rate for Payer: Aetna American Axle |
$1,221.21
|
| Rate for Payer: Aetna Commercial |
$1,596.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,221.21
|
| Rate for Payer: Cash Price |
$1,503.03
|
| Rate for Payer: Cofinity Commercial |
$1,315.15
|
| Rate for Payer: Cofinity Commercial |
$1,615.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,503.03
|
| Rate for Payer: Healthscope Commercial |
$1,690.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,315.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,409.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,596.97
|
| Rate for Payer: PHP Commercial |
$1,596.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,315.15
|
| Rate for Payer: Priority Health SBD |
$1,183.64
|
| Rate for Payer: UMR Bronson Commercial |
$826.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,409.09
|
|
|
LONG CHAIN TRIGLYCERIDES 7.5 GRAM-67.5 KCAL/15 ML ORAL EMULSION
|
Facility
|
IP
|
$17.09
|
|
|
Service Code
|
NDC 4167908702
|
| Hospital Charge Code |
173669
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna American Axle |
$11.11
|
| Rate for Payer: Aetna Commercial |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.11
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$11.96
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.67
|
| Rate for Payer: Healthscope Commercial |
$15.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.53
|
| Rate for Payer: PHP Commercial |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.96
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: UMR Bronson Commercial |
$7.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
|
|
LONG CHAIN TRIGLYCERIDES 7.5 GRAM-67.5 KCAL/15 ML ORAL EMULSION
|
Facility
|
IP
|
$17.09
|
|
|
Service Code
|
NDC 4167908743
|
| Hospital Charge Code |
173669
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna American Axle |
$11.11
|
| Rate for Payer: Aetna Commercial |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.11
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$11.96
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.67
|
| Rate for Payer: Healthscope Commercial |
$15.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.53
|
| Rate for Payer: PHP Commercial |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.96
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: UMR Bronson Commercial |
$7.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$22.26
|
|
|
Service Code
|
NDC 45013444
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$20.03 |
| Rate for Payer: Aetna American Axle |
$14.47
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.92
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 0904-6836-20
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna American Axle |
$10.53
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.77
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$7.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$21.84
|
|
|
Service Code
|
NDC 45013404
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna American Axle |
$14.20
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.29
|
| Rate for Payer: Priority Health SBD |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$9.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.38
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 70000-0418-1
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$9.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.48
|
| Rate for Payer: PHP Commercial |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.45
|
| Rate for Payer: Priority Health SBD |
$8.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 9629513558
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$9.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.48
|
| Rate for Payer: PHP Commercial |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.45
|
| Rate for Payer: Priority Health SBD |
$8.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$324.96
|
|
|
Service Code
|
NDC 51079-690-20
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.98 |
| Max. Negotiated Rate |
$292.46 |
| Rate for Payer: Aetna American Axle |
$211.22
|
| Rate for Payer: Aetna Commercial |
$276.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.22
|
| Rate for Payer: Cash Price |
$259.97
|
| Rate for Payer: Cofinity Commercial |
$227.47
|
| Rate for Payer: Cofinity Commercial |
$279.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.97
|
| Rate for Payer: Healthscope Commercial |
$292.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.22
|
| Rate for Payer: PHP Commercial |
$276.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.47
|
| Rate for Payer: Priority Health SBD |
$204.72
|
| Rate for Payer: UMR Bronson Commercial |
$142.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.72
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 69452-271-20
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.30
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
