|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 0245-0212-11
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.72 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.92
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.28
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UMR Bronson Commercial |
$95.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
IP
|
$19,445.52
|
|
|
Service Code
|
NDC 0078-0698-51
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,556.03 |
| Max. Negotiated Rate |
$17,500.97 |
| Rate for Payer: Aetna American Axle |
$12,639.59
|
| Rate for Payer: Aetna Commercial |
$16,528.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,639.59
|
| Rate for Payer: Cash Price |
$15,556.42
|
| Rate for Payer: Cofinity Commercial |
$13,611.86
|
| Rate for Payer: Cofinity Commercial |
$16,723.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,556.42
|
| Rate for Payer: Healthscope Commercial |
$17,500.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,611.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,584.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,528.69
|
| Rate for Payer: PHP Commercial |
$16,528.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,611.86
|
| Rate for Payer: Priority Health SBD |
$12,250.68
|
| Rate for Payer: UMR Bronson Commercial |
$8,556.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,584.14
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
IP
|
$38,891.03
|
|
|
Service Code
|
NDC 0078-0698-99
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17,112.05 |
| Max. Negotiated Rate |
$35,001.93 |
| Rate for Payer: Aetna American Axle |
$25,279.17
|
| Rate for Payer: Aetna Commercial |
$33,057.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,279.17
|
| Rate for Payer: Cash Price |
$31,112.82
|
| Rate for Payer: Cofinity Commercial |
$27,223.72
|
| Rate for Payer: Cofinity Commercial |
$33,446.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31,112.82
|
| Rate for Payer: Healthscope Commercial |
$35,001.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,223.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29,168.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33,057.38
|
| Rate for Payer: PHP Commercial |
$33,057.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,223.72
|
| Rate for Payer: Priority Health SBD |
$24,501.35
|
| Rate for Payer: UMR Bronson Commercial |
$17,112.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29,168.27
|
|
|
MILNACIPRAN 50 MG TABLET
|
Facility
|
IP
|
$1,677.44
|
|
|
Service Code
|
NDC 0456-1550-60
|
| Hospital Charge Code |
97089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$738.07 |
| Max. Negotiated Rate |
$1,509.70 |
| Rate for Payer: Aetna American Axle |
$1,090.34
|
| Rate for Payer: Aetna Commercial |
$1,425.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,090.34
|
| Rate for Payer: Cash Price |
$1,341.95
|
| Rate for Payer: Cofinity Commercial |
$1,174.21
|
| Rate for Payer: Cofinity Commercial |
$1,442.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,341.95
|
| Rate for Payer: Healthscope Commercial |
$1,509.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,174.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,258.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,425.82
|
| Rate for Payer: PHP Commercial |
$1,425.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,174.21
|
| Rate for Payer: Priority Health SBD |
$1,056.79
|
| Rate for Payer: UMR Bronson Commercial |
$738.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,258.08
|
|
|
MILRINONE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.50
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
27327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.98 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Aetna American Axle |
$84.18
|
| Rate for Payer: Aetna American Axle |
$90.68
|
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.68
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cofinity Commercial |
$90.65
|
| Rate for Payer: Cofinity Commercial |
$111.37
|
| Rate for Payer: Cofinity Commercial |
$119.97
|
| Rate for Payer: Cofinity Commercial |
$97.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.60
|
| Rate for Payer: Healthscope Commercial |
$125.55
|
| Rate for Payer: Healthscope Commercial |
$116.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$118.58
|
| Rate for Payer: PHP Commercial |
$110.08
|
| Rate for Payer: PHP Commercial |
$118.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.65
|
| Rate for Payer: Priority Health SBD |
$81.58
|
| Rate for Payer: Priority Health SBD |
$87.88
|
| Rate for Payer: UMR Bronson Commercial |
$61.38
|
| Rate for Payer: UMR Bronson Commercial |
$56.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.62
|
|
|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
IP
|
$68.59
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
14961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.18 |
| Max. Negotiated Rate |
$61.73 |
| Rate for Payer: Aetna American Axle |
$44.58
|
| Rate for Payer: Aetna American Axle |
$64.79
|
| Rate for Payer: Aetna American Axle |
$58.48
|
| Rate for Payer: Aetna Commercial |
$84.72
|
| Rate for Payer: Aetna Commercial |
$76.47
|
| Rate for Payer: Aetna Commercial |
$58.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.58
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Commercial |
$62.98
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$58.99
|
| Rate for Payer: Cofinity Commercial |
$77.37
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Cofinity Commercial |
$69.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.87
|
| Rate for Payer: Healthscope Commercial |
$80.97
|
| Rate for Payer: Healthscope Commercial |
$61.73
|
| Rate for Payer: Healthscope Commercial |
$89.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.47
|
| Rate for Payer: PHP Commercial |
$76.47
|
| Rate for Payer: PHP Commercial |
$84.72
|
| Rate for Payer: PHP Commercial |
$58.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: Priority Health SBD |
$56.68
|
| Rate for Payer: Priority Health SBD |
$43.21
|
| Rate for Payer: Priority Health SBD |
$62.79
|
| Rate for Payer: UMR Bronson Commercial |
$39.59
|
| Rate for Payer: UMR Bronson Commercial |
$43.85
|
| Rate for Payer: UMR Bronson Commercial |
$30.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.75
|
|
|
MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
IP
|
$100.98
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
118311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.43 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Aetna American Axle |
$65.64
|
| Rate for Payer: Aetna American Axle |
$88.67
|
| Rate for Payer: Aetna Commercial |
$115.96
|
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.67
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$109.14
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Cofinity Commercial |
$95.49
|
| Rate for Payer: Cofinity Commercial |
$117.32
|
| Rate for Payer: Cofinity Commercial |
$70.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.14
|
| Rate for Payer: Healthscope Commercial |
$122.78
|
| Rate for Payer: Healthscope Commercial |
$90.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.96
|
| Rate for Payer: PHP Commercial |
$115.96
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.49
|
| Rate for Payer: Priority Health SBD |
$85.94
|
| Rate for Payer: Priority Health SBD |
$63.62
|
| Rate for Payer: UMR Bronson Commercial |
$44.43
|
| Rate for Payer: UMR Bronson Commercial |
$60.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.32
|
|
|
MINERAL OIL
|
Facility
|
IP
|
$60.28
|
|
|
Service Code
|
NDC 6332325410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$54.25 |
| Rate for Payer: Aetna American Axle |
$39.18
|
| Rate for Payer: Aetna Commercial |
$51.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.18
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Cofinity Commercial |
$42.20
|
| Rate for Payer: Cofinity Commercial |
$51.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.22
|
| Rate for Payer: Healthscope Commercial |
$54.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.24
|
| Rate for Payer: PHP Commercial |
$51.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.20
|
| Rate for Payer: Priority Health SBD |
$37.98
|
| Rate for Payer: UMR Bronson Commercial |
$26.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.21
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$46.89
|
|
|
Service Code
|
NDC 9629512753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna American Axle |
$30.48
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.48
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.86
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.82
|
| Rate for Payer: Priority Health SBD |
$29.54
|
| Rate for Payer: UMR Bronson Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$56.26
|
|
|
Service Code
|
NDC 0132-0301-40
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$50.63 |
| Rate for Payer: Aetna American Axle |
$36.57
|
| Rate for Payer: Aetna Commercial |
$47.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.57
|
| Rate for Payer: Cash Price |
$45.01
|
| Rate for Payer: Cofinity Commercial |
$39.38
|
| Rate for Payer: Cofinity Commercial |
$48.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.01
|
| Rate for Payer: Healthscope Commercial |
$50.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.82
|
| Rate for Payer: PHP Commercial |
$47.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.38
|
| Rate for Payer: Priority Health SBD |
$35.44
|
| Rate for Payer: UMR Bronson Commercial |
$24.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.20
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$7.77
|
|
|
Service Code
|
NDC 48433-202-30
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Aetna American Axle |
$5.05
|
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.05
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$6.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.60
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.44
|
| Rate for Payer: Priority Health SBD |
$4.90
|
| Rate for Payer: UMR Bronson Commercial |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.83
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$8.88
|
|
|
Service Code
|
NDC 96295-13630
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.55
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$3.53
|
|
|
Service Code
|
NDC 9900-0005-69
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.47
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 0591-5694-01
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$211.18 |
| Rate for Payer: Aetna American Axle |
$152.52
|
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$164.26
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.45
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.26
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UMR Bronson Commercial |
$103.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$34,316.16
|
|
|
Service Code
|
MS-DRG 663
|
| Min. Negotiated Rate |
$11,167.68 |
| Max. Negotiated Rate |
$34,316.16 |
| Rate for Payer: Aetna Medicare |
$12,225.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,694.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,694.31
|
| Rate for Payer: BCBS MAPPO |
$11,755.45
|
| Rate for Payer: BCBS Trust/PPO |
$34,316.16
|
| Rate for Payer: BCN Medicare Advantage |
$11,755.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,755.45
|
| Rate for Payer: Mclaren Medicare |
$11,755.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,343.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,518.77
|
| Rate for Payer: PACE Medicare |
$11,167.68
|
| Rate for Payer: PACE SWMI |
$11,755.45
|
| Rate for Payer: PHP Medicare Advantage |
$11,755.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,936.53
|
| Rate for Payer: Priority Health Medicare |
$11,755.45
|
| Rate for Payer: Priority Health Narrow Network |
$16,749.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11,755.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,255.59
|
| Rate for Payer: UHC Core |
$18,249.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,755.45
|
| Rate for Payer: UHC Exchange |
$14,508.30
|
| Rate for Payer: UHC Medicare Advantage |
$12,108.11
|
| Rate for Payer: VA VA |
$11,755.45
|
|
|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$55,396.88
|
|
|
Service Code
|
MS-DRG 662
|
| Min. Negotiated Rate |
$22,424.78 |
| Max. Negotiated Rate |
$55,396.88 |
| Rate for Payer: Aetna Medicare |
$24,549.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,506.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,506.29
|
| Rate for Payer: BCBS MAPPO |
$23,605.03
|
| Rate for Payer: BCBS Trust/PPO |
$55,396.88
|
| Rate for Payer: BCN Medicare Advantage |
$23,605.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,605.03
|
| Rate for Payer: Mclaren Medicare |
$23,605.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,785.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,145.78
|
| Rate for Payer: PACE Medicare |
$22,424.78
|
| Rate for Payer: PACE SWMI |
$23,605.03
|
| Rate for Payer: PHP Medicare Advantage |
$23,605.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,002.41
|
| Rate for Payer: Priority Health Medicare |
$23,605.03
|
| Rate for Payer: Priority Health Narrow Network |
$34,401.93
|
| Rate for Payer: Railroad Medicare Medicare |
$23,605.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,711.66
|
| Rate for Payer: UHC Core |
$37,482.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,605.03
|
| Rate for Payer: UHC Exchange |
$29,799.18
|
| Rate for Payer: UHC Medicare Advantage |
$24,313.18
|
| Rate for Payer: VA VA |
$23,605.03
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,970.69
|
|
|
Service Code
|
MS-DRG 664
|
| Min. Negotiated Rate |
$8,258.43 |
| Max. Negotiated Rate |
$24,970.69 |
| Rate for Payer: Aetna Medicare |
$9,040.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,866.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,866.35
|
| Rate for Payer: BCBS MAPPO |
$8,693.08
|
| Rate for Payer: BCBS Trust/PPO |
$24,970.69
|
| Rate for Payer: BCN Medicare Advantage |
$8,693.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,693.08
|
| Rate for Payer: Mclaren Medicare |
$8,693.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,127.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,997.04
|
| Rate for Payer: PACE Medicare |
$8,258.43
|
| Rate for Payer: PACE SWMI |
$8,693.08
|
| Rate for Payer: PHP Medicare Advantage |
$8,693.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,233.88
|
| Rate for Payer: Priority Health Medicare |
$8,693.08
|
| Rate for Payer: Priority Health Narrow Network |
$12,187.10
|
| Rate for Payer: Railroad Medicare Medicare |
$8,693.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,193.65
|
| Rate for Payer: UHC Core |
$13,278.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,693.08
|
| Rate for Payer: UHC Exchange |
$10,556.55
|
| Rate for Payer: UHC Medicare Advantage |
$8,953.87
|
| Rate for Payer: VA VA |
$8,693.08
|
|
|
MINOR SKIN DISORDERS WITH MCC
|
Facility
|
IP
|
$28,008.78
|
|
|
Service Code
|
MS-DRG 606
|
| Min. Negotiated Rate |
$12,095.95 |
| Max. Negotiated Rate |
$28,008.78 |
| Rate for Payer: Aetna Medicare |
$13,241.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,915.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,915.72
|
| Rate for Payer: BCBS MAPPO |
$12,732.58
|
| Rate for Payer: BCBS Trust/PPO |
$28,008.78
|
| Rate for Payer: BCN Medicare Advantage |
$12,732.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,732.58
|
| Rate for Payer: Mclaren Medicare |
$12,732.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,369.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,642.47
|
| Rate for Payer: PACE Medicare |
$12,095.95
|
| Rate for Payer: PACE SWMI |
$12,732.58
|
| Rate for Payer: PHP Medicare Advantage |
$12,732.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,756.10
|
| Rate for Payer: Priority Health Medicare |
$12,732.58
|
| Rate for Payer: Priority Health Narrow Network |
$18,204.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,732.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,189.79
|
| Rate for Payer: UHC Core |
$19,835.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,732.58
|
| Rate for Payer: UHC Exchange |
$15,769.20
|
| Rate for Payer: UHC Medicare Advantage |
$13,114.56
|
| Rate for Payer: VA VA |
$12,732.58
|
|
|
MINOR SKIN DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$13,629.45
|
|
|
Service Code
|
MS-DRG 607
|
| Min. Negotiated Rate |
$7,027.82 |
| Max. Negotiated Rate |
$13,629.45 |
| Rate for Payer: Aetna Medicare |
$7,693.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,247.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,247.12
|
| Rate for Payer: BCBS MAPPO |
$7,397.70
|
| Rate for Payer: BCBS Trust/PPO |
$13,529.45
|
| Rate for Payer: BCN Medicare Advantage |
$7,397.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,397.70
|
| Rate for Payer: Mclaren Medicare |
$7,397.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,767.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,507.36
|
| Rate for Payer: PACE Medicare |
$7,027.82
|
| Rate for Payer: PACE SWMI |
$7,397.70
|
| Rate for Payer: PHP Medicare Advantage |
$7,397.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,821.65
|
| Rate for Payer: Priority Health Medicare |
$7,397.70
|
| Rate for Payer: Priority Health Narrow Network |
$10,257.32
|
| Rate for Payer: Railroad Medicare Medicare |
$7,397.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,629.45
|
| Rate for Payer: UHC Core |
$11,175.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,397.70
|
| Rate for Payer: UHC Exchange |
$8,884.96
|
| Rate for Payer: UHC Medicare Advantage |
$7,619.63
|
| Rate for Payer: VA VA |
$7,397.70
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC
|
Facility
|
IP
|
$31,092.11
|
|
|
Service Code
|
MS-DRG 345
|
| Min. Negotiated Rate |
$11,765.06 |
| Max. Negotiated Rate |
$31,092.11 |
| Rate for Payer: Aetna Medicare |
$12,879.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,480.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,480.34
|
| Rate for Payer: BCBS MAPPO |
$12,384.27
|
| Rate for Payer: BCBS Trust/PPO |
$31,092.11
|
| Rate for Payer: BCN Medicare Advantage |
$12,384.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,384.27
|
| Rate for Payer: Mclaren Medicare |
$12,384.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,003.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,241.91
|
| Rate for Payer: PACE Medicare |
$11,765.06
|
| Rate for Payer: PACE SWMI |
$12,384.27
|
| Rate for Payer: PHP Medicare Advantage |
$12,384.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,107.49
|
| Rate for Payer: Priority Health Medicare |
$12,384.27
|
| Rate for Payer: Priority Health Narrow Network |
$17,685.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12,384.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,500.31
|
| Rate for Payer: UHC Core |
$19,269.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,384.27
|
| Rate for Payer: UHC Exchange |
$15,319.73
|
| Rate for Payer: UHC Medicare Advantage |
$12,755.80
|
| Rate for Payer: VA VA |
$12,384.27
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC
|
Facility
|
IP
|
$54,032.38
|
|
|
Service Code
|
MS-DRG 344
|
| Min. Negotiated Rate |
$20,548.47 |
| Max. Negotiated Rate |
$54,032.38 |
| Rate for Payer: Aetna Medicare |
$22,495.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,037.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,037.46
|
| Rate for Payer: BCBS MAPPO |
$21,629.97
|
| Rate for Payer: BCBS Trust/PPO |
$54,032.38
|
| Rate for Payer: BCN Medicare Advantage |
$21,629.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,629.97
|
| Rate for Payer: Mclaren Medicare |
$21,629.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,711.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,874.47
|
| Rate for Payer: PACE Medicare |
$20,548.47
|
| Rate for Payer: PACE SWMI |
$21,629.97
|
| Rate for Payer: PHP Medicare Advantage |
$21,629.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,324.52
|
| Rate for Payer: Priority Health Medicare |
$21,629.97
|
| Rate for Payer: Priority Health Narrow Network |
$31,459.62
|
| Rate for Payer: Railroad Medicare Medicare |
$21,629.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,802.06
|
| Rate for Payer: UHC Core |
$34,276.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,629.97
|
| Rate for Payer: UHC Exchange |
$27,250.54
|
| Rate for Payer: UHC Medicare Advantage |
$22,278.87
|
| Rate for Payer: VA VA |
$21,629.97
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$28,943.58
|
|
|
Service Code
|
MS-DRG 346
|
| Min. Negotiated Rate |
$9,914.38 |
| Max. Negotiated Rate |
$28,943.58 |
| Rate for Payer: Aetna Medicare |
$10,853.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,045.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,045.24
|
| Rate for Payer: BCBS MAPPO |
$10,436.19
|
| Rate for Payer: BCBS Trust/PPO |
$28,943.58
|
| Rate for Payer: BCN Medicare Advantage |
$10,436.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,436.19
|
| Rate for Payer: Mclaren Medicare |
$10,436.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,958.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,001.62
|
| Rate for Payer: PACE Medicare |
$9,914.38
|
| Rate for Payer: PACE SWMI |
$10,436.19
|
| Rate for Payer: PHP Medicare Advantage |
$10,436.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,479.83
|
| Rate for Payer: Priority Health Medicare |
$10,436.19
|
| Rate for Payer: Priority Health Narrow Network |
$14,783.86
|
| Rate for Payer: Railroad Medicare Medicare |
$10,436.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,644.10
|
| Rate for Payer: UHC Core |
$16,107.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,436.19
|
| Rate for Payer: UHC Exchange |
$12,805.88
|
| Rate for Payer: UHC Medicare Advantage |
$10,749.28
|
| Rate for Payer: VA VA |
$10,436.19
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 49884-257-01
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.81 |
| Max. Negotiated Rate |
$361.66 |
| Rate for Payer: Aetna American Axle |
$261.20
|
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.57
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.30
|
| Rate for Payer: Priority Health SBD |
$253.17
|
| Rate for Payer: UMR Bronson Commercial |
$176.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$2.63
|
|
|
Service Code
|
NDC 68084-205-11
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Aetna American Axle |
$1.71
|
| Rate for Payer: Aetna Commercial |
$2.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.66
|
| Rate for Payer: UMR Bronson Commercial |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.97
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$262.08
|
|
|
Service Code
|
NDC 68084-205-01
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.32 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Aetna American Axle |
$170.35
|
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.35
|
| Rate for Payer: Cash Price |
$209.66
|
| Rate for Payer: Cofinity Commercial |
$183.46
|
| Rate for Payer: Cofinity Commercial |
$225.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.66
|
| Rate for Payer: Healthscope Commercial |
$235.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.77
|
| Rate for Payer: PHP Commercial |
$222.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.46
|
| Rate for Payer: Priority Health SBD |
$165.11
|
| Rate for Payer: UMR Bronson Commercial |
$115.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.56
|
|
