|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$30,406.09
|
|
|
Service Code
|
MS-DRG 058
|
| Min. Negotiated Rate |
$13,136.22 |
| Max. Negotiated Rate |
$30,406.09 |
| Rate for Payer: Aetna Medicare |
$14,380.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,284.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,284.50
|
| Rate for Payer: BCBS MAPPO |
$13,827.60
|
| Rate for Payer: BCBS Trust/PPO |
$30,406.09
|
| Rate for Payer: BCN Medicare Advantage |
$13,827.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,827.60
|
| Rate for Payer: Mclaren Medicare |
$13,827.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,518.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,901.74
|
| Rate for Payer: PACE Medicare |
$13,136.22
|
| Rate for Payer: PACE SWMI |
$13,827.60
|
| Rate for Payer: PHP Medicare Advantage |
$13,827.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,795.23
|
| Rate for Payer: Priority Health Medicare |
$13,827.60
|
| Rate for Payer: Priority Health Narrow Network |
$19,836.18
|
| Rate for Payer: Railroad Medicare Medicare |
$13,827.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,357.39
|
| Rate for Payer: UHC Core |
$21,612.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,827.60
|
| Rate for Payer: UHC Exchange |
$17,182.24
|
| Rate for Payer: UHC Medicare Advantage |
$14,242.43
|
| Rate for Payer: VA VA |
$13,827.60
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$19,211.12
|
|
|
Service Code
|
MS-DRG 060
|
| Min. Negotiated Rate |
$7,056.36 |
| Max. Negotiated Rate |
$19,211.12 |
| Rate for Payer: Aetna Medicare |
$7,724.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,284.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,284.69
|
| Rate for Payer: BCBS MAPPO |
$7,427.75
|
| Rate for Payer: BCBS Trust/PPO |
$19,211.12
|
| Rate for Payer: BCN Medicare Advantage |
$7,427.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,427.75
|
| Rate for Payer: Mclaren Medicare |
$7,427.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,799.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,541.91
|
| Rate for Payer: PACE Medicare |
$7,056.36
|
| Rate for Payer: PACE SWMI |
$7,427.75
|
| Rate for Payer: PHP Medicare Advantage |
$7,427.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,877.62
|
| Rate for Payer: Priority Health Medicare |
$7,427.75
|
| Rate for Payer: Priority Health Narrow Network |
$10,302.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7,427.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,688.94
|
| Rate for Payer: UHC Core |
$11,224.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,427.75
|
| Rate for Payer: UHC Exchange |
$8,923.75
|
| Rate for Payer: UHC Medicare Advantage |
$7,650.58
|
| Rate for Payer: VA VA |
$7,427.75
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$212.94
|
|
|
Service Code
|
NDC 904549213
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.69 |
| Max. Negotiated Rate |
$191.65 |
| Rate for Payer: Aetna American Axle |
$138.41
|
| Rate for Payer: Aetna Commercial |
$181.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.41
|
| Rate for Payer: Cash Price |
$170.35
|
| Rate for Payer: Cofinity Commercial |
$149.06
|
| Rate for Payer: Cofinity Commercial |
$183.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.35
|
| Rate for Payer: Healthscope Commercial |
$191.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.00
|
| Rate for Payer: PHP Commercial |
$181.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.06
|
| Rate for Payer: Priority Health SBD |
$134.15
|
| Rate for Payer: UMR Bronson Commercial |
$93.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
NDC 536466110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$545.60 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna American Axle |
$806.00
|
| Rate for Payer: Aetna Commercial |
$1,054.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.00
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cofinity Commercial |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$868.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.00
|
| Rate for Payer: Healthscope Commercial |
$1,116.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$868.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$930.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.00
|
| Rate for Payer: PHP Commercial |
$1,054.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.00
|
| Rate for Payer: Priority Health SBD |
$781.20
|
| Rate for Payer: UMR Bronson Commercial |
$545.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$930.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$275.60
|
|
|
Service Code
|
NDC 4098522368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.26 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna American Axle |
$179.14
|
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.14
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$192.92
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.26
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.92
|
| Rate for Payer: Priority Health SBD |
$173.63
|
| Rate for Payer: UMR Bronson Commercial |
$121.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UMR Bronson Commercial |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$188.37
|
|
|
Service Code
|
NDC 8068100300
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$169.53 |
| Rate for Payer: Aetna American Axle |
$122.44
|
| Rate for Payer: Aetna Commercial |
$160.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.44
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cofinity Commercial |
$131.86
|
| Rate for Payer: Cofinity Commercial |
$162.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.70
|
| Rate for Payer: Healthscope Commercial |
$169.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.11
|
| Rate for Payer: PHP Commercial |
$160.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.86
|
| Rate for Payer: Priority Health SBD |
$118.67
|
| Rate for Payer: UMR Bronson Commercial |
$82.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.28
|
|
|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.29
|
|
|
Service Code
|
NDC 9900-0008-00
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Aetna American Axle |
$7.99
|
| Rate for Payer: Aetna Commercial |
$10.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.99
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cofinity Commercial |
$10.57
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.83
|
| Rate for Payer: Healthscope Commercial |
$11.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.45
|
| Rate for Payer: PHP Commercial |
$10.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$7.74
|
| Rate for Payer: UMR Bronson Commercial |
$5.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.22
|
|
|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
IP
|
$387.04
|
|
|
Service Code
|
NDC 573051330
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$348.34 |
| Rate for Payer: Aetna American Axle |
$251.58
|
| Rate for Payer: Aetna Commercial |
$328.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.58
|
| Rate for Payer: Cash Price |
$309.63
|
| Rate for Payer: Cofinity Commercial |
$270.93
|
| Rate for Payer: Cofinity Commercial |
$332.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.63
|
| Rate for Payer: Healthscope Commercial |
$348.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$328.98
|
| Rate for Payer: PHP Commercial |
$328.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.93
|
| Rate for Payer: Priority Health SBD |
$243.84
|
| Rate for Payer: UMR Bronson Commercial |
$170.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.28
|
|
|
MULTIVIT-MINERALS-IRON 8 MG-FOLIC AC 400 MCG-VIT K 10 MCG CHEW TABLET
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
NDC 5452835
|
| Hospital Charge Code |
188719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna American Axle |
$221.00
|
| Rate for Payer: Aetna Commercial |
$289.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$238.00
|
| Rate for Payer: Cofinity Commercial |
$292.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.00
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.00
|
| Rate for Payer: PHP Commercial |
$289.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.00
|
| Rate for Payer: Priority Health SBD |
$214.20
|
| Rate for Payer: UMR Bronson Commercial |
$149.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.00
|
|
|
MULTIVIT-MINS NO.51-FA 100 MCG-VIT K 350 MCG-CO Q10 5 MG CHEW TABLET
|
Facility
|
IP
|
$180.87
|
|
|
Service Code
|
NDC 5891401460
|
| Hospital Charge Code |
120095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.58 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna American Axle |
$117.57
|
| Rate for Payer: Aetna Commercial |
$153.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.57
|
| Rate for Payer: Cash Price |
$144.70
|
| Rate for Payer: Cofinity Commercial |
$126.61
|
| Rate for Payer: Cofinity Commercial |
$155.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.70
|
| Rate for Payer: Healthscope Commercial |
$162.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.74
|
| Rate for Payer: PHP Commercial |
$153.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.61
|
| Rate for Payer: Priority Health SBD |
$113.95
|
| Rate for Payer: UMR Bronson Commercial |
$79.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.65
|
|
|
MULTIVIT-MINS NO.56-FA 200 MCG-VIT K 1,000 MCG-COQ10 10 MG CHEW TABLET
|
Facility
|
IP
|
$178.56
|
|
|
Service Code
|
NDC 6817600015
|
| Hospital Charge Code |
181160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.57 |
| Max. Negotiated Rate |
$160.70 |
| Rate for Payer: Aetna American Axle |
$116.06
|
| Rate for Payer: Aetna Commercial |
$151.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.06
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cofinity Commercial |
$124.99
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.85
|
| Rate for Payer: Healthscope Commercial |
$160.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.78
|
| Rate for Payer: PHP Commercial |
$151.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.99
|
| Rate for Payer: Priority Health SBD |
$112.49
|
| Rate for Payer: UMR Bronson Commercial |
$78.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.92
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 68462-180-22
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.97
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UMR Bronson Commercial |
$13.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$104.96
|
|
|
Service Code
|
NDC 0168-0352-22
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$94.46 |
| Rate for Payer: Aetna American Axle |
$68.22
|
| Rate for Payer: Aetna Commercial |
$89.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.22
|
| Rate for Payer: Cash Price |
$83.97
|
| Rate for Payer: Cofinity Commercial |
$73.47
|
| Rate for Payer: Cofinity Commercial |
$90.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.97
|
| Rate for Payer: Healthscope Commercial |
$94.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.22
|
| Rate for Payer: PHP Commercial |
$89.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.47
|
| Rate for Payer: Priority Health SBD |
$66.12
|
| Rate for Payer: UMR Bronson Commercial |
$46.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.72
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 45802-112-22
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.97
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UMR Bronson Commercial |
$13.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.20
|
|
|
Service Code
|
NDC 51672-1312-0
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna American Axle |
$13.13
|
| Rate for Payer: Aetna Commercial |
$17.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.13
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$14.14
|
| Rate for Payer: Cofinity Commercial |
$17.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.16
|
| Rate for Payer: Healthscope Commercial |
$18.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.17
|
| Rate for Payer: PHP Commercial |
$17.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$12.73
|
| Rate for Payer: UMR Bronson Commercial |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.15
|
|
|
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK
|
Facility
|
OP
|
$10,039.01
|
|
|
Service Code
|
CPT 15734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,473.82 |
| Max. Negotiated Rate |
$10,039.01 |
| Rate for Payer: Aetna Medicare |
$3,316.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,986.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,986.20
|
| Rate for Payer: BCBS Complete |
$1,831.74
|
| Rate for Payer: BCBS MAPPO |
$3,188.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,344.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,188.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,188.96
|
| Rate for Payer: Mclaren Medicaid |
$1,744.36
|
| Rate for Payer: Mclaren Medicare |
$3,188.96
|
| Rate for Payer: Meridian Medicaid |
$1,831.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,348.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,667.30
|
| Rate for Payer: PACE Medicare |
$3,029.51
|
| Rate for Payer: PACE SWMI |
$3,188.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,188.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,744.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,039.01
|
| Rate for Payer: Priority Health Medicare |
$3,188.96
|
| Rate for Payer: Priority Health Narrow Network |
$8,031.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3,188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,621.20
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,188.96
|
| Rate for Payer: UHC Exchange |
$1,473.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,284.63
|
| Rate for Payer: VA VA |
$3,188.96
|
|
|
MVI, ADULT NO.1 WITH VIT K 3,300 UNIT-150 MCG/10 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$117.60
|
|
|
Service Code
|
NDC 61703-434-01
|
| Hospital Charge Code |
10660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$105.84 |
| Rate for Payer: Aetna American Axle |
$76.44
|
| Rate for Payer: Aetna Commercial |
$99.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.44
|
| Rate for Payer: Cash Price |
$94.08
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Cofinity Commercial |
$82.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.08
|
| Rate for Payer: Healthscope Commercial |
$105.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.96
|
| Rate for Payer: PHP Commercial |
$99.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.32
|
| Rate for Payer: Priority Health SBD |
$74.09
|
| Rate for Payer: UMR Bronson Commercial |
$51.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.20
|
|
|
MVI, ADULT NO.1 WITH VIT K 3,300 UNIT-150 MCG/10 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$117.60
|
|
|
Service Code
|
NDC 61703-434-82
|
| Hospital Charge Code |
10660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$105.84 |
| Rate for Payer: Aetna American Axle |
$76.44
|
| Rate for Payer: Aetna Commercial |
$99.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.44
|
| Rate for Payer: Cash Price |
$94.08
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Cofinity Commercial |
$82.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.08
|
| Rate for Payer: Healthscope Commercial |
$105.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.96
|
| Rate for Payer: PHP Commercial |
$99.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.32
|
| Rate for Payer: Priority Health SBD |
$74.09
|
| Rate for Payer: UMR Bronson Commercial |
$51.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.20
|
|
|
MVI,ADULT NO.4,VIT K,COMP(VIAL 1 OF 2) 3,300 UNIT-150 MCG/5 ML IV SOLN
|
Facility
|
IP
|
$28.09
|
|
|
Service Code
|
NDC 54643-9007-8
|
| Hospital Charge Code |
184515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna American Axle |
$18.26
|
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.66
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
MVI, ADULT NO.4, VIT K (VIAL 2 OF 2) 600 MCG-60 MCG-5 MCG/5 ML IV SOLN
|
Facility
|
IP
|
$28.09
|
|
|
Service Code
|
NDC 54643-9007-9
|
| Hospital Charge Code |
184516
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna American Axle |
$18.26
|
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.66
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.78
|
|
|
Service Code
|
NDC 54643-9007-1
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Aetna American Axle |
$21.96
|
| Rate for Payer: Aetna Commercial |
$28.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.96
|
| Rate for Payer: Cash Price |
$27.02
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Cofinity Commercial |
$29.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.02
|
| Rate for Payer: Healthscope Commercial |
$30.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.71
|
| Rate for Payer: PHP Commercial |
$28.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health SBD |
$21.28
|
| Rate for Payer: UMR Bronson Commercial |
$14.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.34
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.78
|
|
|
Service Code
|
NDC 54643-5649-1
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Aetna American Axle |
$21.96
|
| Rate for Payer: Aetna Commercial |
$28.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.96
|
| Rate for Payer: Cash Price |
$27.02
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Cofinity Commercial |
$29.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.02
|
| Rate for Payer: Healthscope Commercial |
$30.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.71
|
| Rate for Payer: PHP Commercial |
$28.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health SBD |
$21.28
|
| Rate for Payer: UMR Bronson Commercial |
$14.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.34
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.78
|
|
|
Service Code
|
NDC 54643-5649-1
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Aetna American Axle |
$21.96
|
| Rate for Payer: Aetna Commercial |
$28.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.96
|
| Rate for Payer: BCBS Complete |
$13.51
|
| Rate for Payer: Cash Price |
$27.02
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Cofinity Commercial |
$29.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.02
|
| Rate for Payer: Healthscope Commercial |
$30.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.71
|
| Rate for Payer: PHP Commercial |
$28.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health SBD |
$21.28
|
| Rate for Payer: UMR Bronson Commercial |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.34
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$249.21
|
|
|
Service Code
|
NDC 54643-5650-2
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$224.29 |
| Rate for Payer: Aetna American Axle |
$161.99
|
| Rate for Payer: Aetna Commercial |
$211.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.99
|
| Rate for Payer: Cash Price |
$199.37
|
| Rate for Payer: Cofinity Commercial |
$174.45
|
| Rate for Payer: Cofinity Commercial |
$214.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.37
|
| Rate for Payer: Healthscope Commercial |
$224.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.83
|
| Rate for Payer: PHP Commercial |
$211.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.45
|
| Rate for Payer: Priority Health SBD |
$157.00
|
| Rate for Payer: UMR Bronson Commercial |
$109.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.91
|
|
