|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$62.30
|
|
|
Service Code
|
NDC 54643-9023-1
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna American Axle |
$40.50
|
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.61
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: UMR Bronson Commercial |
$27.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.72
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$62.30
|
|
|
Service Code
|
NDC 54643-5646-1
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna American Axle |
$40.50
|
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.61
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: UMR Bronson Commercial |
$27.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.72
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$396.72
|
|
|
Service Code
|
NDC 54643-5647-0
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$174.56 |
| Max. Negotiated Rate |
$357.05 |
| Rate for Payer: Aetna American Axle |
$257.87
|
| Rate for Payer: Aetna Commercial |
$337.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.87
|
| Rate for Payer: Cash Price |
$317.38
|
| Rate for Payer: Cofinity Commercial |
$277.70
|
| Rate for Payer: Cofinity Commercial |
$341.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.38
|
| Rate for Payer: Healthscope Commercial |
$357.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.21
|
| Rate for Payer: PHP Commercial |
$337.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.70
|
| Rate for Payer: Priority Health SBD |
$249.93
|
| Rate for Payer: UMR Bronson Commercial |
$174.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.54
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN
|
Facility
|
IP
|
$62.30
|
|
|
Service Code
|
NDC 5464-3564-99
|
| Hospital Charge Code |
115531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna American Axle |
$40.50
|
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.61
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: UMR Bronson Commercial |
$27.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.72
|
|
|
MVI, PEDI NO.2 WITH VIT K 80 MG-400 UNIT-200 MCG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$36.38
|
|
|
Service Code
|
NDC 61703-421-53
|
| Hospital Charge Code |
162010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$32.74 |
| Rate for Payer: Aetna American Axle |
$23.65
|
| Rate for Payer: Aetna Commercial |
$30.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.65
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cofinity Commercial |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.10
|
| Rate for Payer: Healthscope Commercial |
$32.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.92
|
| Rate for Payer: PHP Commercial |
$30.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.47
|
| Rate for Payer: Priority Health SBD |
$22.92
|
| Rate for Payer: UMR Bronson Commercial |
$16.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.28
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.76
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
23968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.01 |
| Max. Negotiated Rate |
$65.48 |
| Rate for Payer: Aetna American Axle |
$47.29
|
| Rate for Payer: Aetna American Axle |
$148.30
|
| Rate for Payer: Aetna Commercial |
$193.94
|
| Rate for Payer: Aetna Commercial |
$61.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.29
|
| Rate for Payer: Cash Price |
$182.53
|
| Rate for Payer: Cash Price |
$58.21
|
| Rate for Payer: Cofinity Commercial |
$62.57
|
| Rate for Payer: Cofinity Commercial |
$50.93
|
| Rate for Payer: Cofinity Commercial |
$159.71
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.21
|
| Rate for Payer: Healthscope Commercial |
$205.34
|
| Rate for Payer: Healthscope Commercial |
$65.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.94
|
| Rate for Payer: PHP Commercial |
$61.85
|
| Rate for Payer: PHP Commercial |
$193.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.93
|
| Rate for Payer: Priority Health SBD |
$45.84
|
| Rate for Payer: Priority Health SBD |
$143.74
|
| Rate for Payer: UMR Bronson Commercial |
$100.39
|
| Rate for Payer: UMR Bronson Commercial |
$32.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.57
|
|
|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$3,706.52
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,630.87 |
| Max. Negotiated Rate |
$3,335.87 |
| Rate for Payer: Aetna American Axle |
$2,409.24
|
| Rate for Payer: Aetna American Axle |
$2,594.71
|
| Rate for Payer: Aetna Commercial |
$3,150.54
|
| Rate for Payer: Aetna Commercial |
$3,393.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,594.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,409.24
|
| Rate for Payer: Cash Price |
$2,965.22
|
| Rate for Payer: Cash Price |
$3,193.49
|
| Rate for Payer: Cofinity Commercial |
$2,594.56
|
| Rate for Payer: Cofinity Commercial |
$3,187.61
|
| Rate for Payer: Cofinity Commercial |
$2,794.30
|
| Rate for Payer: Cofinity Commercial |
$3,433.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,193.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,965.22
|
| Rate for Payer: Healthscope Commercial |
$3,592.67
|
| Rate for Payer: Healthscope Commercial |
$3,335.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,794.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,594.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,993.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,779.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,150.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,393.08
|
| Rate for Payer: PHP Commercial |
$3,150.54
|
| Rate for Payer: PHP Commercial |
$3,393.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,594.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,794.30
|
| Rate for Payer: Priority Health SBD |
$2,335.11
|
| Rate for Payer: Priority Health SBD |
$2,514.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,756.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,630.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,779.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,993.90
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
IP
|
$287.04
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.30 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna American Axle |
$186.58
|
| Rate for Payer: Aetna American Axle |
$2.96
|
| Rate for Payer: Aetna American Axle |
$289.61
|
| Rate for Payer: Aetna American Axle |
$2.90
|
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna American Axle |
$295.78
|
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna American Axle |
$206.24
|
| Rate for Payer: Aetna American Axle |
$291.75
|
| Rate for Payer: Aetna Commercial |
$269.70
|
| Rate for Payer: Aetna Commercial |
$243.98
|
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna Commercial |
$314.92
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Aetna Commercial |
$386.79
|
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cash Price |
$356.44
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cash Price |
$364.04
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cash Price |
$229.63
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Commercial |
$272.88
|
| Rate for Payer: Cofinity Commercial |
$200.93
|
| Rate for Payer: Cofinity Commercial |
$246.85
|
| Rate for Payer: Cofinity Commercial |
$222.11
|
| Rate for Payer: Cofinity Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Cofinity Commercial |
$311.88
|
| Rate for Payer: Cofinity Commercial |
$383.17
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$314.20
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Cofinity Commercial |
$318.54
|
| Rate for Payer: Cofinity Commercial |
$391.34
|
| Rate for Payer: Cofinity Commercial |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$409.54
|
| Rate for Payer: Healthscope Commercial |
$285.57
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$4.10
|
| Rate for Payer: Healthscope Commercial |
$258.34
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$378.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.50
|
| Rate for Payer: PHP Commercial |
$243.98
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Commercial |
$269.70
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: PHP Commercial |
$378.72
|
| Rate for Payer: PHP Commercial |
$386.79
|
| Rate for Payer: PHP Commercial |
$3.88
|
| Rate for Payer: PHP Commercial |
$314.92
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.54
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: Priority Health SBD |
$180.84
|
| Rate for Payer: Priority Health SBD |
$282.78
|
| Rate for Payer: Priority Health SBD |
$2.81
|
| Rate for Payer: Priority Health SBD |
$280.70
|
| Rate for Payer: Priority Health SBD |
$199.90
|
| Rate for Payer: Priority Health SBD |
$286.68
|
| Rate for Payer: Priority Health SBD |
$233.42
|
| Rate for Payer: Priority Health SBD |
$2.87
|
| Rate for Payer: UMR Bronson Commercial |
$139.61
|
| Rate for Payer: UMR Bronson Commercial |
$197.49
|
| Rate for Payer: UMR Bronson Commercial |
$163.02
|
| Rate for Payer: UMR Bronson Commercial |
$1.96
|
| Rate for Payer: UMR Bronson Commercial |
$2.01
|
| Rate for Payer: UMR Bronson Commercial |
$196.04
|
| Rate for Payer: UMR Bronson Commercial |
$176.77
|
| Rate for Payer: UMR Bronson Commercial |
$126.30
|
| Rate for Payer: UMR Bronson Commercial |
$200.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
21374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$178.70 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna American Axle |
$220.90
|
| Rate for Payer: Aetna American Axle |
$343.20
|
| Rate for Payer: Aetna American Axle |
$277.88
|
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna American Axle |
$312.00
|
| Rate for Payer: Aetna American Axle |
$162.40
|
| Rate for Payer: Aetna American Axle |
$3.12
|
| Rate for Payer: Aetna American Axle |
$263.02
|
| Rate for Payer: Aetna Commercial |
$408.00
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Commercial |
$4.08
|
| Rate for Payer: Aetna Commercial |
$448.80
|
| Rate for Payer: Aetna Commercial |
$343.94
|
| Rate for Payer: Aetna Commercial |
$288.86
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Commercial |
$212.37
|
| Rate for Payer: Aetna Commercial |
$363.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$199.88
|
| Rate for Payer: Cash Price |
$271.87
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$323.71
|
| Rate for Payer: Cofinity Commercial |
$138.98
|
| Rate for Payer: Cofinity Commercial |
$283.25
|
| Rate for Payer: Cofinity Commercial |
$299.25
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Cofinity Commercial |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$237.89
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Cofinity Commercial |
$214.87
|
| Rate for Payer: Cofinity Commercial |
$174.90
|
| Rate for Payer: Cofinity Commercial |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$454.08
|
| Rate for Payer: Cofinity Commercial |
$367.65
|
| Rate for Payer: Cofinity Commercial |
$347.99
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.00
|
| Rate for Payer: Healthscope Commercial |
$432.00
|
| Rate for Payer: Healthscope Commercial |
$178.70
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$384.75
|
| Rate for Payer: Healthscope Commercial |
$224.86
|
| Rate for Payer: Healthscope Commercial |
$364.18
|
| Rate for Payer: Healthscope Commercial |
$305.86
|
| Rate for Payer: Healthscope Commercial |
$4.32
|
| Rate for Payer: Healthscope Commercial |
$475.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.94
|
| Rate for Payer: PHP Commercial |
$288.86
|
| Rate for Payer: PHP Commercial |
$448.80
|
| Rate for Payer: PHP Commercial |
$408.00
|
| Rate for Payer: PHP Commercial |
$343.94
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Commercial |
$363.38
|
| Rate for Payer: PHP Commercial |
$4.08
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: PHP Commercial |
$212.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health SBD |
$214.10
|
| Rate for Payer: Priority Health SBD |
$269.32
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: Priority Health SBD |
$254.92
|
| Rate for Payer: Priority Health SBD |
$3.02
|
| Rate for Payer: Priority Health SBD |
$157.41
|
| Rate for Payer: Priority Health SBD |
$302.40
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: Priority Health SBD |
$332.64
|
| Rate for Payer: UMR Bronson Commercial |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: UMR Bronson Commercial |
$87.36
|
| Rate for Payer: UMR Bronson Commercial |
$109.93
|
| Rate for Payer: UMR Bronson Commercial |
$211.20
|
| Rate for Payer: UMR Bronson Commercial |
$188.10
|
| Rate for Payer: UMR Bronson Commercial |
$178.04
|
| Rate for Payer: UMR Bronson Commercial |
$232.32
|
| Rate for Payer: UMR Bronson Commercial |
$149.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.00
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,329.78
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
38062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$585.10 |
| Max. Negotiated Rate |
$1,196.80 |
| Rate for Payer: Aetna American Axle |
$864.36
|
| Rate for Payer: Aetna American Axle |
$9.12
|
| Rate for Payer: Aetna American Axle |
$315.28
|
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna American Axle |
$911.50
|
| Rate for Payer: Aetna American Axle |
$1,768.25
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Commercial |
$1,130.31
|
| Rate for Payer: Aetna Commercial |
$1,191.96
|
| Rate for Payer: Aetna Commercial |
$2,312.33
|
| Rate for Payer: Aetna Commercial |
$412.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,768.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.36
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$2,176.31
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cash Price |
$388.03
|
| Rate for Payer: Cofinity Commercial |
$1,143.61
|
| Rate for Payer: Cofinity Commercial |
$930.85
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Cofinity Commercial |
$981.61
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$1,904.27
|
| Rate for Payer: Cofinity Commercial |
$2,339.54
|
| Rate for Payer: Cofinity Commercial |
$197.90
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$417.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,176.31
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Healthscope Commercial |
$436.54
|
| Rate for Payer: Healthscope Commercial |
$1,196.80
|
| Rate for Payer: Healthscope Commercial |
$1,262.07
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Healthscope Commercial |
$2,448.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,904.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$981.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,040.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,051.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,191.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,312.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,130.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$412.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.31
|
| Rate for Payer: PHP Commercial |
$1,130.31
|
| Rate for Payer: PHP Commercial |
$1,191.96
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$2,312.33
|
| Rate for Payer: PHP Commercial |
$412.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$930.85
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: Priority Health SBD |
$1,713.85
|
| Rate for Payer: Priority Health SBD |
$305.58
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: Priority Health SBD |
$837.76
|
| Rate for Payer: Priority Health SBD |
$883.45
|
| Rate for Payer: UMR Bronson Commercial |
$124.40
|
| Rate for Payer: UMR Bronson Commercial |
$6.17
|
| Rate for Payer: UMR Bronson Commercial |
$585.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,196.97
|
| Rate for Payer: UMR Bronson Commercial |
$617.01
|
| Rate for Payer: UMR Bronson Commercial |
$213.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,051.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,040.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$59,470.29
|
|
|
Service Code
|
MS-DRG 827
|
| Min. Negotiated Rate |
$17,450.34 |
| Max. Negotiated Rate |
$59,470.29 |
| Rate for Payer: Aetna Medicare |
$19,103.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,960.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,960.98
|
| Rate for Payer: BCBS MAPPO |
$18,368.78
|
| Rate for Payer: BCBS Trust/PPO |
$59,470.29
|
| Rate for Payer: BCN Medicare Advantage |
$18,368.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,368.78
|
| Rate for Payer: Mclaren Medicare |
$18,368.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,287.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,124.10
|
| Rate for Payer: PACE Medicare |
$17,450.34
|
| Rate for Payer: PACE SWMI |
$18,368.78
|
| Rate for Payer: PHP Medicare Advantage |
$18,368.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,251.63
|
| Rate for Payer: Priority Health Medicare |
$18,368.78
|
| Rate for Payer: Priority Health Narrow Network |
$26,601.30
|
| Rate for Payer: Railroad Medicare Medicare |
$18,368.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,346.57
|
| Rate for Payer: UHC Core |
$28,983.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,368.78
|
| Rate for Payer: UHC Exchange |
$23,042.24
|
| Rate for Payer: UHC Medicare Advantage |
$18,919.84
|
| Rate for Payer: VA VA |
$18,368.78
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$66,946.76
|
|
|
Service Code
|
MS-DRG 826
|
| Min. Negotiated Rate |
$34,364.88 |
| Max. Negotiated Rate |
$66,946.76 |
| Rate for Payer: Aetna Medicare |
$37,620.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,216.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,216.95
|
| Rate for Payer: BCBS MAPPO |
$36,173.56
|
| Rate for Payer: BCBS Trust/PPO |
$60,035.69
|
| Rate for Payer: BCN Medicare Advantage |
$36,173.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,173.56
|
| Rate for Payer: Mclaren Medicare |
$36,173.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,982.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,599.59
|
| Rate for Payer: PACE Medicare |
$34,364.88
|
| Rate for Payer: PACE SWMI |
$36,173.56
|
| Rate for Payer: PHP Medicare Advantage |
$36,173.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62,978.93
|
| Rate for Payer: Priority Health Medicare |
$36,173.56
|
| Rate for Payer: Priority Health Narrow Network |
$50,383.14
|
| Rate for Payer: Railroad Medicare Medicare |
$36,173.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66,946.76
|
| Rate for Payer: UHC Core |
$54,895.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$36,173.56
|
| Rate for Payer: UHC Exchange |
$43,642.23
|
| Rate for Payer: UHC Medicare Advantage |
$37,258.77
|
| Rate for Payer: VA VA |
$36,173.56
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$40,844.68
|
|
|
Service Code
|
MS-DRG 828
|
| Min. Negotiated Rate |
$12,495.66 |
| Max. Negotiated Rate |
$40,844.68 |
| Rate for Payer: Aetna Medicare |
$13,679.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,441.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,441.66
|
| Rate for Payer: BCBS MAPPO |
$13,153.33
|
| Rate for Payer: BCBS Trust/PPO |
$40,844.68
|
| Rate for Payer: BCN Medicare Advantage |
$13,153.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,153.33
|
| Rate for Payer: Mclaren Medicare |
$13,153.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,811.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,126.33
|
| Rate for Payer: PACE Medicare |
$12,495.66
|
| Rate for Payer: PACE SWMI |
$13,153.33
|
| Rate for Payer: PHP Medicare Advantage |
$13,153.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,539.61
|
| Rate for Payer: Priority Health Medicare |
$13,153.33
|
| Rate for Payer: Priority Health Narrow Network |
$18,831.69
|
| Rate for Payer: Railroad Medicare Medicare |
$13,153.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,022.66
|
| Rate for Payer: UHC Core |
$20,518.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,153.33
|
| Rate for Payer: UHC Exchange |
$16,312.14
|
| Rate for Payer: UHC Medicare Advantage |
$13,547.93
|
| Rate for Payer: VA VA |
$13,153.33
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$81,586.32
|
|
|
Service Code
|
MS-DRG 829
|
| Min. Negotiated Rate |
$23,574.86 |
| Max. Negotiated Rate |
$81,586.32 |
| Rate for Payer: Aetna Medicare |
$25,808.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,019.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,019.55
|
| Rate for Payer: BCBS MAPPO |
$24,815.64
|
| Rate for Payer: BCBS Trust/PPO |
$81,586.32
|
| Rate for Payer: BCN Medicare Advantage |
$24,815.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,815.64
|
| Rate for Payer: Mclaren Medicare |
$24,815.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,056.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,537.99
|
| Rate for Payer: PACE Medicare |
$23,574.86
|
| Rate for Payer: PACE SWMI |
$24,815.64
|
| Rate for Payer: PHP Medicare Advantage |
$24,815.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45,256.78
|
| Rate for Payer: Priority Health Medicare |
$24,815.64
|
| Rate for Payer: Priority Health Narrow Network |
$36,205.42
|
| Rate for Payer: Railroad Medicare Medicare |
$24,815.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48,108.07
|
| Rate for Payer: UHC Core |
$39,447.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,815.64
|
| Rate for Payer: UHC Exchange |
$31,361.39
|
| Rate for Payer: UHC Medicare Advantage |
$25,560.11
|
| Rate for Payer: VA VA |
$24,815.64
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,119.62
|
|
|
Service Code
|
MS-DRG 830
|
| Min. Negotiated Rate |
$12,062.28 |
| Max. Negotiated Rate |
$24,119.62 |
| Rate for Payer: Aetna Medicare |
$13,205.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,871.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,871.42
|
| Rate for Payer: BCBS MAPPO |
$12,697.14
|
| Rate for Payer: BCBS Trust/PPO |
$22,354.76
|
| Rate for Payer: BCN Medicare Advantage |
$12,697.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,697.14
|
| Rate for Payer: Mclaren Medicare |
$12,697.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,332.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,601.71
|
| Rate for Payer: PACE Medicare |
$12,062.28
|
| Rate for Payer: PACE SWMI |
$12,697.14
|
| Rate for Payer: PHP Medicare Advantage |
$12,697.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,690.09
|
| Rate for Payer: Priority Health Medicare |
$12,697.14
|
| Rate for Payer: Priority Health Narrow Network |
$18,152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$12,697.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,119.62
|
| Rate for Payer: UHC Core |
$19,777.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,697.14
|
| Rate for Payer: UHC Exchange |
$15,723.45
|
| Rate for Payer: UHC Medicare Advantage |
$13,078.05
|
| Rate for Payer: VA VA |
$12,697.14
|
|
|
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS; VAGINAL APPROACH
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 58145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$563.86 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.25
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$563.86
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAMURAL MYOMAS WITH TOTAL WEIGHT GREATER THAN 250 G, ABDOMINAL APPROACH
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 58146
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,137.86 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$3,950.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,251.65
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Exchange |
$1,137.86
|
|
|
MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 69620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$490.18 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,616.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.20
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$490.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 69420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.76 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$225.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.40
|
| Rate for Payer: BCBS Complete |
$124.71
|
| Rate for Payer: BCBS MAPPO |
$217.12
|
| Rate for Payer: BCBS Trust/PPO |
$120.81
|
| Rate for Payer: BCN Medicare Advantage |
$217.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.12
|
| Rate for Payer: Mclaren Medicaid |
$118.76
|
| Rate for Payer: Mclaren Medicare |
$217.12
|
| Rate for Payer: Meridian Medicaid |
$124.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.69
|
| Rate for Payer: PACE Medicare |
$206.26
|
| Rate for Payer: PACE SWMI |
$217.12
|
| Rate for Payer: PHP Medicare Advantage |
$217.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.51
|
| Rate for Payer: Priority Health Medicare |
$217.12
|
| Rate for Payer: Priority Health Narrow Network |
$546.81
|
| Rate for Payer: Railroad Medicare Medicare |
$217.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.12
|
| Rate for Payer: UHC Exchange |
$119.84
|
| Rate for Payer: UHC Medicare Advantage |
$223.63
|
| Rate for Payer: VA VA |
$217.12
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,396.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.33
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$150.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$194.75
|
|
|
Service Code
|
NDC 69097-868-07
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.54
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.32
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UMR Bronson Commercial |
$85.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
NDC 76385-134-01
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna American Axle |
$285.64
|
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.53
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.62
|
| Rate for Payer: Priority Health SBD |
$276.85
|
| Rate for Payer: UMR Bronson Commercial |
$193.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.59
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$1,189.55
|
|
|
Service Code
|
NDC 0904-7071-61
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$523.40 |
| Max. Negotiated Rate |
$1,070.60 |
| Rate for Payer: Aetna American Axle |
$773.21
|
| Rate for Payer: Aetna Commercial |
$1,011.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.21
|
| Rate for Payer: Cash Price |
$951.64
|
| Rate for Payer: Cofinity Commercial |
$1,023.01
|
| Rate for Payer: Cofinity Commercial |
$832.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$951.64
|
| Rate for Payer: Healthscope Commercial |
$1,070.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$832.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$892.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,011.12
|
| Rate for Payer: PHP Commercial |
$1,011.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.68
|
| Rate for Payer: Priority Health SBD |
$749.42
|
| Rate for Payer: UMR Bronson Commercial |
$523.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$892.16
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$2,077.92
|
|
|
Service Code
|
NDC 51079-813-20
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$914.28 |
| Max. Negotiated Rate |
$1,870.13 |
| Rate for Payer: Aetna American Axle |
$1,350.65
|
| Rate for Payer: Aetna Commercial |
$1,766.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,350.65
|
| Rate for Payer: Cash Price |
$1,662.34
|
| Rate for Payer: Cofinity Commercial |
$1,454.54
|
| Rate for Payer: Cofinity Commercial |
$1,787.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,662.34
|
| Rate for Payer: Healthscope Commercial |
$1,870.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,454.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,558.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,766.23
|
| Rate for Payer: PHP Commercial |
$1,766.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,454.54
|
| Rate for Payer: Priority Health SBD |
$1,309.09
|
| Rate for Payer: UMR Bronson Commercial |
$914.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,558.44
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$20.78
|
|
|
Service Code
|
NDC 51079-813-01
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Aetna American Axle |
$13.51
|
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.66
|
| Rate for Payer: PHP Commercial |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: UMR Bronson Commercial |
$9.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.58
|
|
