|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
|
IP
|
$31,574.59
|
|
|
Service Code
|
MS-DRG 620
|
| Min. Negotiated Rate |
$12,362.44 |
| Max. Negotiated Rate |
$31,574.59 |
| Rate for Payer: Aetna Medicare |
$13,533.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,266.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,266.36
|
| Rate for Payer: BCBS MAPPO |
$13,013.09
|
| Rate for Payer: BCBS Trust/PPO |
$31,574.59
|
| Rate for Payer: BCN Medicare Advantage |
$13,013.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,013.09
|
| Rate for Payer: Mclaren Medicare |
$13,013.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,663.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,965.05
|
| Rate for Payer: PACE Medicare |
$12,362.44
|
| Rate for Payer: PACE SWMI |
$13,013.09
|
| Rate for Payer: PHP Medicare Advantage |
$13,013.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,278.44
|
| Rate for Payer: Priority Health Medicare |
$13,013.09
|
| Rate for Payer: Priority Health Narrow Network |
$18,622.75
|
| Rate for Payer: Railroad Medicare Medicare |
$13,013.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,745.04
|
| Rate for Payer: UHC Core |
$20,290.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,013.09
|
| Rate for Payer: UHC Exchange |
$16,131.16
|
| Rate for Payer: UHC Medicare Advantage |
$13,403.48
|
| Rate for Payer: VA VA |
$13,013.09
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$43,754.61
|
|
|
Service Code
|
MS-DRG 619
|
| Min. Negotiated Rate |
$19,538.94 |
| Max. Negotiated Rate |
$43,754.61 |
| Rate for Payer: Aetna Medicare |
$21,390.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,709.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,709.14
|
| Rate for Payer: BCBS MAPPO |
$20,567.31
|
| Rate for Payer: BCBS Trust/PPO |
$43,754.61
|
| Rate for Payer: BCN Medicare Advantage |
$20,567.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,567.31
|
| Rate for Payer: Mclaren Medicare |
$20,567.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,595.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,652.41
|
| Rate for Payer: PACE Medicare |
$19,538.94
|
| Rate for Payer: PACE SWMI |
$20,567.31
|
| Rate for Payer: PHP Medicare Advantage |
$20,567.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,144.77
|
| Rate for Payer: Priority Health Medicare |
$20,567.31
|
| Rate for Payer: Priority Health Narrow Network |
$29,715.82
|
| Rate for Payer: Railroad Medicare Medicare |
$20,567.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,484.98
|
| Rate for Payer: UHC Core |
$32,376.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,567.31
|
| Rate for Payer: UHC Exchange |
$25,740.04
|
| Rate for Payer: UHC Medicare Advantage |
$21,184.33
|
| Rate for Payer: VA VA |
$20,567.31
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
|
IP
|
$28,727.47
|
|
|
Service Code
|
MS-DRG 621
|
| Min. Negotiated Rate |
$11,594.48 |
| Max. Negotiated Rate |
$28,727.47 |
| Rate for Payer: Aetna Medicare |
$12,692.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,255.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,255.90
|
| Rate for Payer: BCBS MAPPO |
$12,204.72
|
| Rate for Payer: BCBS Trust/PPO |
$28,727.47
|
| Rate for Payer: BCN Medicare Advantage |
$12,204.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,204.72
|
| Rate for Payer: Mclaren Medicare |
$12,204.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,814.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,035.43
|
| Rate for Payer: PACE Medicare |
$11,594.48
|
| Rate for Payer: PACE SWMI |
$12,204.72
|
| Rate for Payer: PHP Medicare Advantage |
$12,204.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,773.13
|
| Rate for Payer: Priority Health Medicare |
$12,204.72
|
| Rate for Payer: Priority Health Narrow Network |
$17,418.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12,204.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,144.89
|
| Rate for Payer: UHC Core |
$18,978.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,204.72
|
| Rate for Payer: UHC Exchange |
$15,088.03
|
| Rate for Payer: UHC Medicare Advantage |
$12,570.86
|
| Rate for Payer: VA VA |
$12,204.72
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$41,332.18
|
|
|
Service Code
|
MS-DRG 940
|
| Min. Negotiated Rate |
$16,347.84 |
| Max. Negotiated Rate |
$41,332.18 |
| Rate for Payer: Aetna Medicare |
$17,896.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,510.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,510.31
|
| Rate for Payer: BCBS MAPPO |
$17,208.25
|
| Rate for Payer: BCBS Trust/PPO |
$41,332.18
|
| Rate for Payer: BCN Medicare Advantage |
$17,208.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,208.25
|
| Rate for Payer: Mclaren Medicare |
$17,208.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,068.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,789.49
|
| Rate for Payer: PACE Medicare |
$16,347.84
|
| Rate for Payer: PACE SWMI |
$17,208.25
|
| Rate for Payer: PHP Medicare Advantage |
$17,208.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,090.54
|
| Rate for Payer: Priority Health Medicare |
$17,208.25
|
| Rate for Payer: Priority Health Narrow Network |
$24,872.43
|
| Rate for Payer: Railroad Medicare Medicare |
$17,208.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,049.32
|
| Rate for Payer: UHC Core |
$27,099.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,208.25
|
| Rate for Payer: UHC Exchange |
$21,544.67
|
| Rate for Payer: UHC Medicare Advantage |
$17,724.50
|
| Rate for Payer: VA VA |
$17,208.25
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
|
IP
|
$61,337.38
|
|
|
Service Code
|
MS-DRG 939
|
| Min. Negotiated Rate |
$24,025.08 |
| Max. Negotiated Rate |
$61,337.38 |
| Rate for Payer: Aetna Medicare |
$26,301.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,611.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,611.95
|
| Rate for Payer: BCBS MAPPO |
$25,289.56
|
| Rate for Payer: BCBS Trust/PPO |
$61,337.38
|
| Rate for Payer: BCN Medicare Advantage |
$25,289.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,289.56
|
| Rate for Payer: Mclaren Medicare |
$25,289.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,554.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,082.99
|
| Rate for Payer: PACE Medicare |
$24,025.08
|
| Rate for Payer: PACE SWMI |
$25,289.56
|
| Rate for Payer: PHP Medicare Advantage |
$25,289.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,139.30
|
| Rate for Payer: Priority Health Medicare |
$25,289.56
|
| Rate for Payer: Priority Health Narrow Network |
$36,911.44
|
| Rate for Payer: Railroad Medicare Medicare |
$25,289.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,046.19
|
| Rate for Payer: UHC Core |
$40,216.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,289.56
|
| Rate for Payer: UHC Exchange |
$31,972.94
|
| Rate for Payer: UHC Medicare Advantage |
$26,048.25
|
| Rate for Payer: VA VA |
$25,289.56
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,662.94
|
|
|
Service Code
|
MS-DRG 941
|
| Min. Negotiated Rate |
$14,074.01 |
| Max. Negotiated Rate |
$34,662.94 |
| Rate for Payer: Aetna Medicare |
$15,407.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,518.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,518.44
|
| Rate for Payer: BCBS MAPPO |
$14,814.75
|
| Rate for Payer: BCBS Trust/PPO |
$34,662.94
|
| Rate for Payer: BCN Medicare Advantage |
$14,814.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,814.75
|
| Rate for Payer: Mclaren Medicare |
$14,814.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,555.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,036.96
|
| Rate for Payer: PACE Medicare |
$14,074.01
|
| Rate for Payer: PACE SWMI |
$14,814.75
|
| Rate for Payer: PHP Medicare Advantage |
$14,814.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,633.45
|
| Rate for Payer: Priority Health Medicare |
$14,814.75
|
| Rate for Payer: Priority Health Narrow Network |
$21,306.76
|
| Rate for Payer: Railroad Medicare Medicare |
$14,814.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,311.42
|
| Rate for Payer: UHC Core |
$23,214.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,814.75
|
| Rate for Payer: UHC Exchange |
$18,456.06
|
| Rate for Payer: UHC Medicare Advantage |
$15,259.19
|
| Rate for Payer: VA VA |
$14,814.75
|
|
|
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS
|
Facility
|
IP
|
$56,920.30
|
|
|
Service Code
|
MS-DRG 876
|
| Min. Negotiated Rate |
$27,804.05 |
| Max. Negotiated Rate |
$56,920.30 |
| Rate for Payer: Aetna Medicare |
$30,438.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,584.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,584.28
|
| Rate for Payer: BCBS MAPPO |
$29,267.42
|
| Rate for Payer: BCBS Trust/PPO |
$49,918.76
|
| Rate for Payer: BCN Medicare Advantage |
$29,267.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,267.42
|
| Rate for Payer: Mclaren Medicare |
$29,267.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,730.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,657.53
|
| Rate for Payer: PACE Medicare |
$27,804.05
|
| Rate for Payer: PACE SWMI |
$29,267.42
|
| Rate for Payer: PHP Medicare Advantage |
$29,267.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53,546.73
|
| Rate for Payer: Priority Health Medicare |
$29,267.42
|
| Rate for Payer: Priority Health Narrow Network |
$42,837.38
|
| Rate for Payer: Railroad Medicare Medicare |
$29,267.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56,920.30
|
| Rate for Payer: UHC Core |
$46,673.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$29,267.42
|
| Rate for Payer: UHC Exchange |
$37,106.04
|
| Rate for Payer: UHC Medicare Advantage |
$30,145.44
|
| Rate for Payer: VA VA |
$29,267.42
|
|
|
ORTHODONTIC WAX
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 9900-0005-66
|
| Hospital Charge Code |
168918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
ORTHOVISC INJ PER DOSE
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS J7324
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$134.56 |
| Rate for Payer: Aetna Commercial |
$134.56
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS Trust/PPO |
$133.10
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
| Rate for Payer: UMR Bronson Commercial |
$85.10
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$207.39
|
|
|
Service Code
|
NDC 70710-1008-2
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.25 |
| Max. Negotiated Rate |
$186.65 |
| Rate for Payer: Aetna American Axle |
$134.80
|
| Rate for Payer: Aetna Commercial |
$176.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.80
|
| Rate for Payer: Cash Price |
$165.91
|
| Rate for Payer: Cofinity Commercial |
$145.17
|
| Rate for Payer: Cofinity Commercial |
$178.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.91
|
| Rate for Payer: Healthscope Commercial |
$186.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.28
|
| Rate for Payer: PHP Commercial |
$176.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.17
|
| Rate for Payer: Priority Health SBD |
$130.66
|
| Rate for Payer: UMR Bronson Commercial |
$91.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.54
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$273.73
|
|
|
Service Code
|
NDC 69238-1264-1
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$246.36 |
| Rate for Payer: Aetna American Axle |
$177.92
|
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.92
|
| Rate for Payer: Cash Price |
$218.98
|
| Rate for Payer: Cofinity Commercial |
$191.61
|
| Rate for Payer: Cofinity Commercial |
$235.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.98
|
| Rate for Payer: Healthscope Commercial |
$246.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.67
|
| Rate for Payer: PHP Commercial |
$232.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.61
|
| Rate for Payer: Priority Health SBD |
$172.45
|
| Rate for Payer: UMR Bronson Commercial |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.30
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$479.49
|
|
|
Service Code
|
NDC 0004-0802-85
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.98 |
| Max. Negotiated Rate |
$431.54 |
| Rate for Payer: Aetna American Axle |
$311.67
|
| Rate for Payer: Aetna Commercial |
$407.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.67
|
| Rate for Payer: Cash Price |
$383.59
|
| Rate for Payer: Cofinity Commercial |
$335.64
|
| Rate for Payer: Cofinity Commercial |
$412.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.59
|
| Rate for Payer: Healthscope Commercial |
$431.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.57
|
| Rate for Payer: PHP Commercial |
$407.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.64
|
| Rate for Payer: Priority Health SBD |
$302.08
|
| Rate for Payer: UMR Bronson Commercial |
$210.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.62
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 47781-468-13
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.70 |
| Max. Negotiated Rate |
$289.84 |
| Rate for Payer: Aetna American Axle |
$209.33
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.74
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.44
|
| Rate for Payer: Priority Health SBD |
$202.89
|
| Rate for Payer: UMR Bronson Commercial |
$141.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$38.74
|
|
|
Service Code
|
NDC 68180-675-11
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$34.87 |
| Rate for Payer: Aetna American Axle |
$25.18
|
| Rate for Payer: Aetna Commercial |
$32.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.18
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$33.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.99
|
| Rate for Payer: Healthscope Commercial |
$34.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.93
|
| Rate for Payer: PHP Commercial |
$32.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.12
|
| Rate for Payer: Priority Health SBD |
$24.41
|
| Rate for Payer: UMR Bronson Commercial |
$17.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.06
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$522.59
|
|
|
Service Code
|
NDC 0004-0822-05
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.94 |
| Max. Negotiated Rate |
$470.33 |
| Rate for Payer: Aetna American Axle |
$339.68
|
| Rate for Payer: Aetna Commercial |
$444.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.68
|
| Rate for Payer: Cash Price |
$418.07
|
| Rate for Payer: Cofinity Commercial |
$365.81
|
| Rate for Payer: Cofinity Commercial |
$449.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.07
|
| Rate for Payer: Healthscope Commercial |
$470.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$444.20
|
| Rate for Payer: PHP Commercial |
$444.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.81
|
| Rate for Payer: Priority Health SBD |
$329.23
|
| Rate for Payer: UMR Bronson Commercial |
$229.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.94
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$447.56
|
|
|
Service Code
|
NDC 47781-384-26
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.93 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna American Axle |
$290.91
|
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.91
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cofinity Commercial |
$313.29
|
| Rate for Payer: Cofinity Commercial |
$384.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.05
|
| Rate for Payer: Healthscope Commercial |
$402.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.43
|
| Rate for Payer: PHP Commercial |
$380.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.29
|
| Rate for Payer: Priority Health SBD |
$281.96
|
| Rate for Payer: UMR Bronson Commercial |
$196.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.67
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 68180-678-01
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: UMR Bronson Commercial |
$100.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$963.48
|
|
|
Service Code
|
NDC 68094-050-61
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$423.93 |
| Max. Negotiated Rate |
$867.13 |
| Rate for Payer: Aetna American Axle |
$626.26
|
| Rate for Payer: Aetna Commercial |
$818.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.26
|
| Rate for Payer: Cash Price |
$770.78
|
| Rate for Payer: Cofinity Commercial |
$674.44
|
| Rate for Payer: Cofinity Commercial |
$828.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.78
|
| Rate for Payer: Healthscope Commercial |
$867.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$674.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$818.96
|
| Rate for Payer: PHP Commercial |
$818.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.44
|
| Rate for Payer: Priority Health SBD |
$606.99
|
| Rate for Payer: UMR Bronson Commercial |
$423.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.61
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$52.42
|
|
|
Service Code
|
NDC 68180-677-11
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$47.18 |
| Rate for Payer: Aetna American Axle |
$34.07
|
| Rate for Payer: Aetna Commercial |
$44.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.07
|
| Rate for Payer: Cash Price |
$41.94
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Cofinity Commercial |
$45.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.94
|
| Rate for Payer: Healthscope Commercial |
$47.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.56
|
| Rate for Payer: PHP Commercial |
$44.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.69
|
| Rate for Payer: Priority Health SBD |
$33.02
|
| Rate for Payer: UMR Bronson Commercial |
$23.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.32
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$276.21
|
|
|
Service Code
|
NDC 70710-1010-2
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.53 |
| Max. Negotiated Rate |
$248.59 |
| Rate for Payer: Aetna American Axle |
$179.54
|
| Rate for Payer: Aetna Commercial |
$234.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.54
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Cofinity Commercial |
$193.35
|
| Rate for Payer: Cofinity Commercial |
$237.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.97
|
| Rate for Payer: Healthscope Commercial |
$248.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.78
|
| Rate for Payer: PHP Commercial |
$234.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.35
|
| Rate for Payer: Priority Health SBD |
$174.01
|
| Rate for Payer: UMR Bronson Commercial |
$121.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.16
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$298.37
|
|
|
Service Code
|
NDC 60219-1266-1
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.28 |
| Max. Negotiated Rate |
$268.53 |
| Rate for Payer: Aetna American Axle |
$193.94
|
| Rate for Payer: Aetna Commercial |
$253.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.94
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cofinity Commercial |
$208.86
|
| Rate for Payer: Cofinity Commercial |
$256.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.70
|
| Rate for Payer: Healthscope Commercial |
$268.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.61
|
| Rate for Payer: PHP Commercial |
$253.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.86
|
| Rate for Payer: Priority Health SBD |
$187.97
|
| Rate for Payer: UMR Bronson Commercial |
$131.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.78
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$522.63
|
|
|
Service Code
|
NDC 0004-0800-85
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.96 |
| Max. Negotiated Rate |
$470.37 |
| Rate for Payer: Aetna American Axle |
$339.71
|
| Rate for Payer: Aetna Commercial |
$444.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.71
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$365.84
|
| Rate for Payer: Cofinity Commercial |
$449.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$470.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$444.24
|
| Rate for Payer: PHP Commercial |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.84
|
| Rate for Payer: Priority Health SBD |
$329.26
|
| Rate for Payer: UMR Bronson Commercial |
$229.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.97
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$275.25
|
|
|
Service Code
|
NDC 62332-415-10
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.11 |
| Max. Negotiated Rate |
$247.72 |
| Rate for Payer: Aetna American Axle |
$178.91
|
| Rate for Payer: Aetna Commercial |
$233.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.91
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cofinity Commercial |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.20
|
| Rate for Payer: Healthscope Commercial |
$247.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.96
|
| Rate for Payer: PHP Commercial |
$233.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.68
|
| Rate for Payer: Priority Health SBD |
$173.41
|
| Rate for Payer: UMR Bronson Commercial |
$121.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.44
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$9.64
|
|
|
Service Code
|
NDC 68094-050-59
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna American Axle |
$6.27
|
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.27
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Cofinity Commercial |
$6.75
|
| Rate for Payer: Cofinity Commercial |
$8.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.71
|
| Rate for Payer: Healthscope Commercial |
$8.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.19
|
| Rate for Payer: PHP Commercial |
$8.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health SBD |
$6.07
|
| Rate for Payer: UMR Bronson Commercial |
$4.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.23
|
|
|
OSTECTOMY, CALCANEUS;
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$419.78 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.76
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$419.78
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
