|
HYPERTENSION
|
Facility
|
IP
|
$11,679.75
|
|
|
Service Code
|
APR-DRG 1994
|
| Min. Negotiated Rate |
$11,123.57 |
| Max. Negotiated Rate |
$11,679.75 |
| Rate for Payer: BCBS Complete |
$11,679.75
|
| Rate for Payer: Mclaren Medicaid |
$11,123.57
|
| Rate for Payer: Meridian Medicaid |
$11,679.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,123.57
|
| Rate for Payer: UHC Medicaid |
$11,123.57
|
| Rate for Payer: UHCCP Medicaid |
$11,123.57
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$4,922.50
|
|
|
Service Code
|
APR-DRG 1992
|
| Min. Negotiated Rate |
$4,688.10 |
| Max. Negotiated Rate |
$4,922.50 |
| Rate for Payer: BCBS Complete |
$4,922.50
|
| Rate for Payer: Mclaren Medicaid |
$4,688.10
|
| Rate for Payer: Meridian Medicaid |
$4,922.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,688.10
|
| Rate for Payer: UHC Medicaid |
$4,688.10
|
| Rate for Payer: UHCCP Medicaid |
$4,688.10
|
|
|
HYPERTENSION WITH MCC
|
Facility
|
IP
|
$30,561.20
|
|
|
Service Code
|
MSDRG 304
|
| Min. Negotiated Rate |
$10,017.35 |
| Max. Negotiated Rate |
$30,561.20 |
| Rate for Payer: Aetna Medicare |
$10,966.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,180.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,180.73
|
| Rate for Payer: BCBS MAPPO |
$10,544.58
|
| Rate for Payer: BCBS Trust/PPO |
$30,561.20
|
| Rate for Payer: BCN Commercial |
$30,561.20
|
| Rate for Payer: BCN Medicare Advantage |
$10,544.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,544.58
|
| Rate for Payer: Mclaren Medicare |
$10,544.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,071.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,126.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,599.04
|
| Rate for Payer: Nomi Health Commercial |
$15,351.00
|
| Rate for Payer: PACE Medicare |
$10,017.35
|
| Rate for Payer: PACE SWMI |
$10,544.58
|
| Rate for Payer: PHP Medicare Advantage |
$10,544.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,185.35
|
| Rate for Payer: Priority Health Medicare |
$10,544.58
|
| Rate for Payer: Priority Health Tiered Network |
$15,348.27
|
| Rate for Payer: Railroad Medicare Medicare |
$10,544.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,397.00
|
| Rate for Payer: UHC Core |
$16,228.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,544.58
|
| Rate for Payer: UHC Exchange |
$13,253.03
|
| Rate for Payer: VA VA |
$10,544.58
|
|
|
HYPERTENSION WITHOUT MCC
|
Facility
|
IP
|
$15,899.62
|
|
|
Service Code
|
MSDRG 305
|
| Min. Negotiated Rate |
$6,562.25 |
| Max. Negotiated Rate |
$15,899.62 |
| Rate for Payer: Aetna Medicare |
$7,183.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,634.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,634.54
|
| Rate for Payer: BCBS MAPPO |
$6,907.63
|
| Rate for Payer: BCBS Trust/PPO |
$15,899.62
|
| Rate for Payer: BCN Commercial |
$15,899.62
|
| Rate for Payer: BCN Medicare Advantage |
$6,907.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,907.63
|
| Rate for Payer: Mclaren Medicare |
$6,907.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,253.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,943.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,598.39
|
| Rate for Payer: Nomi Health Commercial |
$9,740.79
|
| Rate for Payer: PACE Medicare |
$6,562.25
|
| Rate for Payer: PACE SWMI |
$6,907.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,907.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,173.83
|
| Rate for Payer: Priority Health Medicare |
$6,907.63
|
| Rate for Payer: Priority Health Tiered Network |
$9,739.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6,907.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,308.13
|
| Rate for Payer: UHC Core |
$10,297.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,907.63
|
| Rate for Payer: UHC Exchange |
$8,409.55
|
| Rate for Payer: VA VA |
$6,907.63
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$3,220.93
|
|
|
Service Code
|
APR-DRG 4222
|
| Min. Negotiated Rate |
$3,067.56 |
| Max. Negotiated Rate |
$3,220.93 |
| Rate for Payer: BCBS Complete |
$3,220.93
|
| Rate for Payer: Mclaren Medicaid |
$3,067.56
|
| Rate for Payer: Meridian Medicaid |
$3,220.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,067.56
|
| Rate for Payer: UHC Medicaid |
$3,067.56
|
| Rate for Payer: UHCCP Medicaid |
$3,067.56
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$2,398.30
|
|
|
Service Code
|
APR-DRG 4221
|
| Min. Negotiated Rate |
$2,284.09 |
| Max. Negotiated Rate |
$2,398.30 |
| Rate for Payer: BCBS Complete |
$2,398.30
|
| Rate for Payer: Mclaren Medicaid |
$2,284.09
|
| Rate for Payer: Meridian Medicaid |
$2,398.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,284.09
|
| Rate for Payer: UHC Medicaid |
$2,284.09
|
| Rate for Payer: UHCCP Medicaid |
$2,284.09
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$4,500.59
|
|
|
Service Code
|
APR-DRG 4223
|
| Min. Negotiated Rate |
$4,286.28 |
| Max. Negotiated Rate |
$4,500.59 |
| Rate for Payer: BCBS Complete |
$4,500.59
|
| Rate for Payer: Mclaren Medicaid |
$4,286.28
|
| Rate for Payer: Meridian Medicaid |
$4,500.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,286.28
|
| Rate for Payer: UHC Medicaid |
$4,286.28
|
| Rate for Payer: UHCCP Medicaid |
$4,286.28
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$8,906.75
|
|
|
Service Code
|
APR-DRG 4224
|
| Min. Negotiated Rate |
$8,482.62 |
| Max. Negotiated Rate |
$8,906.75 |
| Rate for Payer: BCBS Complete |
$8,906.75
|
| Rate for Payer: Mclaren Medicaid |
$8,482.62
|
| Rate for Payer: Meridian Medicaid |
$8,906.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,482.62
|
| Rate for Payer: UHC Medicaid |
$8,482.62
|
| Rate for Payer: UHCCP Medicaid |
$8,482.62
|
|
|
HYPROMELLOSE 2.5 % EYE DROPS
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
NDC 59390018213
|
| Hospital Charge Code |
38092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.17
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.88
|
| Rate for Payer: UHC Core |
$11.93
|
| Rate for Payer: UHC Exchange |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
HYPROMELLOSE 2.5 % EYE DROPS
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
NDC 59390018213
|
| Hospital Charge Code |
38092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.17
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
HYPROMELLOSE 2.5 % EYE DROPS
|
Facility
|
IP
|
$88.05
|
|
|
Service Code
|
NDC 17478006412
|
| Hospital Charge Code |
38092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$79.25 |
| Rate for Payer: Aetna American Axle |
$57.23
|
| Rate for Payer: Aetna Commercial |
$74.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.23
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cofinity Advantage |
$61.63
|
| Rate for Payer: Cofinity Commercial |
$75.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.44
|
| Rate for Payer: Healthscope Commercial |
$79.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.04
|
| Rate for Payer: PHP Commercial |
$74.84
|
| Rate for Payer: Priority Health SBD |
$55.47
|
| Rate for Payer: UMR Bronson Commercial |
$38.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.04
|
|
|
HYPROMELLOSE 2.5 % EYE DROPS
|
Facility
|
OP
|
$88.05
|
|
|
Service Code
|
NDC 17478006412
|
| Hospital Charge Code |
38092
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$79.25 |
| Rate for Payer: Aetna American Axle |
$57.23
|
| Rate for Payer: Aetna Commercial |
$74.84
|
| Rate for Payer: Aetna Medicare |
$44.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.23
|
| Rate for Payer: BCBS Complete |
$35.22
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cofinity Advantage |
$61.63
|
| Rate for Payer: Cofinity Commercial |
$75.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.44
|
| Rate for Payer: Healthscope Commercial |
$79.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.04
|
| Rate for Payer: PHP Commercial |
$74.84
|
| Rate for Payer: Priority Health SBD |
$55.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.23
|
| Rate for Payer: UHC Core |
$45.87
|
| Rate for Payer: UHC Exchange |
$34.60
|
| Rate for Payer: UMR Bronson Commercial |
$32.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.04
|
|
|
HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 58555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,035.75
|
| Rate for Payer: BCN Commercial |
$2,035.75
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROSURGICAL ABLATION, THERMOABLATION)
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 58563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,300.31
|
| Rate for Payer: BCN Commercial |
$4,300.31
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 58562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,263.60
|
| Rate for Payer: BCN Commercial |
$3,263.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 58561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$5,192.60
|
| Rate for Payer: BCN Commercial |
$5,192.60
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 58558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,900.10
|
| Rate for Payer: BCN Commercial |
$3,900.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$256.21
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
70544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$230.59 |
| Rate for Payer: Aetna American Axle |
$166.54
|
| Rate for Payer: Aetna American Axle |
$132.71
|
| Rate for Payer: Aetna American Axle |
$278.98
|
| Rate for Payer: Aetna Commercial |
$217.78
|
| Rate for Payer: Aetna Commercial |
$364.82
|
| Rate for Payer: Aetna Commercial |
$173.54
|
| Rate for Payer: Aetna Medicare |
$128.10
|
| Rate for Payer: Aetna Medicare |
$102.08
|
| Rate for Payer: Aetna Medicare |
$214.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.98
|
| Rate for Payer: BCBS Complete |
$81.67
|
| Rate for Payer: BCBS Complete |
$102.48
|
| Rate for Payer: BCBS Complete |
$171.68
|
| Rate for Payer: BCBS Trust/PPO |
$47.74
|
| Rate for Payer: BCBS Trust/PPO |
$47.74
|
| Rate for Payer: BCBS Trust/PPO |
$47.74
|
| Rate for Payer: BCN Commercial |
$47.74
|
| Rate for Payer: BCN Commercial |
$47.74
|
| Rate for Payer: BCN Commercial |
$47.74
|
| Rate for Payer: Cash Price |
$163.34
|
| Rate for Payer: Cash Price |
$163.34
|
| Rate for Payer: Cash Price |
$343.36
|
| Rate for Payer: Cash Price |
$343.36
|
| Rate for Payer: Cash Price |
$204.97
|
| Rate for Payer: Cash Price |
$204.97
|
| Rate for Payer: Cofinity Advantage |
$300.44
|
| Rate for Payer: Cofinity Advantage |
$179.35
|
| Rate for Payer: Cofinity Advantage |
$142.92
|
| Rate for Payer: Cofinity Commercial |
$175.59
|
| Rate for Payer: Cofinity Commercial |
$220.34
|
| Rate for Payer: Cofinity Commercial |
$369.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.97
|
| Rate for Payer: Healthscope Commercial |
$183.75
|
| Rate for Payer: Healthscope Commercial |
$230.59
|
| Rate for Payer: Healthscope Commercial |
$386.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.90
|
| Rate for Payer: PHP Commercial |
$217.78
|
| Rate for Payer: PHP Commercial |
$173.54
|
| Rate for Payer: PHP Commercial |
$364.82
|
| Rate for Payer: Priority Health SBD |
$128.63
|
| Rate for Payer: Priority Health SBD |
$270.40
|
| Rate for Payer: Priority Health SBD |
$161.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.68
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Exchange |
$21.68
|
| Rate for Payer: UHC Exchange |
$21.68
|
| Rate for Payer: UHC Exchange |
$21.68
|
| Rate for Payer: UMR Bronson Commercial |
$158.80
|
| Rate for Payer: UMR Bronson Commercial |
$75.54
|
| Rate for Payer: UMR Bronson Commercial |
$94.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.90
|
|
|
IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$204.17
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
70544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.83 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Aetna American Axle |
$132.71
|
| Rate for Payer: Aetna American Axle |
$278.98
|
| Rate for Payer: Aetna Commercial |
$173.54
|
| Rate for Payer: Aetna Commercial |
$364.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.98
|
| Rate for Payer: Cash Price |
$163.34
|
| Rate for Payer: Cash Price |
$343.36
|
| Rate for Payer: Cofinity Advantage |
$300.44
|
| Rate for Payer: Cofinity Advantage |
$142.92
|
| Rate for Payer: Cofinity Commercial |
$369.11
|
| Rate for Payer: Cofinity Commercial |
$175.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.36
|
| Rate for Payer: Healthscope Commercial |
$183.75
|
| Rate for Payer: Healthscope Commercial |
$386.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.90
|
| Rate for Payer: PHP Commercial |
$173.54
|
| Rate for Payer: PHP Commercial |
$364.82
|
| Rate for Payer: Priority Health SBD |
$270.40
|
| Rate for Payer: Priority Health SBD |
$128.63
|
| Rate for Payer: UMR Bronson Commercial |
$89.83
|
| Rate for Payer: UMR Bronson Commercial |
$188.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.90
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.91
|
|
|
Service Code
|
NDC 68094050362
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna American Axle |
$3.84
|
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Advantage |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.43
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health SBD |
$3.72
|
| Rate for Payer: UMR Bronson Commercial |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 00121091805
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna American Axle |
$1.89
|
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Advantage |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.89
|
| Rate for Payer: UHC Core |
$1.52
|
| Rate for Payer: UHC Exchange |
$1.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.18
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$20.43
|
|
|
Service Code
|
NDC 00904530909
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$18.39 |
| Rate for Payer: Aetna American Axle |
$13.28
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Medicare |
$10.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.28
|
| Rate for Payer: BCBS Complete |
$8.17
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cofinity Advantage |
$14.30
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$18.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.32
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: Priority Health SBD |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.28
|
| Rate for Payer: UHC Core |
$10.64
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UMR Bronson Commercial |
$7.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.32
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.94
|
|
|
Service Code
|
NDC 68094049461
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna American Axle |
$2.56
|
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.56
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cofinity Advantage |
$2.76
|
| Rate for Payer: Cofinity Commercial |
$3.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.96
|
| Rate for Payer: PHP Commercial |
$3.35
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: UHC Exchange |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.96
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$6.34
|
|
|
Service Code
|
NDC 68094050361
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna American Axle |
$4.12
|
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.12
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Cofinity Advantage |
$4.44
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.07
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.75
|
| Rate for Payer: PHP Commercial |
$5.39
|
| Rate for Payer: Priority Health SBD |
$3.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.75
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 00121102200
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Advantage |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.06
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC Core |
$1.43
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
