|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$26,679.46
|
|
|
Service Code
|
MS-DRG 186
|
| Min. Negotiated Rate |
$11,849.25 |
| Max. Negotiated Rate |
$26,679.46 |
| Rate for Payer: Aetna Medicare |
$12,971.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,591.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,591.11
|
| Rate for Payer: BCBS MAPPO |
$12,472.89
|
| Rate for Payer: BCBS Trust/PPO |
$26,679.46
|
| Rate for Payer: BCN Medicare Advantage |
$12,472.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,472.89
|
| Rate for Payer: Mclaren Medicare |
$12,472.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,096.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,343.82
|
| Rate for Payer: PACE Medicare |
$11,849.25
|
| Rate for Payer: PACE SWMI |
$12,472.89
|
| Rate for Payer: PHP Medicare Advantage |
$12,472.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,272.51
|
| Rate for Payer: Priority Health Medicare |
$12,472.89
|
| Rate for Payer: Priority Health Narrow Network |
$17,818.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12,472.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,675.73
|
| Rate for Payer: UHC Core |
$19,413.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,472.89
|
| Rate for Payer: UHC Exchange |
$15,434.08
|
| Rate for Payer: UHC Medicare Advantage |
$12,847.08
|
| Rate for Payer: VA VA |
$12,472.89
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$13,366.12
|
|
|
Service Code
|
MS-DRG 188
|
| Min. Negotiated Rate |
$5,951.66 |
| Max. Negotiated Rate |
$13,366.12 |
| Rate for Payer: Aetna Medicare |
$6,515.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,831.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,831.12
|
| Rate for Payer: BCBS MAPPO |
$6,264.90
|
| Rate for Payer: BCBS Trust/PPO |
$13,366.12
|
| Rate for Payer: BCN Medicare Advantage |
$6,264.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,264.90
|
| Rate for Payer: Mclaren Medicare |
$6,264.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,578.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,204.64
|
| Rate for Payer: PACE Medicare |
$5,951.66
|
| Rate for Payer: PACE SWMI |
$6,264.90
|
| Rate for Payer: PHP Medicare Advantage |
$6,264.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,712.22
|
| Rate for Payer: Priority Health Medicare |
$6,264.90
|
| Rate for Payer: Priority Health Narrow Network |
$8,569.78
|
| Rate for Payer: Railroad Medicare Medicare |
$6,264.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,387.11
|
| Rate for Payer: UHC Core |
$9,337.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,264.90
|
| Rate for Payer: UHC Exchange |
$7,423.20
|
| Rate for Payer: UHC Medicare Advantage |
$6,452.85
|
| Rate for Payer: VA VA |
$6,264.90
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$673.24
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$296.23 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna American Axle |
$437.61
|
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.61
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$471.27
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$471.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.25
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.27
|
| Rate for Payer: Priority Health SBD |
$424.14
|
| Rate for Payer: UMR Bronson Commercial |
$296.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.93
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$694.28
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$856.36 |
| Rate for Payer: Aetna American Axle |
$451.28
|
| Rate for Payer: Aetna Commercial |
$590.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.28
|
| Rate for Payer: BCBS Complete |
$277.71
|
| Rate for Payer: BCBS Trust/PPO |
$856.36
|
| Rate for Payer: Cash Price |
$555.42
|
| Rate for Payer: Cash Price |
$555.42
|
| Rate for Payer: Cofinity Commercial |
$486.00
|
| Rate for Payer: Cofinity Commercial |
$597.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.42
|
| Rate for Payer: Healthscope Commercial |
$624.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$486.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$590.14
|
| Rate for Payer: PHP Commercial |
$590.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.99
|
| Rate for Payer: Priority Health Narrow Network |
$206.39
|
| Rate for Payer: Priority Health SBD |
$437.40
|
| Rate for Payer: UMR Bronson Commercial |
$256.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.71
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$761.16
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$334.91 |
| Max. Negotiated Rate |
$685.04 |
| Rate for Payer: Aetna American Axle |
$494.75
|
| Rate for Payer: Aetna American Axle |
$510.24
|
| Rate for Payer: Aetna Commercial |
$646.99
|
| Rate for Payer: Aetna Commercial |
$667.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.75
|
| Rate for Payer: Cash Price |
$608.93
|
| Rate for Payer: Cash Price |
$627.98
|
| Rate for Payer: Cofinity Commercial |
$675.08
|
| Rate for Payer: Cofinity Commercial |
$654.60
|
| Rate for Payer: Cofinity Commercial |
$549.49
|
| Rate for Payer: Cofinity Commercial |
$532.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.98
|
| Rate for Payer: Healthscope Commercial |
$685.04
|
| Rate for Payer: Healthscope Commercial |
$706.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$532.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$549.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$588.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$667.23
|
| Rate for Payer: PHP Commercial |
$646.99
|
| Rate for Payer: PHP Commercial |
$667.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.81
|
| Rate for Payer: Priority Health SBD |
$494.54
|
| Rate for Payer: Priority Health SBD |
$479.53
|
| Rate for Payer: UMR Bronson Commercial |
$334.91
|
| Rate for Payer: UMR Bronson Commercial |
$345.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$588.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.87
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$374.95
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.98 |
| Max. Negotiated Rate |
$337.46 |
| Rate for Payer: Aetna American Axle |
$243.72
|
| Rate for Payer: Aetna Commercial |
$318.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.72
|
| Rate for Payer: Cash Price |
$299.96
|
| Rate for Payer: Cofinity Commercial |
$262.46
|
| Rate for Payer: Cofinity Commercial |
$322.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.96
|
| Rate for Payer: Healthscope Commercial |
$337.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.71
|
| Rate for Payer: PHP Commercial |
$318.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.46
|
| Rate for Payer: Priority Health SBD |
$236.22
|
| Rate for Payer: UMR Bronson Commercial |
$164.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.21
|
|
|
PNEUMOTHORAX WITH CC
|
Facility
|
IP
|
$17,535.02
|
|
|
Service Code
|
MS-DRG 200
|
| Min. Negotiated Rate |
$8,371.16 |
| Max. Negotiated Rate |
$17,535.02 |
| Rate for Payer: Aetna Medicare |
$9,164.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,014.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,014.69
|
| Rate for Payer: BCBS MAPPO |
$8,811.75
|
| Rate for Payer: BCBS Trust/PPO |
$17,535.02
|
| Rate for Payer: BCN Medicare Advantage |
$8,811.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,811.75
|
| Rate for Payer: Mclaren Medicare |
$8,811.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,252.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,133.51
|
| Rate for Payer: PACE Medicare |
$8,371.16
|
| Rate for Payer: PACE SWMI |
$8,811.75
|
| Rate for Payer: PHP Medicare Advantage |
$8,811.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,454.86
|
| Rate for Payer: Priority Health Medicare |
$8,811.75
|
| Rate for Payer: Priority Health Narrow Network |
$12,363.89
|
| Rate for Payer: Railroad Medicare Medicare |
$8,811.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,428.56
|
| Rate for Payer: UHC Core |
$13,471.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,811.75
|
| Rate for Payer: UHC Exchange |
$10,709.69
|
| Rate for Payer: UHC Medicare Advantage |
$9,076.10
|
| Rate for Payer: VA VA |
$8,811.75
|
|
|
PNEUMOTHORAX WITH MCC
|
Facility
|
IP
|
$27,062.12
|
|
|
Service Code
|
MS-DRG 199
|
| Min. Negotiated Rate |
$13,474.45 |
| Max. Negotiated Rate |
$27,062.12 |
| Rate for Payer: Aetna Medicare |
$14,750.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,729.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,729.54
|
| Rate for Payer: BCBS MAPPO |
$14,183.63
|
| Rate for Payer: BCBS Trust/PPO |
$24,264.56
|
| Rate for Payer: BCN Medicare Advantage |
$14,183.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,183.63
|
| Rate for Payer: Mclaren Medicare |
$14,183.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,892.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,311.17
|
| Rate for Payer: PACE Medicare |
$13,474.45
|
| Rate for Payer: PACE SWMI |
$14,183.63
|
| Rate for Payer: PHP Medicare Advantage |
$14,183.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,458.19
|
| Rate for Payer: Priority Health Medicare |
$14,183.63
|
| Rate for Payer: Priority Health Narrow Network |
$20,366.55
|
| Rate for Payer: Railroad Medicare Medicare |
$14,183.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,062.12
|
| Rate for Payer: UHC Core |
$22,190.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,183.63
|
| Rate for Payer: UHC Exchange |
$17,641.65
|
| Rate for Payer: UHC Medicare Advantage |
$14,609.14
|
| Rate for Payer: VA VA |
$14,183.63
|
|
|
PNEUMOTHORAX WITHOUT CC/MCC
|
Facility
|
IP
|
$11,928.74
|
|
|
Service Code
|
MS-DRG 201
|
| Min. Negotiated Rate |
$5,655.90 |
| Max. Negotiated Rate |
$11,928.74 |
| Rate for Payer: Aetna Medicare |
$6,191.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,441.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,441.98
|
| Rate for Payer: BCBS MAPPO |
$5,953.58
|
| Rate for Payer: BCBS Trust/PPO |
$11,928.74
|
| Rate for Payer: BCN Medicare Advantage |
$5,953.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,953.58
|
| Rate for Payer: Mclaren Medicare |
$5,953.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,251.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,846.62
|
| Rate for Payer: PACE Medicare |
$5,655.90
|
| Rate for Payer: PACE SWMI |
$5,953.58
|
| Rate for Payer: PHP Medicare Advantage |
$5,953.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,132.48
|
| Rate for Payer: Priority Health Medicare |
$5,953.58
|
| Rate for Payer: Priority Health Narrow Network |
$8,105.98
|
| Rate for Payer: Railroad Medicare Medicare |
$5,953.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,770.85
|
| Rate for Payer: UHC Core |
$8,831.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,953.58
|
| Rate for Payer: UHC Exchange |
$7,021.46
|
| Rate for Payer: UHC Medicare Advantage |
$6,132.19
|
| Rate for Payer: VA VA |
$5,953.58
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC
|
Facility
|
IP
|
$26,144.21
|
|
|
Service Code
|
MS-DRG 917
|
| Min. Negotiated Rate |
$12,169.89 |
| Max. Negotiated Rate |
$26,144.21 |
| Rate for Payer: Aetna Medicare |
$13,322.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,013.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,013.01
|
| Rate for Payer: BCBS MAPPO |
$12,810.41
|
| Rate for Payer: BCBS Trust/PPO |
$26,144.21
|
| Rate for Payer: BCN Medicare Advantage |
$12,810.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,810.41
|
| Rate for Payer: Mclaren Medicare |
$12,810.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,450.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,731.97
|
| Rate for Payer: PACE Medicare |
$12,169.89
|
| Rate for Payer: PACE SWMI |
$12,810.41
|
| Rate for Payer: PHP Medicare Advantage |
$12,810.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,901.04
|
| Rate for Payer: Priority Health Medicare |
$12,810.41
|
| Rate for Payer: Priority Health Narrow Network |
$18,320.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12,810.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,343.86
|
| Rate for Payer: UHC Core |
$19,961.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,810.41
|
| Rate for Payer: UHC Exchange |
$15,869.63
|
| Rate for Payer: UHC Medicare Advantage |
$13,194.72
|
| Rate for Payer: VA VA |
$12,810.41
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
|
IP
|
$13,132.17
|
|
|
Service Code
|
MS-DRG 918
|
| Min. Negotiated Rate |
$6,789.16 |
| Max. Negotiated Rate |
$13,132.17 |
| Rate for Payer: Aetna Medicare |
$7,432.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,933.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,933.10
|
| Rate for Payer: BCBS MAPPO |
$7,146.48
|
| Rate for Payer: BCBS Trust/PPO |
$10,684.85
|
| Rate for Payer: BCN Medicare Advantage |
$7,146.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,146.48
|
| Rate for Payer: Mclaren Medicare |
$7,146.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,503.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,218.45
|
| Rate for Payer: PACE Medicare |
$6,789.16
|
| Rate for Payer: PACE SWMI |
$7,146.48
|
| Rate for Payer: PHP Medicare Advantage |
$7,146.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,353.85
|
| Rate for Payer: Priority Health Medicare |
$7,146.48
|
| Rate for Payer: Priority Health Narrow Network |
$9,883.08
|
| Rate for Payer: Railroad Medicare Medicare |
$7,146.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,132.17
|
| Rate for Payer: UHC Core |
$10,768.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,146.48
|
| Rate for Payer: UHC Exchange |
$8,560.79
|
| Rate for Payer: UHC Medicare Advantage |
$7,360.87
|
| Rate for Payer: VA VA |
$7,146.48
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$78,768.25
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
190691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.99 |
| Max. Negotiated Rate |
$70,891.42 |
| Rate for Payer: Aetna American Axle |
$51,199.36
|
| Rate for Payer: Aetna Commercial |
$66,953.01
|
| Rate for Payer: Aetna Medicare |
$129.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51,199.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.36
|
| Rate for Payer: BCBS Complete |
$71.39
|
| Rate for Payer: BCBS MAPPO |
$124.29
|
| Rate for Payer: BCBS Trust/PPO |
$401.63
|
| Rate for Payer: BCN Medicare Advantage |
$124.29
|
| Rate for Payer: Cash Price |
$63,014.60
|
| Rate for Payer: Cash Price |
$63,014.60
|
| Rate for Payer: Cofinity Commercial |
$55,137.78
|
| Rate for Payer: Cofinity Commercial |
$67,740.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63,014.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.29
|
| Rate for Payer: Healthscope Commercial |
$70,891.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55,137.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59,076.19
|
| Rate for Payer: Mclaren Medicaid |
$67.99
|
| Rate for Payer: Mclaren Medicare |
$124.29
|
| Rate for Payer: Meridian Medicaid |
$71.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$130.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66,953.01
|
| Rate for Payer: PACE Medicare |
$118.07
|
| Rate for Payer: PACE SWMI |
$124.29
|
| Rate for Payer: PHP Commercial |
$66,953.01
|
| Rate for Payer: PHP Medicare Advantage |
$124.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,137.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$356.05
|
| Rate for Payer: Priority Health Medicare |
$124.29
|
| Rate for Payer: Priority Health Narrow Network |
$284.84
|
| Rate for Payer: Priority Health SBD |
$49,624.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.29
|
| Rate for Payer: UHC Medicare Advantage |
$128.02
|
| Rate for Payer: UMR Bronson Commercial |
$29,144.25
|
| Rate for Payer: VA VA |
$124.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59,076.19
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$78,768.25
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
190691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34,658.03 |
| Max. Negotiated Rate |
$70,891.42 |
| Rate for Payer: Aetna American Axle |
$51,199.36
|
| Rate for Payer: Aetna Commercial |
$66,953.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51,199.36
|
| Rate for Payer: Cash Price |
$63,014.60
|
| Rate for Payer: Cofinity Commercial |
$55,137.78
|
| Rate for Payer: Cofinity Commercial |
$67,740.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63,014.60
|
| Rate for Payer: Healthscope Commercial |
$70,891.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55,137.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59,076.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66,953.01
|
| Rate for Payer: PHP Commercial |
$66,953.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,137.78
|
| Rate for Payer: Priority Health SBD |
$49,624.00
|
| Rate for Payer: UMR Bronson Commercial |
$34,658.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59,076.19
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 30 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,878.95
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
195050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,426.74 |
| Max. Negotiated Rate |
$15,191.06 |
| Rate for Payer: Aetna American Axle |
$10,971.32
|
| Rate for Payer: Aetna Commercial |
$14,347.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,971.32
|
| Rate for Payer: Cash Price |
$13,503.16
|
| Rate for Payer: Cofinity Commercial |
$11,815.26
|
| Rate for Payer: Cofinity Commercial |
$14,515.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,503.16
|
| Rate for Payer: Healthscope Commercial |
$15,191.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,815.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,659.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,347.11
|
| Rate for Payer: PHP Commercial |
$14,347.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,815.26
|
| Rate for Payer: Priority Health SBD |
$10,633.74
|
| Rate for Payer: UMR Bronson Commercial |
$7,426.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,659.21
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 30 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,878.95
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
195050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.99 |
| Max. Negotiated Rate |
$15,191.06 |
| Rate for Payer: Aetna American Axle |
$10,971.32
|
| Rate for Payer: Aetna Commercial |
$14,347.11
|
| Rate for Payer: Aetna Medicare |
$129.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,971.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.36
|
| Rate for Payer: BCBS Complete |
$71.39
|
| Rate for Payer: BCBS MAPPO |
$124.29
|
| Rate for Payer: BCBS Trust/PPO |
$401.63
|
| Rate for Payer: BCN Medicare Advantage |
$124.29
|
| Rate for Payer: Cash Price |
$13,503.16
|
| Rate for Payer: Cash Price |
$13,503.16
|
| Rate for Payer: Cofinity Commercial |
$14,515.90
|
| Rate for Payer: Cofinity Commercial |
$11,815.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,503.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.29
|
| Rate for Payer: Healthscope Commercial |
$15,191.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,815.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,659.21
|
| Rate for Payer: Mclaren Medicaid |
$67.99
|
| Rate for Payer: Mclaren Medicare |
$124.29
|
| Rate for Payer: Meridian Medicaid |
$71.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$130.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,347.11
|
| Rate for Payer: PACE Medicare |
$118.07
|
| Rate for Payer: PACE SWMI |
$124.29
|
| Rate for Payer: PHP Commercial |
$14,347.11
|
| Rate for Payer: PHP Medicare Advantage |
$124.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,815.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$356.05
|
| Rate for Payer: Priority Health Medicare |
$124.29
|
| Rate for Payer: Priority Health Narrow Network |
$284.84
|
| Rate for Payer: Priority Health SBD |
$10,633.74
|
| Rate for Payer: Railroad Medicare Medicare |
$124.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.29
|
| Rate for Payer: UHC Medicare Advantage |
$128.02
|
| Rate for Payer: UMR Bronson Commercial |
$6,245.21
|
| Rate for Payer: VA VA |
$124.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,659.21
|
|
|
POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION
|
Facility
|
IP
|
$1,088.74
|
|
|
Service Code
|
NDC 49281-860-10
|
| Hospital Charge Code |
108802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$479.05 |
| Max. Negotiated Rate |
$979.87 |
| Rate for Payer: Aetna American Axle |
$707.68
|
| Rate for Payer: Aetna Commercial |
$925.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.68
|
| Rate for Payer: Cash Price |
$870.99
|
| Rate for Payer: Cofinity Commercial |
$762.12
|
| Rate for Payer: Cofinity Commercial |
$936.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.99
|
| Rate for Payer: Healthscope Commercial |
$979.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$762.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$925.43
|
| Rate for Payer: PHP Commercial |
$925.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$762.12
|
| Rate for Payer: Priority Health SBD |
$685.91
|
| Rate for Payer: UMR Bronson Commercial |
$479.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.56
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
IP
|
$17.14
|
|
|
Service Code
|
NDC 45802-868-01
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$15.43 |
| Rate for Payer: Aetna American Axle |
$11.14
|
| Rate for Payer: Aetna Commercial |
$14.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.14
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$15.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.57
|
| Rate for Payer: PHP Commercial |
$14.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health SBD |
$10.80
|
| Rate for Payer: UMR Bronson Commercial |
$7.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.86
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
IP
|
$39.99
|
|
|
Service Code
|
NDC 4110082073
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$35.99 |
| Rate for Payer: Aetna American Axle |
$25.99
|
| Rate for Payer: Aetna Commercial |
$33.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.99
|
| Rate for Payer: Cash Price |
$31.99
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Cofinity Commercial |
$34.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.99
|
| Rate for Payer: Healthscope Commercial |
$35.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.99
|
| Rate for Payer: PHP Commercial |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.99
|
| Rate for Payer: Priority Health SBD |
$25.19
|
| Rate for Payer: UMR Bronson Commercial |
$17.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.99
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 70000-0415-1
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna American Axle |
$9.75
|
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.75
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health SBD |
$9.45
|
| Rate for Payer: UMR Bronson Commercial |
$6.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
IP
|
$24.16
|
|
|
Service Code
|
NDC 57896-489-14
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna American Axle |
$15.70
|
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.70
|
| Rate for Payer: Cash Price |
$19.33
|
| Rate for Payer: Cofinity Commercial |
$16.91
|
| Rate for Payer: Cofinity Commercial |
$20.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.33
|
| Rate for Payer: Healthscope Commercial |
$21.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.54
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$15.22
|
| Rate for Payer: UMR Bronson Commercial |
$10.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.12
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
IP
|
$24.10
|
|
|
Service Code
|
NDC 69230-324-34
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$21.69 |
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Cash Price |
$19.28
|
| Rate for Payer: Cofinity Commercial |
$16.87
|
| Rate for Payer: Cofinity Commercial |
$20.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.28
|
| Rate for Payer: Healthscope Commercial |
$21.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.48
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.87
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$10.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.08
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.49
|
|
|
Service Code
|
NDC 0904-6931-86
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: Aetna American Axle |
$4.22
|
| Rate for Payer: Aetna Commercial |
$5.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.22
|
| Rate for Payer: Cash Price |
$5.19
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Cofinity Commercial |
$5.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.19
|
| Rate for Payer: Healthscope Commercial |
$5.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.52
|
| Rate for Payer: PHP Commercial |
$5.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.54
|
| Rate for Payer: Priority Health SBD |
$4.09
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.87
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$69.89
|
|
|
Service Code
|
NDC 68084-430-98
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna American Axle |
$45.43
|
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.43
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$48.92
|
| Rate for Payer: Cofinity Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.41
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.92
|
| Rate for Payer: Priority Health SBD |
$44.03
|
| Rate for Payer: UMR Bronson Commercial |
$30.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.42
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$54.20
|
|
|
Service Code
|
NDC 4110080676
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$48.78 |
| Rate for Payer: Aetna American Axle |
$35.23
|
| Rate for Payer: Aetna Commercial |
$46.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.23
|
| Rate for Payer: Cash Price |
$43.36
|
| Rate for Payer: Cofinity Commercial |
$37.94
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.36
|
| Rate for Payer: Healthscope Commercial |
$48.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.07
|
| Rate for Payer: PHP Commercial |
$46.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.94
|
| Rate for Payer: Priority Health SBD |
$34.15
|
| Rate for Payer: UMR Bronson Commercial |
$23.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.65
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$504.48
|
|
|
Service Code
|
NDC 0904-6931-81
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.97 |
| Max. Negotiated Rate |
$454.03 |
| Rate for Payer: Aetna American Axle |
$327.91
|
| Rate for Payer: Aetna Commercial |
$428.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.91
|
| Rate for Payer: Cash Price |
$403.58
|
| Rate for Payer: Cofinity Commercial |
$353.14
|
| Rate for Payer: Cofinity Commercial |
$433.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.58
|
| Rate for Payer: Healthscope Commercial |
$454.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.81
|
| Rate for Payer: PHP Commercial |
$428.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.14
|
| Rate for Payer: Priority Health SBD |
$317.82
|
| Rate for Payer: UMR Bronson Commercial |
$221.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.36
|
|
