|
POSTERIOR CHAMBER INTRAOCULAR LENS
|
Facility
|
OP
|
$167.42
|
|
|
Service Code
|
CPT V2632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.52 |
| Max. Negotiated Rate |
$167.42 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.42
|
| Rate for Payer: UHC Exchange |
$139.52
|
|
|
POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 57250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.71 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,466.98
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.58
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$608.71
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS 1 INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$2,681.61
|
|
|
Service Code
|
CPT 22840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,681.61 |
| Rate for Payer: BCBS Trust/PPO |
$2,681.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.02
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$740.02
|
|
|
POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); 3 TO 6 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$2,692.42
|
|
|
Service Code
|
CPT 22842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,692.42 |
| Rate for Payer: BCBS Trust/PPO |
$2,692.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.59
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$746.90
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$28,097.87
|
|
|
Service Code
|
MS-DRG 862
|
| Min. Negotiated Rate |
$13,971.52 |
| Max. Negotiated Rate |
$28,097.87 |
| Rate for Payer: Aetna Medicare |
$15,295.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,383.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,383.58
|
| Rate for Payer: BCBS MAPPO |
$14,706.86
|
| Rate for Payer: BCBS Trust/PPO |
$23,392.59
|
| Rate for Payer: BCN Medicare Advantage |
$14,706.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,706.86
|
| Rate for Payer: Mclaren Medicare |
$14,706.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,442.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,912.89
|
| Rate for Payer: PACE Medicare |
$13,971.52
|
| Rate for Payer: PACE SWMI |
$14,706.86
|
| Rate for Payer: PHP Medicare Advantage |
$14,706.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,432.55
|
| Rate for Payer: Priority Health Medicare |
$14,706.86
|
| Rate for Payer: Priority Health Narrow Network |
$21,146.04
|
| Rate for Payer: Railroad Medicare Medicare |
$14,706.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,097.87
|
| Rate for Payer: UHC Core |
$23,039.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,706.86
|
| Rate for Payer: UHC Exchange |
$18,316.85
|
| Rate for Payer: UHC Medicare Advantage |
$15,148.07
|
| Rate for Payer: VA VA |
$14,706.86
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$16,110.20
|
|
|
Service Code
|
MS-DRG 863
|
| Min. Negotiated Rate |
$7,847.72 |
| Max. Negotiated Rate |
$16,110.20 |
| Rate for Payer: Aetna Medicare |
$8,591.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,325.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,325.95
|
| Rate for Payer: BCBS MAPPO |
$8,260.76
|
| Rate for Payer: BCBS Trust/PPO |
$16,110.20
|
| Rate for Payer: BCN Medicare Advantage |
$8,260.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,260.76
|
| Rate for Payer: Mclaren Medicare |
$8,260.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,673.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,499.87
|
| Rate for Payer: PACE Medicare |
$7,847.72
|
| Rate for Payer: PACE SWMI |
$8,260.76
|
| Rate for Payer: PHP Medicare Advantage |
$8,260.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,428.84
|
| Rate for Payer: Priority Health Medicare |
$8,260.76
|
| Rate for Payer: Priority Health Narrow Network |
$11,543.07
|
| Rate for Payer: Railroad Medicare Medicare |
$8,260.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,337.90
|
| Rate for Payer: UHC Core |
$12,576.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,260.76
|
| Rate for Payer: UHC Exchange |
$9,998.69
|
| Rate for Payer: UHC Medicare Advantage |
$8,508.58
|
| Rate for Payer: VA VA |
$8,260.76
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$33,125.05
|
|
|
Service Code
|
MS-DRG 857
|
| Min. Negotiated Rate |
$16,121.62 |
| Max. Negotiated Rate |
$33,125.05 |
| Rate for Payer: Aetna Medicare |
$17,648.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,212.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,212.66
|
| Rate for Payer: BCBS MAPPO |
$16,970.13
|
| Rate for Payer: BCBS Trust/PPO |
$33,125.05
|
| Rate for Payer: BCN Medicare Advantage |
$16,970.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,970.13
|
| Rate for Payer: Mclaren Medicare |
$16,970.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,818.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,515.65
|
| Rate for Payer: PACE Medicare |
$16,121.62
|
| Rate for Payer: PACE SWMI |
$16,970.13
|
| Rate for Payer: PHP Medicare Advantage |
$16,970.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,647.12
|
| Rate for Payer: Priority Health Medicare |
$16,970.13
|
| Rate for Payer: Priority Health Narrow Network |
$24,517.70
|
| Rate for Payer: Railroad Medicare Medicare |
$16,970.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,577.97
|
| Rate for Payer: UHC Core |
$26,713.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,970.13
|
| Rate for Payer: UHC Exchange |
$21,237.40
|
| Rate for Payer: UHC Medicare Advantage |
$17,479.23
|
| Rate for Payer: VA VA |
$16,970.13
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$81,689.35
|
|
|
Service Code
|
MS-DRG 856
|
| Min. Negotiated Rate |
$32,905.87 |
| Max. Negotiated Rate |
$81,689.35 |
| Rate for Payer: Aetna Medicare |
$36,023.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,297.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,297.20
|
| Rate for Payer: BCBS MAPPO |
$34,637.76
|
| Rate for Payer: BCBS Trust/PPO |
$81,689.35
|
| Rate for Payer: BCN Medicare Advantage |
$34,637.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,637.76
|
| Rate for Payer: Mclaren Medicare |
$34,637.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,369.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,833.42
|
| Rate for Payer: PACE Medicare |
$32,905.87
|
| Rate for Payer: PACE SWMI |
$34,637.76
|
| Rate for Payer: PHP Medicare Advantage |
$34,637.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63,547.19
|
| Rate for Payer: Priority Health Medicare |
$34,637.76
|
| Rate for Payer: Priority Health Narrow Network |
$50,837.75
|
| Rate for Payer: Railroad Medicare Medicare |
$34,637.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67,550.81
|
| Rate for Payer: UHC Core |
$55,390.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$34,637.76
|
| Rate for Payer: UHC Exchange |
$44,036.01
|
| Rate for Payer: UHC Medicare Advantage |
$35,676.89
|
| Rate for Payer: VA VA |
$34,637.76
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,075.96
|
|
|
Service Code
|
MS-DRG 858
|
| Min. Negotiated Rate |
$9,882.17 |
| Max. Negotiated Rate |
$23,075.96 |
| Rate for Payer: Aetna Medicare |
$10,818.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,002.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,002.85
|
| Rate for Payer: BCBS MAPPO |
$10,402.28
|
| Rate for Payer: BCBS Trust/PPO |
$23,075.96
|
| Rate for Payer: BCN Medicare Advantage |
$10,402.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,402.28
|
| Rate for Payer: Mclaren Medicare |
$10,402.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,922.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,962.62
|
| Rate for Payer: PACE Medicare |
$9,882.17
|
| Rate for Payer: PACE SWMI |
$10,402.28
|
| Rate for Payer: PHP Medicare Advantage |
$10,402.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,416.69
|
| Rate for Payer: Priority Health Medicare |
$10,402.28
|
| Rate for Payer: Priority Health Narrow Network |
$14,733.35
|
| Rate for Payer: Railroad Medicare Medicare |
$10,402.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,576.98
|
| Rate for Payer: UHC Core |
$16,052.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,402.28
|
| Rate for Payer: UHC Exchange |
$12,762.13
|
| Rate for Payer: UHC Medicare Advantage |
$10,714.35
|
| Rate for Payer: VA VA |
$10,402.28
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$29,901.00
|
|
|
Service Code
|
MS-DRG 769
|
| Min. Negotiated Rate |
$11,789.22 |
| Max. Negotiated Rate |
$29,901.00 |
| Rate for Payer: Aetna Medicare |
$12,906.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,512.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,512.14
|
| Rate for Payer: BCBS MAPPO |
$12,409.71
|
| Rate for Payer: BCBS Trust/PPO |
$29,901.00
|
| Rate for Payer: BCN Medicare Advantage |
$12,409.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,409.71
|
| Rate for Payer: Mclaren Medicare |
$12,409.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,030.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,271.17
|
| Rate for Payer: PACE Medicare |
$11,789.22
|
| Rate for Payer: PACE SWMI |
$12,409.71
|
| Rate for Payer: PHP Medicare Advantage |
$12,409.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,154.84
|
| Rate for Payer: Priority Health Medicare |
$12,409.71
|
| Rate for Payer: Priority Health Narrow Network |
$17,723.87
|
| Rate for Payer: Railroad Medicare Medicare |
$12,409.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,550.65
|
| Rate for Payer: UHC Core |
$19,311.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,409.71
|
| Rate for Payer: UHC Exchange |
$15,352.54
|
| Rate for Payer: UHC Medicare Advantage |
$12,782.00
|
| Rate for Payer: VA VA |
$12,409.71
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$10,932.54
|
|
|
Service Code
|
MS-DRG 776
|
| Min. Negotiated Rate |
$5,733.51 |
| Max. Negotiated Rate |
$10,932.54 |
| Rate for Payer: Aetna Medicare |
$6,276.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,544.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,544.09
|
| Rate for Payer: BCBS MAPPO |
$6,035.27
|
| Rate for Payer: BCBS Trust/PPO |
$8,199.59
|
| Rate for Payer: BCN Medicare Advantage |
$6,035.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,035.27
|
| Rate for Payer: Mclaren Medicare |
$6,035.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,337.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,940.56
|
| Rate for Payer: PACE Medicare |
$5,733.51
|
| Rate for Payer: PACE SWMI |
$6,035.27
|
| Rate for Payer: PHP Medicare Advantage |
$6,035.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,284.59
|
| Rate for Payer: Priority Health Medicare |
$6,035.27
|
| Rate for Payer: Priority Health Narrow Network |
$8,227.67
|
| Rate for Payer: Railroad Medicare Medicare |
$6,035.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,932.54
|
| Rate for Payer: UHC Core |
$8,964.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,035.27
|
| Rate for Payer: UHC Exchange |
$7,126.86
|
| Rate for Payer: UHC Medicare Advantage |
$6,216.33
|
| Rate for Payer: VA VA |
$6,035.27
|
|
|
POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN
|
Facility
|
IP
|
$1,322.75
|
|
|
Service Code
|
NDC 5865731116
|
| Hospital Charge Code |
11057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$582.01 |
| Max. Negotiated Rate |
$1,190.48 |
| Rate for Payer: Aetna American Axle |
$859.79
|
| Rate for Payer: Aetna Commercial |
$1,124.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.79
|
| Rate for Payer: Cash Price |
$1,058.20
|
| Rate for Payer: Cofinity Commercial |
$1,137.56
|
| Rate for Payer: Cofinity Commercial |
$925.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,058.20
|
| Rate for Payer: Healthscope Commercial |
$1,190.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$925.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$992.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,124.34
|
| Rate for Payer: PHP Commercial |
$1,124.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$925.92
|
| Rate for Payer: Priority Health SBD |
$833.33
|
| Rate for Payer: UMR Bronson Commercial |
$582.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$992.06
|
|
|
POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN
|
Facility
|
IP
|
$244.55
|
|
|
Service Code
|
NDC 121067716
|
| Hospital Charge Code |
11057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$220.10 |
| Rate for Payer: Aetna American Axle |
$158.96
|
| Rate for Payer: Aetna Commercial |
$207.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.96
|
| Rate for Payer: Cash Price |
$195.64
|
| Rate for Payer: Cofinity Commercial |
$171.18
|
| Rate for Payer: Cofinity Commercial |
$210.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.64
|
| Rate for Payer: Healthscope Commercial |
$220.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.87
|
| Rate for Payer: PHP Commercial |
$207.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.18
|
| Rate for Payer: Priority Health SBD |
$154.07
|
| Rate for Payer: UMR Bronson Commercial |
$107.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.41
|
|
|
POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN
|
Facility
|
IP
|
$1,289.40
|
|
|
Service Code
|
NDC 6025800216
|
| Hospital Charge Code |
11057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$567.34 |
| Max. Negotiated Rate |
$1,160.46 |
| Rate for Payer: Aetna American Axle |
$838.11
|
| Rate for Payer: Aetna Commercial |
$1,095.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.11
|
| Rate for Payer: Cash Price |
$1,031.52
|
| Rate for Payer: Cofinity Commercial |
$1,108.88
|
| Rate for Payer: Cofinity Commercial |
$902.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.52
|
| Rate for Payer: Healthscope Commercial |
$1,160.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$967.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.99
|
| Rate for Payer: PHP Commercial |
$1,095.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.58
|
| Rate for Payer: Priority Health SBD |
$812.32
|
| Rate for Payer: UMR Bronson Commercial |
$567.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$967.05
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 0409-3294-15
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Aetna American Axle |
$25.02
|
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$26.95
|
| Rate for Payer: Cofinity Commercial |
$33.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$34.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.72
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.95
|
| Rate for Payer: Priority Health SBD |
$24.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.88
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.72
|
|
|
Service Code
|
NDC 0409-8183-25
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.61
|
| Rate for Payer: PHP Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.54
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.72
|
|
|
Service Code
|
NDC 0409-8183-11
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.61
|
| Rate for Payer: PHP Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.54
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.72
|
|
|
Service Code
|
NDC 0409-8183-01
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.61
|
| Rate for Payer: PHP Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.54
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 0409-3294-51
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Aetna American Axle |
$25.02
|
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$26.95
|
| Rate for Payer: Cofinity Commercial |
$33.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$34.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.72
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.95
|
| Rate for Payer: Priority Health SBD |
$24.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.88
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.05
|
|
|
Service Code
|
NDC 51754-2001-4
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.19
|
| Rate for Payer: PHP Commercial |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.34
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.29
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
NDC 51754-2004-4
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.02
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.72
|
|
|
Service Code
|
NDC 0409-8183-15
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.61
|
| Rate for Payer: PHP Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.54
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
NDC 51754-2004-1
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.02
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 0409-3294-25
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Aetna American Axle |
$25.02
|
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$26.95
|
| Rate for Payer: Cofinity Commercial |
$33.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$34.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.72
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.95
|
| Rate for Payer: Priority Health SBD |
$24.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.88
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 0409-3294-61
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Aetna American Axle |
$25.02
|
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$26.95
|
| Rate for Payer: Cofinity Commercial |
$33.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$34.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.72
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.95
|
| Rate for Payer: Priority Health SBD |
$24.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.88
|
|
