|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Advantage |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
NDC 50268050411
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$340.10
|
|
|
Service Code
|
NDC 68084034601
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.84 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna American Axle |
$221.06
|
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna Medicare |
$170.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: BCBS Complete |
$136.04
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Advantage |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.07
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health SBD |
$214.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.06
|
| Rate for Payer: UHC Core |
$177.19
|
| Rate for Payer: UHC Exchange |
$133.66
|
| Rate for Payer: UMR Bronson Commercial |
$125.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.07
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$80.37
|
|
|
Service Code
|
NDC 43547036109
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$72.33 |
| Rate for Payer: Aetna American Axle |
$52.24
|
| Rate for Payer: Aetna Commercial |
$68.31
|
| Rate for Payer: Aetna Medicare |
$40.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.24
|
| Rate for Payer: BCBS Complete |
$32.15
|
| Rate for Payer: Cash Price |
$64.30
|
| Rate for Payer: Cofinity Advantage |
$56.26
|
| Rate for Payer: Cofinity Commercial |
$69.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.30
|
| Rate for Payer: Healthscope Commercial |
$72.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.28
|
| Rate for Payer: PHP Commercial |
$68.31
|
| Rate for Payer: Priority Health SBD |
$50.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.24
|
| Rate for Payer: UHC Core |
$41.87
|
| Rate for Payer: UHC Exchange |
$31.59
|
| Rate for Payer: UMR Bronson Commercial |
$29.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.28
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Advantage |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UMR Bronson Commercial |
$114.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
NDC 68084034701
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.96 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna Medicare |
$129.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: BCBS Complete |
$103.74
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Advantage |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.58
|
| Rate for Payer: UHC Core |
$135.12
|
| Rate for Payer: UHC Exchange |
$101.92
|
| Rate for Payer: UMR Bronson Commercial |
$95.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$67.68
|
|
|
Service Code
|
NDC 65862020290
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$60.91 |
| Rate for Payer: Aetna American Axle |
$43.99
|
| Rate for Payer: Aetna Commercial |
$57.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.99
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Advantage |
$47.38
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$60.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: PHP Commercial |
$57.53
|
| Rate for Payer: Priority Health SBD |
$42.64
|
| Rate for Payer: UMR Bronson Commercial |
$29.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.76
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$235.60
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna American Axle |
$153.14
|
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: Aetna Medicare |
$117.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.14
|
| Rate for Payer: BCBS Complete |
$94.24
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Advantage |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: Priority Health SBD |
$148.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.14
|
| Rate for Payer: UHC Core |
$122.75
|
| Rate for Payer: UHC Exchange |
$92.59
|
| Rate for Payer: UMR Bronson Commercial |
$87.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.70
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$67.68
|
|
|
Service Code
|
NDC 65862020290
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$60.91 |
| Rate for Payer: Aetna American Axle |
$43.99
|
| Rate for Payer: Aetna Commercial |
$57.53
|
| Rate for Payer: Aetna Medicare |
$33.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.99
|
| Rate for Payer: BCBS Complete |
$27.07
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Advantage |
$47.38
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$60.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: PHP Commercial |
$57.53
|
| Rate for Payer: Priority Health SBD |
$42.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.99
|
| Rate for Payer: UHC Core |
$35.26
|
| Rate for Payer: UHC Exchange |
$26.60
|
| Rate for Payer: UMR Bronson Commercial |
$25.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.76
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$80.37
|
|
|
Service Code
|
NDC 43547036109
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$72.33 |
| Rate for Payer: Aetna American Axle |
$52.24
|
| Rate for Payer: Aetna Commercial |
$68.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.24
|
| Rate for Payer: Cash Price |
$64.30
|
| Rate for Payer: Cofinity Advantage |
$56.26
|
| Rate for Payer: Cofinity Commercial |
$69.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.30
|
| Rate for Payer: Healthscope Commercial |
$72.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.28
|
| Rate for Payer: PHP Commercial |
$68.31
|
| Rate for Payer: Priority Health SBD |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$35.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.28
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.96 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna Medicare |
$129.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: BCBS Complete |
$103.74
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Advantage |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.58
|
| Rate for Payer: UHC Core |
$135.12
|
| Rate for Payer: UHC Exchange |
$101.92
|
| Rate for Payer: UMR Bronson Commercial |
$95.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 68084034701
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Advantage |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UMR Bronson Commercial |
$114.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$235.60
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.66 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna American Axle |
$153.14
|
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.14
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Advantage |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: Priority Health SBD |
$148.43
|
| Rate for Payer: UMR Bronson Commercial |
$103.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.70
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC
|
Facility
|
IP
|
$57,518.08
|
|
|
Service Code
|
MSDRG 493
|
| Min. Negotiated Rate |
$20,711.51 |
| Max. Negotiated Rate |
$57,518.08 |
| Rate for Payer: Aetna Medicare |
$22,673.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,251.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,251.99
|
| Rate for Payer: BCBS MAPPO |
$21,801.59
|
| Rate for Payer: BCBS Trust/PPO |
$57,518.08
|
| Rate for Payer: BCN Commercial |
$57,518.08
|
| Rate for Payer: BCN Medicare Advantage |
$21,801.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,801.59
|
| Rate for Payer: Mclaren Medicare |
$21,801.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,891.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,071.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,981.75
|
| Rate for Payer: Nomi Health Commercial |
$32,715.69
|
| Rate for Payer: PACE Medicare |
$20,711.51
|
| Rate for Payer: PACE SWMI |
$21,801.59
|
| Rate for Payer: PHP Medicare Advantage |
$21,801.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40,887.36
|
| Rate for Payer: Priority Health Medicare |
$21,801.59
|
| Rate for Payer: Priority Health Tiered Network |
$32,709.88
|
| Rate for Payer: Railroad Medicare Medicare |
$21,801.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,338.43
|
| Rate for Payer: UHC Core |
$34,584.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,801.59
|
| Rate for Payer: UHC Exchange |
$28,244.55
|
| Rate for Payer: VA VA |
$21,801.59
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC
|
Facility
|
IP
|
$72,311.42
|
|
|
Service Code
|
MSDRG 492
|
| Min. Negotiated Rate |
$29,732.56 |
| Max. Negotiated Rate |
$72,311.42 |
| Rate for Payer: Aetna Medicare |
$32,549.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,121.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,121.79
|
| Rate for Payer: BCBS MAPPO |
$31,297.43
|
| Rate for Payer: BCBS Trust/PPO |
$72,311.42
|
| Rate for Payer: BCN Commercial |
$72,311.42
|
| Rate for Payer: BCN Medicare Advantage |
$31,297.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,297.43
|
| Rate for Payer: Mclaren Medicare |
$31,297.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,862.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,992.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$34,427.17
|
| Rate for Payer: Nomi Health Commercial |
$47,363.64
|
| Rate for Payer: PACE Medicare |
$29,732.56
|
| Rate for Payer: PACE SWMI |
$31,297.43
|
| Rate for Payer: PHP Medicare Advantage |
$31,297.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,194.05
|
| Rate for Payer: Priority Health Medicare |
$31,297.43
|
| Rate for Payer: Priority Health Tiered Network |
$47,355.23
|
| Rate for Payer: Railroad Medicare Medicare |
$31,297.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,847.08
|
| Rate for Payer: UHC Core |
$50,069.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,297.43
|
| Rate for Payer: UHC Exchange |
$40,890.61
|
| Rate for Payer: VA VA |
$31,297.43
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$39,114.93
|
|
|
Service Code
|
MSDRG 494
|
| Min. Negotiated Rate |
$16,504.07 |
| Max. Negotiated Rate |
$39,114.93 |
| Rate for Payer: Aetna Medicare |
$18,067.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,715.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,715.89
|
| Rate for Payer: BCBS MAPPO |
$17,372.71
|
| Rate for Payer: BCBS Trust/PPO |
$39,114.93
|
| Rate for Payer: BCN Commercial |
$39,114.93
|
| Rate for Payer: BCN Medicare Advantage |
$17,372.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,372.71
|
| Rate for Payer: Mclaren Medicare |
$17,372.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,241.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,978.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,109.98
|
| Rate for Payer: Nomi Health Commercial |
$25,883.85
|
| Rate for Payer: PACE Medicare |
$16,504.07
|
| Rate for Payer: PACE SWMI |
$17,372.71
|
| Rate for Payer: PHP Medicare Advantage |
$17,372.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$32,349.07
|
| Rate for Payer: Priority Health Medicare |
$17,372.71
|
| Rate for Payer: Priority Health Tiered Network |
$25,879.26
|
| Rate for Payer: Railroad Medicare Medicare |
$17,372.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,705.95
|
| Rate for Payer: UHC Core |
$27,362.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,372.71
|
| Rate for Payer: UHC Exchange |
$22,346.39
|
| Rate for Payer: VA VA |
$17,372.71
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$15,315.93
|
|
|
Service Code
|
APR-DRG 1812
|
| Min. Negotiated Rate |
$14,586.60 |
| Max. Negotiated Rate |
$15,315.93 |
| Rate for Payer: BCBS Complete |
$15,315.93
|
| Rate for Payer: Mclaren Medicaid |
$14,586.60
|
| Rate for Payer: Meridian Medicaid |
$15,315.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,586.60
|
| Rate for Payer: UHC Medicaid |
$14,586.60
|
| Rate for Payer: UHCCP Medicaid |
$14,586.60
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$10,479.99
|
|
|
Service Code
|
APR-DRG 1811
|
| Min. Negotiated Rate |
$9,980.94 |
| Max. Negotiated Rate |
$10,479.99 |
| Rate for Payer: BCBS Complete |
$10,479.99
|
| Rate for Payer: Mclaren Medicaid |
$9,980.94
|
| Rate for Payer: Meridian Medicaid |
$10,479.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,980.94
|
| Rate for Payer: UHC Medicaid |
$9,980.94
|
| Rate for Payer: UHCCP Medicaid |
$9,980.94
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$30,742.64
|
|
|
Service Code
|
APR-DRG 1814
|
| Min. Negotiated Rate |
$29,278.71 |
| Max. Negotiated Rate |
$30,742.64 |
| Rate for Payer: BCBS Complete |
$30,742.64
|
| Rate for Payer: Mclaren Medicaid |
$29,278.71
|
| Rate for Payer: Meridian Medicaid |
$30,742.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,278.71
|
| Rate for Payer: UHC Medicaid |
$29,278.71
|
| Rate for Payer: UHCCP Medicaid |
$29,278.71
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$20,906.11
|
|
|
Service Code
|
APR-DRG 1813
|
| Min. Negotiated Rate |
$19,910.58 |
| Max. Negotiated Rate |
$20,906.11 |
| Rate for Payer: BCBS Complete |
$20,906.11
|
| Rate for Payer: Mclaren Medicaid |
$19,910.58
|
| Rate for Payer: Meridian Medicaid |
$20,906.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,910.58
|
| Rate for Payer: UHC Medicaid |
$19,910.58
|
| Rate for Payer: UHCCP Medicaid |
$19,910.58
|
|
|
LOXAPINE SUCCINATE 10 MG CAPSULE
|
Facility
|
OP
|
$321.12
|
|
|
Service Code
|
NDC 00591037001
|
| Hospital Charge Code |
4599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$289.01 |
| Rate for Payer: Aetna American Axle |
$208.73
|
| Rate for Payer: Aetna Commercial |
$272.95
|
| Rate for Payer: Aetna Medicare |
$160.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.73
|
| Rate for Payer: BCBS Complete |
$128.45
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Advantage |
$224.78
|
| Rate for Payer: Cofinity Commercial |
$276.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Healthscope Commercial |
$289.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.84
|
| Rate for Payer: PHP Commercial |
$272.95
|
| Rate for Payer: Priority Health SBD |
$202.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.73
|
| Rate for Payer: UHC Core |
$167.30
|
| Rate for Payer: UHC Exchange |
$126.20
|
| Rate for Payer: UMR Bronson Commercial |
$118.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.84
|
|
|
LOXAPINE SUCCINATE 10 MG CAPSULE
|
Facility
|
IP
|
$321.12
|
|
|
Service Code
|
NDC 00591037001
|
| Hospital Charge Code |
4599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$289.01 |
| Rate for Payer: Aetna American Axle |
$208.73
|
| Rate for Payer: Aetna Commercial |
$272.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.73
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Advantage |
$224.78
|
| Rate for Payer: Cofinity Commercial |
$276.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Healthscope Commercial |
$289.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.84
|
| Rate for Payer: PHP Commercial |
$272.95
|
| Rate for Payer: Priority Health SBD |
$202.31
|
| Rate for Payer: UMR Bronson Commercial |
$141.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.84
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
OP
|
$486.24
|
|
|
Service Code
|
NDC 00378702501
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.91 |
| Max. Negotiated Rate |
$437.62 |
| Rate for Payer: Aetna American Axle |
$316.06
|
| Rate for Payer: Aetna Commercial |
$413.30
|
| Rate for Payer: Aetna Medicare |
$243.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.06
|
| Rate for Payer: BCBS Complete |
$194.50
|
| Rate for Payer: Cash Price |
$388.99
|
| Rate for Payer: Cofinity Advantage |
$340.37
|
| Rate for Payer: Cofinity Commercial |
$418.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.99
|
| Rate for Payer: Healthscope Commercial |
$437.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.68
|
| Rate for Payer: PHP Commercial |
$413.30
|
| Rate for Payer: Priority Health SBD |
$306.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.06
|
| Rate for Payer: UHC Core |
$253.33
|
| Rate for Payer: UHC Exchange |
$191.09
|
| Rate for Payer: UMR Bronson Commercial |
$179.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.68
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$488.16
|
|
|
Service Code
|
NDC 00591037101
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.79 |
| Max. Negotiated Rate |
$439.34 |
| Rate for Payer: Aetna American Axle |
$317.30
|
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.30
|
| Rate for Payer: Cash Price |
$390.53
|
| Rate for Payer: Cofinity Advantage |
$341.71
|
| Rate for Payer: Cofinity Commercial |
$419.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.53
|
| Rate for Payer: Healthscope Commercial |
$439.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.12
|
| Rate for Payer: PHP Commercial |
$414.94
|
| Rate for Payer: Priority Health SBD |
$307.54
|
| Rate for Payer: UMR Bronson Commercial |
$214.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.12
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
OP
|
$488.16
|
|
|
Service Code
|
NDC 00591037101
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.62 |
| Max. Negotiated Rate |
$439.34 |
| Rate for Payer: Aetna American Axle |
$317.30
|
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna Medicare |
$244.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.30
|
| Rate for Payer: BCBS Complete |
$195.26
|
| Rate for Payer: Cash Price |
$390.53
|
| Rate for Payer: Cofinity Advantage |
$341.71
|
| Rate for Payer: Cofinity Commercial |
$419.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.53
|
| Rate for Payer: Healthscope Commercial |
$439.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$390.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.12
|
| Rate for Payer: PHP Commercial |
$414.94
|
| Rate for Payer: Priority Health SBD |
$307.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.30
|
| Rate for Payer: UHC Core |
$254.33
|
| Rate for Payer: UHC Exchange |
$191.85
|
| Rate for Payer: UMR Bronson Commercial |
$180.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.12
|
|
