|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$308.75
|
|
|
Service Code
|
NDC 68084-070-01
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna American Axle |
$200.69
|
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.69
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$216.12
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.44
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.12
|
| Rate for Payer: Priority Health SBD |
$194.51
|
| Rate for Payer: UMR Bronson Commercial |
$135.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 0904-7083-61
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.93 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna American Axle |
$221.49
|
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.49
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$238.52
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.64
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.52
|
| Rate for Payer: Priority Health SBD |
$214.67
|
| Rate for Payer: UMR Bronson Commercial |
$149.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$1,183.63
|
|
|
Service Code
|
NDC 62135-309-01
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$1,065.27 |
| Rate for Payer: Aetna American Axle |
$769.36
|
| Rate for Payer: Aetna Commercial |
$1,006.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$769.36
|
| Rate for Payer: Cash Price |
$946.90
|
| Rate for Payer: Cofinity Commercial |
$1,017.92
|
| Rate for Payer: Cofinity Commercial |
$828.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.90
|
| Rate for Payer: Healthscope Commercial |
$1,065.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$828.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,006.09
|
| Rate for Payer: PHP Commercial |
$1,006.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.54
|
| Rate for Payer: Priority Health SBD |
$745.69
|
| Rate for Payer: UMR Bronson Commercial |
$520.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.72
|
|
|
CIPROFLOXACIN 6 % (6 MG/0.1 ML) INTRATYMPANIC SUSPENSION
|
Facility
|
IP
|
$981.30
|
|
|
Service Code
|
HCPCS J7342
|
| Hospital Charge Code |
177132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$431.77 |
| Max. Negotiated Rate |
$883.17 |
| Rate for Payer: Aetna American Axle |
$637.84
|
| Rate for Payer: Aetna American Axle |
$644.28
|
| Rate for Payer: Aetna Commercial |
$842.52
|
| Rate for Payer: Aetna Commercial |
$834.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.28
|
| Rate for Payer: Cash Price |
$785.04
|
| Rate for Payer: Cash Price |
$792.96
|
| Rate for Payer: Cofinity Commercial |
$843.92
|
| Rate for Payer: Cofinity Commercial |
$686.91
|
| Rate for Payer: Cofinity Commercial |
$693.84
|
| Rate for Payer: Cofinity Commercial |
$852.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.96
|
| Rate for Payer: Healthscope Commercial |
$892.08
|
| Rate for Payer: Healthscope Commercial |
$883.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$693.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$686.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$834.10
|
| Rate for Payer: PHP Commercial |
$834.10
|
| Rate for Payer: PHP Commercial |
$842.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.84
|
| Rate for Payer: Priority Health SBD |
$618.22
|
| Rate for Payer: Priority Health SBD |
$624.46
|
| Rate for Payer: UMR Bronson Commercial |
$436.13
|
| Rate for Payer: UMR Bronson Commercial |
$431.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.98
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$887.82
|
|
|
Service Code
|
NDC 62135-310-50
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$390.64 |
| Max. Negotiated Rate |
$799.04 |
| Rate for Payer: Aetna American Axle |
$577.08
|
| Rate for Payer: Aetna Commercial |
$754.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.08
|
| Rate for Payer: Cash Price |
$710.26
|
| Rate for Payer: Cofinity Commercial |
$621.47
|
| Rate for Payer: Cofinity Commercial |
$763.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$710.26
|
| Rate for Payer: Healthscope Commercial |
$799.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$621.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$754.65
|
| Rate for Payer: PHP Commercial |
$754.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.47
|
| Rate for Payer: Priority Health SBD |
$559.33
|
| Rate for Payer: UMR Bronson Commercial |
$390.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.86
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$260.64
|
|
|
Service Code
|
NDC 68084-071-01
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.68 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna American Axle |
$169.42
|
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.42
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cofinity Commercial |
$182.45
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.54
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.45
|
| Rate for Payer: Priority Health SBD |
$164.20
|
| Rate for Payer: UMR Bronson Commercial |
$114.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$141.55
|
|
|
Service Code
|
NDC 55111-128-50
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.08
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$62.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$141.55
|
|
|
Service Code
|
NDC 0143-9929-50
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.08
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$62.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$37,381.90
|
|
|
Service Code
|
MS-DRG 286
|
| Min. Negotiated Rate |
$16,267.31 |
| Max. Negotiated Rate |
$37,381.90 |
| Rate for Payer: Aetna Medicare |
$17,808.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,404.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,404.35
|
| Rate for Payer: BCBS MAPPO |
$17,123.48
|
| Rate for Payer: BCBS Trust/PPO |
$37,381.90
|
| Rate for Payer: BCN Medicare Advantage |
$17,123.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,123.48
|
| Rate for Payer: Mclaren Medicare |
$17,123.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,979.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,692.00
|
| Rate for Payer: PACE Medicare |
$16,267.31
|
| Rate for Payer: PACE SWMI |
$17,123.48
|
| Rate for Payer: PHP Medicare Advantage |
$17,123.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,932.69
|
| Rate for Payer: Priority Health Medicare |
$17,123.48
|
| Rate for Payer: Priority Health Narrow Network |
$24,746.15
|
| Rate for Payer: Railroad Medicare Medicare |
$17,123.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,881.52
|
| Rate for Payer: UHC Core |
$26,962.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,123.48
|
| Rate for Payer: UHC Exchange |
$21,435.29
|
| Rate for Payer: UHC Medicare Advantage |
$17,637.18
|
| Rate for Payer: VA VA |
$17,123.48
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$23,093.55
|
|
|
Service Code
|
MS-DRG 287
|
| Min. Negotiated Rate |
$8,404.84 |
| Max. Negotiated Rate |
$23,093.55 |
| Rate for Payer: Aetna Medicare |
$9,201.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,059.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,059.00
|
| Rate for Payer: BCBS MAPPO |
$8,847.20
|
| Rate for Payer: BCBS Trust/PPO |
$23,093.55
|
| Rate for Payer: BCN Medicare Advantage |
$8,847.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,847.20
|
| Rate for Payer: Mclaren Medicare |
$8,847.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,289.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,174.28
|
| Rate for Payer: PACE Medicare |
$8,404.84
|
| Rate for Payer: PACE SWMI |
$8,847.20
|
| Rate for Payer: PHP Medicare Advantage |
$8,847.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,520.87
|
| Rate for Payer: Priority Health Medicare |
$8,847.20
|
| Rate for Payer: Priority Health Narrow Network |
$12,416.70
|
| Rate for Payer: Railroad Medicare Medicare |
$8,847.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,498.73
|
| Rate for Payer: UHC Core |
$13,528.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,847.20
|
| Rate for Payer: UHC Exchange |
$10,755.43
|
| Rate for Payer: UHC Medicare Advantage |
$9,112.62
|
| Rate for Payer: VA VA |
$8,847.20
|
|
|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,840.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.24
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$193.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 54150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.32 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.65
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$93.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$16,190.61
|
|
|
Service Code
|
MS-DRG 433
|
| Min. Negotiated Rate |
$8,034.43 |
| Max. Negotiated Rate |
$16,190.61 |
| Rate for Payer: Aetna Medicare |
$8,795.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,571.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,571.61
|
| Rate for Payer: BCBS MAPPO |
$8,457.29
|
| Rate for Payer: BCBS Trust/PPO |
$16,190.61
|
| Rate for Payer: BCN Medicare Advantage |
$8,457.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,457.29
|
| Rate for Payer: Mclaren Medicare |
$8,457.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,880.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,725.88
|
| Rate for Payer: PACE Medicare |
$8,034.43
|
| Rate for Payer: PACE SWMI |
$8,457.29
|
| Rate for Payer: PHP Medicare Advantage |
$8,457.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,794.77
|
| Rate for Payer: Priority Health Medicare |
$8,457.29
|
| Rate for Payer: Priority Health Narrow Network |
$11,835.82
|
| Rate for Payer: Railroad Medicare Medicare |
$8,457.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,726.87
|
| Rate for Payer: UHC Core |
$12,895.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,457.29
|
| Rate for Payer: UHC Exchange |
$10,252.26
|
| Rate for Payer: UHC Medicare Advantage |
$8,711.01
|
| Rate for Payer: VA VA |
$8,457.29
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$37,027.58
|
|
|
Service Code
|
MS-DRG 432
|
| Min. Negotiated Rate |
$14,513.26 |
| Max. Negotiated Rate |
$37,027.58 |
| Rate for Payer: Aetna Medicare |
$15,888.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,096.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,096.40
|
| Rate for Payer: BCBS MAPPO |
$15,277.12
|
| Rate for Payer: BCBS Trust/PPO |
$37,027.58
|
| Rate for Payer: BCN Medicare Advantage |
$15,277.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,277.12
|
| Rate for Payer: Mclaren Medicare |
$15,277.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,040.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,568.69
|
| Rate for Payer: PACE Medicare |
$14,513.26
|
| Rate for Payer: PACE SWMI |
$15,277.12
|
| Rate for Payer: PHP Medicare Advantage |
$15,277.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,494.45
|
| Rate for Payer: Priority Health Medicare |
$15,277.12
|
| Rate for Payer: Priority Health Narrow Network |
$21,995.56
|
| Rate for Payer: Railroad Medicare Medicare |
$15,277.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,226.66
|
| Rate for Payer: UHC Core |
$23,965.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,277.12
|
| Rate for Payer: UHC Exchange |
$19,052.70
|
| Rate for Payer: UHC Medicare Advantage |
$15,735.43
|
| Rate for Payer: VA VA |
$15,277.12
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,865.78
|
|
|
Service Code
|
MS-DRG 434
|
| Min. Negotiated Rate |
$5,387.96 |
| Max. Negotiated Rate |
$10,865.78 |
| Rate for Payer: Aetna Medicare |
$5,898.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,089.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,089.42
|
| Rate for Payer: BCBS MAPPO |
$5,671.54
|
| Rate for Payer: BCBS Trust/PPO |
$10,865.78
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.54
|
| Rate for Payer: Mclaren Medicare |
$5,671.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,955.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,522.27
|
| Rate for Payer: PACE Medicare |
$5,387.96
|
| Rate for Payer: PACE SWMI |
$5,671.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,607.27
|
| Rate for Payer: Priority Health Medicare |
$5,671.54
|
| Rate for Payer: Priority Health Narrow Network |
$7,685.82
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,212.55
|
| Rate for Payer: UHC Core |
$8,374.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,671.54
|
| Rate for Payer: UHC Exchange |
$6,657.51
|
| Rate for Payer: UHC Medicare Advantage |
$5,841.69
|
| Rate for Payer: VA VA |
$5,671.54
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.24
|
|
|
Service Code
|
NDC 0781-3150-75
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna American Axle |
$15.11
|
| Rate for Payer: Aetna Commercial |
$19.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: Cash Price |
$18.59
|
| Rate for Payer: Cofinity Commercial |
$16.27
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.59
|
| Rate for Payer: Healthscope Commercial |
$20.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.75
|
| Rate for Payer: PHP Commercial |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.27
|
| Rate for Payer: Priority Health SBD |
$14.64
|
| Rate for Payer: UMR Bronson Commercial |
$10.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.43
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$64.89
|
|
|
Service Code
|
NDC 0074-4378-05
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$58.40 |
| Rate for Payer: Aetna American Axle |
$42.18
|
| Rate for Payer: Aetna Commercial |
$55.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.18
|
| Rate for Payer: Cash Price |
$51.91
|
| Rate for Payer: Cofinity Commercial |
$45.42
|
| Rate for Payer: Cofinity Commercial |
$55.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.91
|
| Rate for Payer: Healthscope Commercial |
$58.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.16
|
| Rate for Payer: PHP Commercial |
$55.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.42
|
| Rate for Payer: Priority Health SBD |
$40.88
|
| Rate for Payer: UMR Bronson Commercial |
$28.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.67
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.24
|
|
|
Service Code
|
NDC 0781-3150-95
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna American Axle |
$15.11
|
| Rate for Payer: Aetna Commercial |
$19.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: Cash Price |
$18.59
|
| Rate for Payer: Cofinity Commercial |
$16.27
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.59
|
| Rate for Payer: Healthscope Commercial |
$20.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.75
|
| Rate for Payer: PHP Commercial |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.27
|
| Rate for Payer: Priority Health SBD |
$14.64
|
| Rate for Payer: UMR Bronson Commercial |
$10.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.43
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.90
|
|
|
Service Code
|
NDC 63323-416-05
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna American Axle |
$25.28
|
| Rate for Payer: Aetna Commercial |
$33.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.28
|
| Rate for Payer: Cash Price |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$27.23
|
| Rate for Payer: Cofinity Commercial |
$33.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.12
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.06
|
| Rate for Payer: PHP Commercial |
$33.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.23
|
| Rate for Payer: Priority Health SBD |
$24.51
|
| Rate for Payer: UMR Bronson Commercial |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.18
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$31.02
|
|
|
Service Code
|
NDC 0703-2056-03
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: Aetna American Axle |
$20.16
|
| Rate for Payer: Aetna Commercial |
$26.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.16
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$21.71
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.82
|
| Rate for Payer: Healthscope Commercial |
$27.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.37
|
| Rate for Payer: PHP Commercial |
$26.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.71
|
| Rate for Payer: Priority Health SBD |
$19.54
|
| Rate for Payer: UMR Bronson Commercial |
$13.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.26
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$31.02
|
|
|
Service Code
|
NDC 0703-2056-01
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: Aetna American Axle |
$20.16
|
| Rate for Payer: Aetna Commercial |
$26.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.16
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$21.71
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.82
|
| Rate for Payer: Healthscope Commercial |
$27.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.37
|
| Rate for Payer: PHP Commercial |
$26.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.71
|
| Rate for Payer: Priority Health SBD |
$19.54
|
| Rate for Payer: UMR Bronson Commercial |
$13.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.26
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$180.56
|
|
|
Service Code
|
NDC 0781-3153-80
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$162.50 |
| Rate for Payer: Aetna American Axle |
$117.36
|
| Rate for Payer: Aetna Commercial |
$153.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.36
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cofinity Commercial |
$126.39
|
| Rate for Payer: Cofinity Commercial |
$155.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.45
|
| Rate for Payer: Healthscope Commercial |
$162.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.48
|
| Rate for Payer: PHP Commercial |
$153.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.39
|
| Rate for Payer: Priority Health SBD |
$113.75
|
| Rate for Payer: UMR Bronson Commercial |
$79.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.42
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$180.56
|
|
|
Service Code
|
NDC 0781-3153-95
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$162.50 |
| Rate for Payer: Aetna American Axle |
$117.36
|
| Rate for Payer: Aetna Commercial |
$153.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.36
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cofinity Commercial |
$126.39
|
| Rate for Payer: Cofinity Commercial |
$155.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.45
|
| Rate for Payer: Healthscope Commercial |
$162.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.48
|
| Rate for Payer: PHP Commercial |
$153.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.39
|
| Rate for Payer: Priority Health SBD |
$113.75
|
| Rate for Payer: UMR Bronson Commercial |
$79.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.42
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$226.99
|
|
|
Service Code
|
NDC 0409-1103-11
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$204.29 |
| Rate for Payer: Aetna American Axle |
$147.54
|
| Rate for Payer: Aetna Commercial |
$192.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.54
|
| Rate for Payer: Cash Price |
$181.59
|
| Rate for Payer: Cofinity Commercial |
$158.89
|
| Rate for Payer: Cofinity Commercial |
$195.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.59
|
| Rate for Payer: Healthscope Commercial |
$204.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.94
|
| Rate for Payer: PHP Commercial |
$192.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.89
|
| Rate for Payer: Priority Health SBD |
$143.00
|
| Rate for Payer: UMR Bronson Commercial |
$99.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.24
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$980.51
|
|
|
Service Code
|
NDC 0074-4382-20
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$431.42 |
| Max. Negotiated Rate |
$882.46 |
| Rate for Payer: Aetna American Axle |
$637.33
|
| Rate for Payer: Aetna Commercial |
$833.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.33
|
| Rate for Payer: Cash Price |
$784.41
|
| Rate for Payer: Cofinity Commercial |
$686.36
|
| Rate for Payer: Cofinity Commercial |
$843.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$784.41
|
| Rate for Payer: Healthscope Commercial |
$882.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$686.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$833.43
|
| Rate for Payer: PHP Commercial |
$833.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.36
|
| Rate for Payer: Priority Health SBD |
$617.72
|
| Rate for Payer: UMR Bronson Commercial |
$431.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.38
|
|
