|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$12,942.45
|
|
|
Service Code
|
APR-DRG 5324
|
| Min. Negotiated Rate |
$12,326.15 |
| Max. Negotiated Rate |
$12,942.45 |
| Rate for Payer: BCBS Complete |
$12,942.45
|
| Rate for Payer: Mclaren Medicaid |
$12,326.15
|
| Rate for Payer: Meridian Medicaid |
$12,942.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,326.15
|
| Rate for Payer: UHC Medicaid |
$12,326.15
|
| Rate for Payer: UHCCP Medicaid |
$12,326.15
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$6,922.50
|
|
|
Service Code
|
APR-DRG 5323
|
| Min. Negotiated Rate |
$6,592.85 |
| Max. Negotiated Rate |
$6,922.50 |
| Rate for Payer: BCBS Complete |
$6,922.50
|
| Rate for Payer: Mclaren Medicaid |
$6,592.85
|
| Rate for Payer: Meridian Medicaid |
$6,922.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,592.85
|
| Rate for Payer: UHC Medicaid |
$6,592.85
|
| Rate for Payer: UHCCP Medicaid |
$6,592.85
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$18,691.39
|
|
|
Service Code
|
MSDRG 760
|
| Min. Negotiated Rate |
$8,567.46 |
| Max. Negotiated Rate |
$18,691.39 |
| Rate for Payer: Aetna Medicare |
$9,379.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,272.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,272.98
|
| Rate for Payer: BCBS MAPPO |
$9,018.38
|
| Rate for Payer: BCBS Trust/PPO |
$18,691.39
|
| Rate for Payer: BCN Commercial |
$18,691.39
|
| Rate for Payer: BCN Medicare Advantage |
$9,018.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,018.38
|
| Rate for Payer: Mclaren Medicare |
$9,018.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,469.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,371.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,920.22
|
| Rate for Payer: Nomi Health Commercial |
$12,996.75
|
| Rate for Payer: PACE Medicare |
$8,567.46
|
| Rate for Payer: PACE SWMI |
$9,018.38
|
| Rate for Payer: PHP Medicare Advantage |
$9,018.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,243.06
|
| Rate for Payer: Priority Health Medicare |
$9,018.38
|
| Rate for Payer: Priority Health Tiered Network |
$12,994.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9,018.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,422.25
|
| Rate for Payer: UHC Core |
$13,739.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,018.38
|
| Rate for Payer: UHC Exchange |
$11,220.53
|
| Rate for Payer: VA VA |
$9,018.38
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,372.95
|
|
|
Service Code
|
MSDRG 761
|
| Min. Negotiated Rate |
$5,095.69 |
| Max. Negotiated Rate |
$11,372.95 |
| Rate for Payer: Aetna Medicare |
$5,578.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,704.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,704.85
|
| Rate for Payer: BCBS MAPPO |
$5,363.88
|
| Rate for Payer: BCBS Trust/PPO |
$11,372.95
|
| Rate for Payer: BCN Commercial |
$11,372.95
|
| Rate for Payer: BCN Medicare Advantage |
$5,363.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,363.88
|
| Rate for Payer: Mclaren Medicare |
$5,363.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,632.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,168.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,900.27
|
| Rate for Payer: Nomi Health Commercial |
$7,347.84
|
| Rate for Payer: PACE Medicare |
$5,095.69
|
| Rate for Payer: PACE SWMI |
$5,363.88
|
| Rate for Payer: PHP Medicare Advantage |
$5,363.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,197.68
|
| Rate for Payer: Priority Health Medicare |
$5,363.88
|
| Rate for Payer: Priority Health Tiered Network |
$7,358.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5,363.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,284.48
|
| Rate for Payer: UHC Core |
$7,767.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,363.88
|
| Rate for Payer: UHC Exchange |
$6,343.64
|
| Rate for Payer: VA VA |
$5,363.88
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$18,710.60
|
|
|
Service Code
|
APR-DRG 7403
|
| Min. Negotiated Rate |
$17,819.62 |
| Max. Negotiated Rate |
$18,710.60 |
| Rate for Payer: BCBS Complete |
$18,710.60
|
| Rate for Payer: Mclaren Medicaid |
$17,819.62
|
| Rate for Payer: Meridian Medicaid |
$18,710.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,819.62
|
| Rate for Payer: UHC Medicaid |
$17,819.62
|
| Rate for Payer: UHCCP Medicaid |
$17,819.62
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$6,005.43
|
|
|
Service Code
|
APR-DRG 7401
|
| Min. Negotiated Rate |
$5,719.46 |
| Max. Negotiated Rate |
$6,005.43 |
| Rate for Payer: BCBS Complete |
$6,005.43
|
| Rate for Payer: Mclaren Medicaid |
$5,719.46
|
| Rate for Payer: Meridian Medicaid |
$6,005.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,719.46
|
| Rate for Payer: UHC Medicaid |
$5,719.46
|
| Rate for Payer: UHCCP Medicaid |
$5,719.46
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$10,095.61
|
|
|
Service Code
|
APR-DRG 7402
|
| Min. Negotiated Rate |
$9,614.87 |
| Max. Negotiated Rate |
$10,095.61 |
| Rate for Payer: BCBS Complete |
$10,095.61
|
| Rate for Payer: Mclaren Medicaid |
$9,614.87
|
| Rate for Payer: Meridian Medicaid |
$10,095.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,614.87
|
| Rate for Payer: UHC Medicaid |
$9,614.87
|
| Rate for Payer: UHCCP Medicaid |
$9,614.87
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$35,033.79
|
|
|
Service Code
|
APR-DRG 7404
|
| Min. Negotiated Rate |
$33,365.51 |
| Max. Negotiated Rate |
$35,033.79 |
| Rate for Payer: BCBS Complete |
$35,033.79
|
| Rate for Payer: Mclaren Medicaid |
$33,365.51
|
| Rate for Payer: Meridian Medicaid |
$35,033.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$33,365.51
|
| Rate for Payer: UHC Medicaid |
$33,365.51
|
| Rate for Payer: UHCCP Medicaid |
$33,365.51
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00799000104
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.32
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.14
|
| Rate for Payer: UHC Core |
$11.34
|
| Rate for Payer: UHC Exchange |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00799000104
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.32
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
OP
|
$25.94
|
|
|
Service Code
|
NDC 46876000040
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Advantage |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.86
|
| Rate for Payer: UHC Core |
$13.51
|
| Rate for Payer: UHC Exchange |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 46876000040
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Advantage |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$34.75
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$31.27 |
| Rate for Payer: Aetna American Axle |
$22.59
|
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.59
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Cofinity Advantage |
$24.32
|
| Rate for Payer: Cofinity Commercial |
$29.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$31.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.06
|
| Rate for Payer: PHP Commercial |
$29.54
|
| Rate for Payer: Priority Health SBD |
$21.89
|
| Rate for Payer: UMR Bronson Commercial |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.06
|
|
|
MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$34.75
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$31.27 |
| Rate for Payer: Aetna American Axle |
$22.59
|
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna Medicare |
$17.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.59
|
| Rate for Payer: BCBS Complete |
$13.90
|
| Rate for Payer: BCBS Trust/PPO |
$26.42
|
| Rate for Payer: BCN Commercial |
$26.42
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Cofinity Advantage |
$24.32
|
| Rate for Payer: Cofinity Commercial |
$29.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$31.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.06
|
| Rate for Payer: PHP Commercial |
$29.54
|
| Rate for Payer: Priority Health SBD |
$21.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.45
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Exchange |
$13.45
|
| Rate for Payer: UMR Bronson Commercial |
$12.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.06
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$36.08
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
4904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna American Axle |
$23.45
|
| Rate for Payer: Aetna Commercial |
$30.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.45
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Advantage |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$31.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: PHP Commercial |
$30.67
|
| Rate for Payer: Priority Health SBD |
$22.73
|
| Rate for Payer: UMR Bronson Commercial |
$15.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.06
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$36.08
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
4904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna American Axle |
$23.45
|
| Rate for Payer: Aetna Commercial |
$30.67
|
| Rate for Payer: Aetna Medicare |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.45
|
| Rate for Payer: BCBS Complete |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$26.42
|
| Rate for Payer: BCN Commercial |
$26.42
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Advantage |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$31.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: PHP Commercial |
$30.67
|
| Rate for Payer: Priority Health SBD |
$22.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.45
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Exchange |
$13.45
|
| Rate for Payer: UMR Bronson Commercial |
$13.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.06
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$41.21
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$37.09 |
| Rate for Payer: Aetna American Axle |
$26.79
|
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare |
$20.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.79
|
| Rate for Payer: BCBS Complete |
$16.48
|
| Rate for Payer: BCBS Trust/PPO |
$26.42
|
| Rate for Payer: BCN Commercial |
$26.42
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Cofinity Advantage |
$28.85
|
| Rate for Payer: Cofinity Commercial |
$35.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.97
|
| Rate for Payer: Healthscope Commercial |
$37.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.91
|
| Rate for Payer: PHP Commercial |
$35.03
|
| Rate for Payer: Priority Health SBD |
$25.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.45
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Exchange |
$13.45
|
| Rate for Payer: UMR Bronson Commercial |
$15.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.91
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$41.21
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$37.09 |
| Rate for Payer: Aetna American Axle |
$26.79
|
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.79
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Cofinity Advantage |
$28.85
|
| Rate for Payer: Cofinity Commercial |
$35.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.97
|
| Rate for Payer: Healthscope Commercial |
$37.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.91
|
| Rate for Payer: PHP Commercial |
$35.03
|
| Rate for Payer: Priority Health SBD |
$25.96
|
| Rate for Payer: UMR Bronson Commercial |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.91
|
|
|
MEPIVACAINE 1 % (10 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$35.16
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
4914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Aetna American Axle |
$22.85
|
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.85
|
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Cofinity Advantage |
$24.61
|
| Rate for Payer: Cofinity Commercial |
$30.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$31.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.37
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health SBD |
$22.15
|
| Rate for Payer: UMR Bronson Commercial |
$15.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.37
|
|
|
MEPIVACAINE 1 % (10 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$35.16
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
4914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Aetna American Axle |
$22.85
|
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.85
|
| Rate for Payer: BCBS Complete |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.16
|
| Rate for Payer: BCN Commercial |
$12.16
|
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Cofinity Advantage |
$24.61
|
| Rate for Payer: Cofinity Commercial |
$30.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$31.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.37
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health SBD |
$22.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.19
|
| Rate for Payer: UHC Core |
$6.19
|
| Rate for Payer: UHC Exchange |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.37
|
|
|
MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$25.10
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna American Axle |
$16.32
|
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cofinity Advantage |
$17.57
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$22.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.82
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health SBD |
$15.81
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.82
|
|
|
MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$25.10
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna American Axle |
$16.32
|
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: BCBS Complete |
$10.04
|
| Rate for Payer: BCBS Trust/PPO |
$12.16
|
| Rate for Payer: BCN Commercial |
$12.16
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cofinity Advantage |
$17.57
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$22.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.82
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health SBD |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.19
|
| Rate for Payer: UHC Core |
$6.19
|
| Rate for Payer: UHC Exchange |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.82
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$27.86
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna American Axle |
$18.11
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.11
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.16
|
| Rate for Payer: BCN Commercial |
$12.16
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cofinity Advantage |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.89
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.19
|
| Rate for Payer: UHC Core |
$6.19
|
| Rate for Payer: UHC Exchange |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$10.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.89
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.86
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna American Axle |
$18.11
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.11
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cofinity Advantage |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.89
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: UMR Bronson Commercial |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.89
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$8,599.22
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,783.66 |
| Max. Negotiated Rate |
$7,739.30 |
| Rate for Payer: Aetna American Axle |
$5,589.49
|
| Rate for Payer: Aetna Commercial |
$7,309.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,589.49
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cofinity Advantage |
$6,019.45
|
| Rate for Payer: Cofinity Commercial |
$7,395.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,879.38
|
| Rate for Payer: Healthscope Commercial |
$7,739.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,019.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,449.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,309.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,449.41
|
| Rate for Payer: PHP Commercial |
$7,309.34
|
| Rate for Payer: Priority Health SBD |
$5,417.51
|
| Rate for Payer: UMR Bronson Commercial |
$3,783.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,449.41
|
|
