|
MINERAL OIL ORAL
|
Facility
|
IP
|
$9.33
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna American Axle |
$6.06
|
| Rate for Payer: Aetna Commercial |
$7.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$8.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.00
|
| Rate for Payer: PHP Commercial |
$7.93
|
| Rate for Payer: Priority Health SBD |
$5.88
|
| Rate for Payer: UMR Bronson Commercial |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.00
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$9.33
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna American Axle |
$6.06
|
| Rate for Payer: Aetna Commercial |
$7.93
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: BCBS Complete |
$3.73
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$8.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.00
|
| Rate for Payer: PHP Commercial |
$7.93
|
| Rate for Payer: Priority Health SBD |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.06
|
| Rate for Payer: UHC Core |
$4.86
|
| Rate for Payer: UHC Exchange |
$3.67
|
| Rate for Payer: UMR Bronson Commercial |
$3.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.00
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$3.53
|
|
|
Service Code
|
NDC 09900000569
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Advantage |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$8.88
|
|
|
Service Code
|
NDC 96295013630
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$3.53
|
|
|
Service Code
|
NDC 09900000569
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Advantage |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$8.88
|
|
|
Service Code
|
NDC 96295013630
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.77
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$3.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MINOCYCLINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$916.26
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
10612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$403.15 |
| Max. Negotiated Rate |
$824.63 |
| Rate for Payer: Aetna American Axle |
$595.57
|
| Rate for Payer: Aetna Commercial |
$778.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.57
|
| Rate for Payer: Cash Price |
$733.01
|
| Rate for Payer: Cofinity Advantage |
$641.38
|
| Rate for Payer: Cofinity Commercial |
$787.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.01
|
| Rate for Payer: Healthscope Commercial |
$824.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$641.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$687.20
|
| Rate for Payer: PHP Commercial |
$778.82
|
| Rate for Payer: Priority Health SBD |
$577.24
|
| Rate for Payer: UMR Bronson Commercial |
$403.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.20
|
|
|
MINOCYCLINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$916.26
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
10612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$824.63 |
| Rate for Payer: Aetna American Axle |
$595.57
|
| Rate for Payer: Aetna Commercial |
$778.82
|
| Rate for Payer: Aetna Medicare |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.33
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$2.66
|
| Rate for Payer: BCBS Trust/PPO |
$8.08
|
| Rate for Payer: BCN Commercial |
$8.08
|
| Rate for Payer: BCN Medicare Advantage |
$2.66
|
| Rate for Payer: Cash Price |
$733.01
|
| Rate for Payer: Cash Price |
$733.01
|
| Rate for Payer: Cofinity Advantage |
$641.38
|
| Rate for Payer: Cofinity Commercial |
$787.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$824.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$641.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.20
|
| Rate for Payer: Mclaren Medicaid |
$2.66
|
| Rate for Payer: Mclaren Medicare |
$2.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.82
|
| Rate for Payer: Nomi Health Commercial |
$7.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$687.20
|
| Rate for Payer: PACE Medicare |
$2.53
|
| Rate for Payer: PACE SWMI |
$2.66
|
| Rate for Payer: PHP Commercial |
$778.82
|
| Rate for Payer: PHP Medicare Advantage |
$2.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.42
|
| Rate for Payer: Priority Health Medicare |
$2.66
|
| Rate for Payer: Priority Health SBD |
$577.24
|
| Rate for Payer: Priority Health Tiered Network |
$6.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.41
|
| Rate for Payer: UHC Core |
$4.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.66
|
| Rate for Payer: UHC Exchange |
$4.41
|
| Rate for Payer: UHC Medicaid |
$1.39
|
| Rate for Payer: UHCCP Medicaid |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$339.02
|
| Rate for Payer: VA VA |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.20
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
OP
|
$448.85
|
|
|
Service Code
|
NDC 68382031601
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.07 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna American Axle |
$291.75
|
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna Medicare |
$224.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.75
|
| Rate for Payer: BCBS Complete |
$179.54
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Advantage |
$314.19
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$359.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.64
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health SBD |
$282.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.75
|
| Rate for Payer: UHC Core |
$233.85
|
| Rate for Payer: UHC Exchange |
$176.40
|
| Rate for Payer: UMR Bronson Commercial |
$166.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 00591569401
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna American Axle |
$152.52
|
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UMR Bronson Commercial |
$103.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 00591569401
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna American Axle |
$152.52
|
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$117.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: BCBS Complete |
$93.86
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.52
|
| Rate for Payer: UHC Core |
$122.25
|
| Rate for Payer: UHC Exchange |
$92.22
|
| Rate for Payer: UMR Bronson Commercial |
$86.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
NDC 68382031601
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.49 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna American Axle |
$291.75
|
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.75
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Advantage |
$314.19
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.64
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health SBD |
$282.78
|
| Rate for Payer: UMR Bronson Commercial |
$197.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$37,487.09
|
|
|
Service Code
|
MSDRG 663
|
| Min. Negotiated Rate |
$12,640.64 |
| Max. Negotiated Rate |
$37,487.09 |
| Rate for Payer: Aetna Medicare |
$13,838.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,632.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,632.42
|
| Rate for Payer: BCBS MAPPO |
$13,305.94
|
| Rate for Payer: BCBS Trust/PPO |
$37,487.09
|
| Rate for Payer: BCN Commercial |
$37,487.09
|
| Rate for Payer: BCN Medicare Advantage |
$13,305.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,305.94
|
| Rate for Payer: Mclaren Medicare |
$13,305.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,971.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,301.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,636.53
|
| Rate for Payer: Nomi Health Commercial |
$19,610.58
|
| Rate for Payer: PACE Medicare |
$12,640.64
|
| Rate for Payer: PACE SWMI |
$13,305.94
|
| Rate for Payer: PHP Medicare Advantage |
$13,305.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,508.88
|
| Rate for Payer: Priority Health Medicare |
$13,305.94
|
| Rate for Payer: Priority Health Tiered Network |
$19,607.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13,305.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,779.26
|
| Rate for Payer: UHC Core |
$20,730.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,305.94
|
| Rate for Payer: UHC Exchange |
$16,930.47
|
| Rate for Payer: VA VA |
$13,305.94
|
|
|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$60,515.73
|
|
|
Service Code
|
MSDRG 662
|
| Min. Negotiated Rate |
$24,885.58 |
| Max. Negotiated Rate |
$60,515.73 |
| Rate for Payer: Aetna Medicare |
$27,243.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,744.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,744.19
|
| Rate for Payer: BCBS MAPPO |
$26,195.35
|
| Rate for Payer: BCBS Trust/PPO |
$60,515.73
|
| Rate for Payer: BCN Commercial |
$60,515.73
|
| Rate for Payer: BCN Medicare Advantage |
$26,195.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,195.35
|
| Rate for Payer: Mclaren Medicare |
$26,195.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27,505.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,124.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,814.88
|
| Rate for Payer: Nomi Health Commercial |
$39,493.35
|
| Rate for Payer: PACE Medicare |
$24,885.58
|
| Rate for Payer: PACE SWMI |
$26,195.35
|
| Rate for Payer: PHP Medicare Advantage |
$26,195.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49,357.93
|
| Rate for Payer: Priority Health Medicare |
$26,195.35
|
| Rate for Payer: Priority Health Tiered Network |
$39,486.34
|
| Rate for Payer: Railroad Medicare Medicare |
$26,195.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,902.45
|
| Rate for Payer: UHC Core |
$41,749.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26,195.35
|
| Rate for Payer: UHC Exchange |
$34,095.93
|
| Rate for Payer: VA VA |
$26,195.35
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,278.06
|
|
|
Service Code
|
MSDRG 664
|
| Min. Negotiated Rate |
$8,880.49 |
| Max. Negotiated Rate |
$27,278.06 |
| Rate for Payer: Aetna Medicare |
$9,721.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,684.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,684.85
|
| Rate for Payer: BCBS MAPPO |
$9,347.88
|
| Rate for Payer: BCBS Trust/PPO |
$27,278.06
|
| Rate for Payer: BCN Commercial |
$27,278.06
|
| Rate for Payer: BCN Medicare Advantage |
$9,347.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,347.88
|
| Rate for Payer: Mclaren Medicare |
$9,347.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,815.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,750.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,282.67
|
| Rate for Payer: Nomi Health Commercial |
$13,505.01
|
| Rate for Payer: PACE Medicare |
$8,880.49
|
| Rate for Payer: PACE SWMI |
$9,347.88
|
| Rate for Payer: PHP Medicare Advantage |
$9,347.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,878.27
|
| Rate for Payer: Priority Health Medicare |
$9,347.88
|
| Rate for Payer: Priority Health Tiered Network |
$13,502.61
|
| Rate for Payer: Railroad Medicare Medicare |
$9,347.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,064.47
|
| Rate for Payer: UHC Core |
$14,276.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,347.88
|
| Rate for Payer: UHC Exchange |
$11,659.33
|
| Rate for Payer: VA VA |
$9,347.88
|
|
|
MINOR SKIN DISORDERS WITH MCC
|
Facility
|
IP
|
$30,596.88
|
|
|
Service Code
|
MSDRG 606
|
| Min. Negotiated Rate |
$12,585.02 |
| Max. Negotiated Rate |
$30,596.88 |
| Rate for Payer: Aetna Medicare |
$13,777.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,559.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,559.24
|
| Rate for Payer: BCBS MAPPO |
$13,247.39
|
| Rate for Payer: BCBS Trust/PPO |
$30,596.88
|
| Rate for Payer: BCN Commercial |
$30,596.88
|
| Rate for Payer: BCN Medicare Advantage |
$13,247.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,247.39
|
| Rate for Payer: Mclaren Medicare |
$13,247.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,909.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,234.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,572.13
|
| Rate for Payer: Nomi Health Commercial |
$19,520.28
|
| Rate for Payer: PACE Medicare |
$12,585.02
|
| Rate for Payer: PACE SWMI |
$13,247.39
|
| Rate for Payer: PHP Medicare Advantage |
$13,247.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,396.02
|
| Rate for Payer: Priority Health Medicare |
$13,247.39
|
| Rate for Payer: Priority Health Tiered Network |
$19,516.81
|
| Rate for Payer: Railroad Medicare Medicare |
$13,247.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,665.16
|
| Rate for Payer: UHC Core |
$20,635.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,247.39
|
| Rate for Payer: UHC Exchange |
$16,852.51
|
| Rate for Payer: VA VA |
$13,247.39
|
|
|
MINOR SKIN DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$14,779.62
|
|
|
Service Code
|
MSDRG 607
|
| Min. Negotiated Rate |
$7,764.26 |
| Max. Negotiated Rate |
$14,779.62 |
| Rate for Payer: Aetna Medicare |
$8,499.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,216.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,216.12
|
| Rate for Payer: BCBS MAPPO |
$8,172.90
|
| Rate for Payer: BCBS Trust/PPO |
$14,779.62
|
| Rate for Payer: BCN Commercial |
$14,779.62
|
| Rate for Payer: BCN Medicare Advantage |
$8,172.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,172.90
|
| Rate for Payer: Mclaren Medicare |
$8,172.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,581.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,398.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,990.19
|
| Rate for Payer: Nomi Health Commercial |
$11,692.56
|
| Rate for Payer: PACE Medicare |
$7,764.26
|
| Rate for Payer: PACE SWMI |
$8,172.90
|
| Rate for Payer: PHP Medicare Advantage |
$8,172.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,613.11
|
| Rate for Payer: Priority Health Medicare |
$8,172.90
|
| Rate for Payer: Priority Health Tiered Network |
$11,690.48
|
| Rate for Payer: Railroad Medicare Medicare |
$8,172.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,774.32
|
| Rate for Payer: UHC Core |
$12,360.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,172.90
|
| Rate for Payer: UHC Exchange |
$10,094.58
|
| Rate for Payer: VA VA |
$8,172.90
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC
|
Facility
|
IP
|
$33,965.12
|
|
|
Service Code
|
MSDRG 345
|
| Min. Negotiated Rate |
$12,517.49 |
| Max. Negotiated Rate |
$33,965.12 |
| Rate for Payer: Aetna Medicare |
$13,703.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,470.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,470.39
|
| Rate for Payer: BCBS MAPPO |
$13,176.31
|
| Rate for Payer: BCBS Trust/PPO |
$33,965.12
|
| Rate for Payer: BCN Commercial |
$33,965.12
|
| Rate for Payer: BCN Medicare Advantage |
$13,176.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,176.31
|
| Rate for Payer: Mclaren Medicare |
$13,176.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,835.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,152.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,493.94
|
| Rate for Payer: Nomi Health Commercial |
$19,410.63
|
| Rate for Payer: PACE Medicare |
$12,517.49
|
| Rate for Payer: PACE SWMI |
$13,176.31
|
| Rate for Payer: PHP Medicare Advantage |
$13,176.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,258.98
|
| Rate for Payer: Priority Health Medicare |
$13,176.31
|
| Rate for Payer: Priority Health Tiered Network |
$19,407.18
|
| Rate for Payer: Railroad Medicare Medicare |
$13,176.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,526.61
|
| Rate for Payer: UHC Core |
$20,519.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,176.31
|
| Rate for Payer: UHC Exchange |
$16,757.84
|
| Rate for Payer: VA VA |
$13,176.31
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC
|
Facility
|
IP
|
$59,025.14
|
|
|
Service Code
|
MSDRG 344
|
| Min. Negotiated Rate |
$21,082.53 |
| Max. Negotiated Rate |
$59,025.14 |
| Rate for Payer: Aetna Medicare |
$23,079.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,740.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,740.17
|
| Rate for Payer: BCBS MAPPO |
$22,192.14
|
| Rate for Payer: BCBS Trust/PPO |
$59,025.14
|
| Rate for Payer: BCN Commercial |
$59,025.14
|
| Rate for Payer: BCN Medicare Advantage |
$22,192.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,192.14
|
| Rate for Payer: Mclaren Medicare |
$22,192.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,301.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,520.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,411.35
|
| Rate for Payer: Nomi Health Commercial |
$33,318.12
|
| Rate for Payer: PACE Medicare |
$21,082.53
|
| Rate for Payer: PACE SWMI |
$22,192.14
|
| Rate for Payer: PHP Medicare Advantage |
$22,192.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,640.26
|
| Rate for Payer: Priority Health Medicare |
$22,192.14
|
| Rate for Payer: Priority Health Tiered Network |
$33,312.21
|
| Rate for Payer: Railroad Medicare Medicare |
$22,192.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,099.64
|
| Rate for Payer: UHC Core |
$35,221.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,192.14
|
| Rate for Payer: UHC Exchange |
$28,764.64
|
| Rate for Payer: VA VA |
$22,192.14
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,618.06
|
|
|
Service Code
|
MSDRG 346
|
| Min. Negotiated Rate |
$9,987.15 |
| Max. Negotiated Rate |
$31,618.06 |
| Rate for Payer: Aetna Medicare |
$10,933.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,140.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,140.99
|
| Rate for Payer: BCBS MAPPO |
$10,512.79
|
| Rate for Payer: BCBS Trust/PPO |
$31,618.06
|
| Rate for Payer: BCN Commercial |
$31,618.06
|
| Rate for Payer: BCN Medicare Advantage |
$10,512.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,512.79
|
| Rate for Payer: Mclaren Medicare |
$10,512.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,038.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,089.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,564.07
|
| Rate for Payer: Nomi Health Commercial |
$15,301.98
|
| Rate for Payer: PACE Medicare |
$9,987.15
|
| Rate for Payer: PACE SWMI |
$10,512.79
|
| Rate for Payer: PHP Medicare Advantage |
$10,512.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,124.08
|
| Rate for Payer: Priority Health Medicare |
$10,512.79
|
| Rate for Payer: Priority Health Tiered Network |
$15,299.26
|
| Rate for Payer: Railroad Medicare Medicare |
$10,512.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,335.06
|
| Rate for Payer: UHC Core |
$16,176.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,512.79
|
| Rate for Payer: UHC Exchange |
$13,210.71
|
| Rate for Payer: VA VA |
$10,512.79
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$406.60
|
|
|
Service Code
|
NDC 49884025701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.90 |
| Max. Negotiated Rate |
$365.94 |
| Rate for Payer: Aetna American Axle |
$264.29
|
| Rate for Payer: Aetna Commercial |
$345.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.29
|
| Rate for Payer: Cash Price |
$325.28
|
| Rate for Payer: Cofinity Advantage |
$284.62
|
| Rate for Payer: Cofinity Commercial |
$349.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.28
|
| Rate for Payer: Healthscope Commercial |
$365.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.95
|
| Rate for Payer: PHP Commercial |
$345.61
|
| Rate for Payer: Priority Health SBD |
$256.16
|
| Rate for Payer: UMR Bronson Commercial |
$178.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.95
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna American Axle |
$1.85
|
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Advantage |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health SBD |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.85
|
| Rate for Payer: UHC Core |
$1.48
|
| Rate for Payer: UHC Exchange |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 53489038701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna American Axle |
$152.52
|
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UMR Bronson Commercial |
$103.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna American Axle |
$1.85
|
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Advantage |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health SBD |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$284.64
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.32 |
| Max. Negotiated Rate |
$256.18 |
| Rate for Payer: Aetna American Axle |
$185.02
|
| Rate for Payer: Aetna Commercial |
$241.94
|
| Rate for Payer: Aetna Medicare |
$142.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.02
|
| Rate for Payer: BCBS Complete |
$113.86
|
| Rate for Payer: Cash Price |
$227.71
|
| Rate for Payer: Cofinity Advantage |
$199.25
|
| Rate for Payer: Cofinity Commercial |
$244.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.71
|
| Rate for Payer: Healthscope Commercial |
$256.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.48
|
| Rate for Payer: PHP Commercial |
$241.94
|
| Rate for Payer: Priority Health SBD |
$179.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.02
|
| Rate for Payer: UHC Core |
$148.30
|
| Rate for Payer: UHC Exchange |
$111.86
|
| Rate for Payer: UMR Bronson Commercial |
$105.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.48
|
|
