|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: PHP Commercial |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health SBD |
$7.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
|
MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$84,087.15
|
|
|
Service Code
|
HCPCS J9350
|
| Hospital Charge Code |
202489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$350.88 |
| Max. Negotiated Rate |
$75,678.43 |
| Rate for Payer: Aetna American Axle |
$54,656.65
|
| Rate for Payer: Aetna American Axle |
$1,821.88
|
| Rate for Payer: Aetna Commercial |
$2,382.46
|
| Rate for Payer: Aetna Commercial |
$71,474.08
|
| Rate for Payer: Aetna Medicare |
$680.82
|
| Rate for Payer: Aetna Medicare |
$680.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54,656.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,821.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$818.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$818.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$818.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$818.29
|
| Rate for Payer: BCBS Complete |
$368.43
|
| Rate for Payer: BCBS Complete |
$368.43
|
| Rate for Payer: BCBS MAPPO |
$654.63
|
| Rate for Payer: BCBS MAPPO |
$654.63
|
| Rate for Payer: BCN Medicare Advantage |
$654.63
|
| Rate for Payer: BCN Medicare Advantage |
$654.63
|
| Rate for Payer: Cash Price |
$2,242.31
|
| Rate for Payer: Cash Price |
$67,269.72
|
| Rate for Payer: Cash Price |
$67,269.72
|
| Rate for Payer: Cash Price |
$2,242.31
|
| Rate for Payer: Cofinity Commercial |
$1,962.02
|
| Rate for Payer: Cofinity Commercial |
$2,410.49
|
| Rate for Payer: Cofinity Commercial |
$58,861.00
|
| Rate for Payer: Cofinity Commercial |
$72,314.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,962.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$58,861.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67,269.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,242.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.63
|
| Rate for Payer: Healthscope Commercial |
$75,678.43
|
| Rate for Payer: Healthscope Commercial |
$2,522.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58,861.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,962.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,102.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63,065.36
|
| Rate for Payer: Mclaren Medicaid |
$350.88
|
| Rate for Payer: Mclaren Medicaid |
$350.88
|
| Rate for Payer: Mclaren Medicare |
$654.63
|
| Rate for Payer: Mclaren Medicare |
$654.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.36
|
| Rate for Payer: Meridian Medicaid |
$368.43
|
| Rate for Payer: Meridian Medicaid |
$368.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71,474.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,382.46
|
| Rate for Payer: PACE Medicare |
$621.90
|
| Rate for Payer: PACE Medicare |
$621.90
|
| Rate for Payer: PACE SWMI |
$654.63
|
| Rate for Payer: PACE SWMI |
$654.63
|
| Rate for Payer: PHP Commercial |
$2,382.46
|
| Rate for Payer: PHP Commercial |
$71,474.08
|
| Rate for Payer: PHP Medicare Advantage |
$654.63
|
| Rate for Payer: PHP Medicare Advantage |
$654.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,821.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54,656.65
|
| Rate for Payer: Priority Health Medicare |
$654.63
|
| Rate for Payer: Priority Health Medicare |
$654.63
|
| Rate for Payer: Priority Health SBD |
$1,765.82
|
| Rate for Payer: Priority Health SBD |
$52,974.90
|
| Rate for Payer: Railroad Medicare Medicare |
$654.63
|
| Rate for Payer: Railroad Medicare Medicare |
$654.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,842.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,842.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$654.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$654.63
|
| Rate for Payer: UHC Exchange |
$1,251.06
|
| Rate for Payer: UHC Exchange |
$1,251.06
|
| Rate for Payer: UHC Medicare Advantage |
$654.63
|
| Rate for Payer: UHC Medicare Advantage |
$654.63
|
| Rate for Payer: UHCCP Medicaid |
$350.88
|
| Rate for Payer: UHCCP Medicaid |
$350.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,037.07
|
| Rate for Payer: UMR Bronson Commercial |
$31,112.25
|
| Rate for Payer: VA VA |
$654.63
|
| Rate for Payer: VA VA |
$654.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63,065.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,102.17
|
|
|
MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,802.89
|
|
|
Service Code
|
HCPCS J9350
|
| Hospital Charge Code |
202489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,233.27 |
| Max. Negotiated Rate |
$2,522.60 |
| Rate for Payer: Aetna American Axle |
$1,821.88
|
| Rate for Payer: Aetna American Axle |
$54,656.65
|
| Rate for Payer: Aetna Commercial |
$2,382.46
|
| Rate for Payer: Aetna Commercial |
$71,474.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,821.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54,656.65
|
| Rate for Payer: Cash Price |
$2,242.31
|
| Rate for Payer: Cash Price |
$67,269.72
|
| Rate for Payer: Cofinity Commercial |
$72,314.95
|
| Rate for Payer: Cofinity Commercial |
$58,861.00
|
| Rate for Payer: Cofinity Commercial |
$1,962.02
|
| Rate for Payer: Cofinity Commercial |
$2,410.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,962.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$58,861.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,242.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67,269.72
|
| Rate for Payer: Healthscope Commercial |
$2,522.60
|
| Rate for Payer: Healthscope Commercial |
$75,678.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,962.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58,861.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,102.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63,065.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71,474.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,382.46
|
| Rate for Payer: PHP Commercial |
$71,474.08
|
| Rate for Payer: PHP Commercial |
$2,382.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,821.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54,656.65
|
| Rate for Payer: Priority Health SBD |
$1,765.82
|
| Rate for Payer: Priority Health SBD |
$52,974.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,233.27
|
| Rate for Payer: UMR Bronson Commercial |
$36,998.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,102.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63,065.36
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$91.91
|
|
|
Service Code
|
NDC 00781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Aetna American Axle |
$59.74
|
| Rate for Payer: Aetna Commercial |
$78.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.74
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$64.34
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.53
|
| Rate for Payer: Healthscope Commercial |
$82.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.12
|
| Rate for Payer: PHP Commercial |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.74
|
| Rate for Payer: Priority Health SBD |
$57.90
|
| Rate for Payer: UMR Bronson Commercial |
$40.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.93
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$91.91
|
|
|
Service Code
|
NDC 00781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Aetna American Axle |
$59.74
|
| Rate for Payer: Aetna Commercial |
$78.12
|
| Rate for Payer: Aetna Medicare |
$45.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.74
|
| Rate for Payer: BCBS Complete |
$36.76
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$64.34
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.53
|
| Rate for Payer: Healthscope Commercial |
$82.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.12
|
| Rate for Payer: PHP Commercial |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.74
|
| Rate for Payer: Priority Health SBD |
$57.90
|
| Rate for Payer: UMR Bronson Commercial |
$34.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.93
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$30.14
|
|
|
Service Code
|
NDC 72266015801
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$27.13 |
| Rate for Payer: Aetna American Axle |
$19.59
|
| Rate for Payer: Aetna Commercial |
$25.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.59
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cofinity Commercial |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$25.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$27.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.62
|
| Rate for Payer: PHP Commercial |
$25.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.59
|
| Rate for Payer: Priority Health SBD |
$18.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.61
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.87 |
| Max. Negotiated Rate |
$196.09 |
| Rate for Payer: Aetna American Axle |
$141.62
|
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.62
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.20
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.62
|
| Rate for Payer: Priority Health SBD |
$137.26
|
| Rate for Payer: UMR Bronson Commercial |
$95.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.41
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.62 |
| Max. Negotiated Rate |
$196.09 |
| Rate for Payer: Aetna American Axle |
$141.62
|
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: Aetna Medicare |
$108.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.62
|
| Rate for Payer: BCBS Complete |
$87.15
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.20
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.62
|
| Rate for Payer: Priority Health SBD |
$137.26
|
| Rate for Payer: UMR Bronson Commercial |
$80.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.41
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$48.80
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$43.92 |
| Rate for Payer: Aetna American Axle |
$31.72
|
| Rate for Payer: Aetna Commercial |
$41.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.72
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$34.16
|
| Rate for Payer: Cofinity Commercial |
$41.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.04
|
| Rate for Payer: Healthscope Commercial |
$43.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.48
|
| Rate for Payer: PHP Commercial |
$41.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.72
|
| Rate for Payer: Priority Health SBD |
$30.74
|
| Rate for Payer: UMR Bronson Commercial |
$21.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.60
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$108.96
|
|
|
Service Code
|
NDC 65862084003
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$98.06 |
| Rate for Payer: Aetna American Axle |
$70.82
|
| Rate for Payer: Aetna Commercial |
$92.62
|
| Rate for Payer: Aetna Medicare |
$54.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.82
|
| Rate for Payer: BCBS Complete |
$43.58
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Commercial |
$76.27
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$98.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.62
|
| Rate for Payer: PHP Commercial |
$92.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.82
|
| Rate for Payer: Priority Health SBD |
$68.64
|
| Rate for Payer: UMR Bronson Commercial |
$40.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.72
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$108.96
|
|
|
Service Code
|
NDC 65862084003
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$98.06 |
| Rate for Payer: Aetna American Axle |
$70.82
|
| Rate for Payer: Aetna Commercial |
$92.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.82
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Commercial |
$76.27
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$98.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.62
|
| Rate for Payer: PHP Commercial |
$92.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.82
|
| Rate for Payer: Priority Health SBD |
$68.64
|
| Rate for Payer: UMR Bronson Commercial |
$47.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.72
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$657.83
|
|
|
Service Code
|
NDC 00078093926
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$592.05 |
| Rate for Payer: Aetna American Axle |
$427.59
|
| Rate for Payer: Aetna Commercial |
$559.16
|
| Rate for Payer: Aetna Medicare |
$328.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.59
|
| Rate for Payer: BCBS Complete |
$263.13
|
| Rate for Payer: Cash Price |
$526.26
|
| Rate for Payer: Cofinity Commercial |
$460.48
|
| Rate for Payer: Cofinity Commercial |
$565.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$460.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.26
|
| Rate for Payer: Healthscope Commercial |
$592.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.16
|
| Rate for Payer: PHP Commercial |
$559.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.59
|
| Rate for Payer: Priority Health SBD |
$414.43
|
| Rate for Payer: UMR Bronson Commercial |
$243.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.37
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$657.83
|
|
|
Service Code
|
NDC 00078093926
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.45 |
| Max. Negotiated Rate |
$592.05 |
| Rate for Payer: Aetna American Axle |
$427.59
|
| Rate for Payer: Aetna Commercial |
$559.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.59
|
| Rate for Payer: Cash Price |
$526.26
|
| Rate for Payer: Cofinity Commercial |
$460.48
|
| Rate for Payer: Cofinity Commercial |
$565.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$460.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.26
|
| Rate for Payer: Healthscope Commercial |
$592.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.16
|
| Rate for Payer: PHP Commercial |
$559.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.59
|
| Rate for Payer: Priority Health SBD |
$414.43
|
| Rate for Payer: UMR Bronson Commercial |
$289.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.37
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$48.80
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$43.92 |
| Rate for Payer: Aetna American Axle |
$31.72
|
| Rate for Payer: Aetna Commercial |
$41.48
|
| Rate for Payer: Aetna Medicare |
$24.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.72
|
| Rate for Payer: BCBS Complete |
$19.52
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$34.16
|
| Rate for Payer: Cofinity Commercial |
$41.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.04
|
| Rate for Payer: Healthscope Commercial |
$43.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.48
|
| Rate for Payer: PHP Commercial |
$41.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.72
|
| Rate for Payer: Priority Health SBD |
$30.74
|
| Rate for Payer: UMR Bronson Commercial |
$18.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.60
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$30.14
|
|
|
Service Code
|
NDC 72266015801
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$27.13 |
| Rate for Payer: Aetna American Axle |
$19.59
|
| Rate for Payer: Aetna Commercial |
$25.62
|
| Rate for Payer: Aetna Medicare |
$15.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.59
|
| Rate for Payer: BCBS Complete |
$12.06
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cofinity Commercial |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$25.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$27.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.62
|
| Rate for Payer: PHP Commercial |
$25.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.59
|
| Rate for Payer: Priority Health SBD |
$18.99
|
| Rate for Payer: UMR Bronson Commercial |
$11.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.61
|
|
|
MS-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$11,438.09
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$8,692.95 |
| Max. Negotiated Rate |
$11,438.09 |
| Rate for Payer: Aetna Medicare |
$9,516.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,438.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,438.09
|
| Rate for Payer: BCBS MAPPO |
$9,150.47
|
| Rate for Payer: BCN Medicare Advantage |
$9,150.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,150.47
|
| Rate for Payer: Mclaren Medicare |
$9,150.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,607.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,523.04
|
| Rate for Payer: PACE Medicare |
$8,692.95
|
| Rate for Payer: PACE SWMI |
$9,150.47
|
| Rate for Payer: PHP Medicare Advantage |
$9,150.47
|
| Rate for Payer: Priority Health Medicare |
$9,150.47
|
| Rate for Payer: Railroad Medicare Medicare |
$9,150.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,150.47
|
| Rate for Payer: UHC Medicare Advantage |
$9,150.47
|
| Rate for Payer: VA VA |
$9,150.47
|
|
|
MS-DRG 42.00: ABORTION WITHOUT D&C
|
Facility
|
IP
|
$10,009.40
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$7,607.14 |
| Max. Negotiated Rate |
$10,009.40 |
| Rate for Payer: Aetna Medicare |
$8,327.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,009.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,009.40
|
| Rate for Payer: BCBS MAPPO |
$8,007.52
|
| Rate for Payer: BCN Medicare Advantage |
$8,007.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,007.52
|
| Rate for Payer: Mclaren Medicare |
$8,007.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,407.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,208.65
|
| Rate for Payer: PACE Medicare |
$7,607.14
|
| Rate for Payer: PACE SWMI |
$8,007.52
|
| Rate for Payer: PHP Medicare Advantage |
$8,007.52
|
| Rate for Payer: Priority Health Medicare |
$8,007.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,007.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,007.52
|
| Rate for Payer: UHC Medicare Advantage |
$8,007.52
|
| Rate for Payer: VA VA |
$8,007.52
|
|
|
MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$10,250.21
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$7,790.16 |
| Max. Negotiated Rate |
$10,250.21 |
| Rate for Payer: Aetna Medicare |
$8,528.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,250.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,250.21
|
| Rate for Payer: BCBS MAPPO |
$8,200.17
|
| Rate for Payer: BCN Medicare Advantage |
$8,200.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,200.17
|
| Rate for Payer: Mclaren Medicare |
$8,200.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,610.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,430.20
|
| Rate for Payer: PACE Medicare |
$7,790.16
|
| Rate for Payer: PACE SWMI |
$8,200.17
|
| Rate for Payer: PHP Medicare Advantage |
$8,200.17
|
| Rate for Payer: Priority Health Medicare |
$8,200.17
|
| Rate for Payer: Railroad Medicare Medicare |
$8,200.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,200.17
|
| Rate for Payer: UHC Medicare Advantage |
$8,200.17
|
| Rate for Payer: VA VA |
$8,200.17
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$16,504.30
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$12,543.27 |
| Max. Negotiated Rate |
$16,504.30 |
| Rate for Payer: Aetna Medicare |
$13,731.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,504.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,504.30
|
| Rate for Payer: BCBS MAPPO |
$13,203.44
|
| Rate for Payer: BCN Medicare Advantage |
$13,203.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,203.44
|
| Rate for Payer: Mclaren Medicare |
$13,203.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,863.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,183.96
|
| Rate for Payer: PACE Medicare |
$12,543.27
|
| Rate for Payer: PACE SWMI |
$13,203.44
|
| Rate for Payer: PHP Medicare Advantage |
$13,203.44
|
| Rate for Payer: Priority Health Medicare |
$13,203.44
|
| Rate for Payer: Railroad Medicare Medicare |
$13,203.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,203.44
|
| Rate for Payer: UHC Medicare Advantage |
$13,203.44
|
| Rate for Payer: VA VA |
$13,203.44
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$28,188.84
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$21,423.52 |
| Max. Negotiated Rate |
$28,188.84 |
| Rate for Payer: Aetna Medicare |
$23,453.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,188.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,188.84
|
| Rate for Payer: BCBS MAPPO |
$22,551.07
|
| Rate for Payer: BCN Medicare Advantage |
$22,551.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,551.07
|
| Rate for Payer: Mclaren Medicare |
$22,551.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,678.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,933.73
|
| Rate for Payer: PACE Medicare |
$21,423.52
|
| Rate for Payer: PACE SWMI |
$22,551.07
|
| Rate for Payer: PHP Medicare Advantage |
$22,551.07
|
| Rate for Payer: Priority Health Medicare |
$22,551.07
|
| Rate for Payer: Railroad Medicare Medicare |
$22,551.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,551.07
|
| Rate for Payer: UHC Medicare Advantage |
$22,551.07
|
| Rate for Payer: VA VA |
$22,551.07
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,456.60
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$7,947.02 |
| Max. Negotiated Rate |
$10,456.60 |
| Rate for Payer: Aetna Medicare |
$8,699.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,456.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,456.60
|
| Rate for Payer: BCBS MAPPO |
$8,365.28
|
| Rate for Payer: BCN Medicare Advantage |
$8,365.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,365.28
|
| Rate for Payer: Mclaren Medicare |
$8,365.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,783.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,620.07
|
| Rate for Payer: PACE Medicare |
$7,947.02
|
| Rate for Payer: PACE SWMI |
$8,365.28
|
| Rate for Payer: PHP Medicare Advantage |
$8,365.28
|
| Rate for Payer: Priority Health Medicare |
$8,365.28
|
| Rate for Payer: Railroad Medicare Medicare |
$8,365.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,365.28
|
| Rate for Payer: UHC Medicare Advantage |
$8,365.28
|
| Rate for Payer: VA VA |
$8,365.28
|
|
|
MS-DRG 42.00: ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$22,162.42
|
|
|
Service Code
|
MSDRG 835
|
| Min. Negotiated Rate |
$16,843.44 |
| Max. Negotiated Rate |
$22,162.42 |
| Rate for Payer: Aetna Medicare |
$18,439.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,162.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,162.42
|
| Rate for Payer: BCBS MAPPO |
$17,729.94
|
| Rate for Payer: BCN Medicare Advantage |
$17,729.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,729.94
|
| Rate for Payer: Mclaren Medicare |
$17,729.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,616.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,389.43
|
| Rate for Payer: PACE Medicare |
$16,843.44
|
| Rate for Payer: PACE SWMI |
$17,729.94
|
| Rate for Payer: PHP Medicare Advantage |
$17,729.94
|
| Rate for Payer: Priority Health Medicare |
$17,729.94
|
| Rate for Payer: Railroad Medicare Medicare |
$17,729.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,729.94
|
| Rate for Payer: UHC Medicare Advantage |
$17,729.94
|
| Rate for Payer: VA VA |
$17,729.94
|
|
|
MS-DRG 42.00: ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$56,477.47
|
|
|
Service Code
|
MSDRG 834
|
| Min. Negotiated Rate |
$42,922.88 |
| Max. Negotiated Rate |
$56,477.47 |
| Rate for Payer: Aetna Medicare |
$46,989.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,477.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,477.47
|
| Rate for Payer: BCBS MAPPO |
$45,181.98
|
| Rate for Payer: BCN Medicare Advantage |
$45,181.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,181.98
|
| Rate for Payer: Mclaren Medicare |
$45,181.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47,441.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,959.28
|
| Rate for Payer: PACE Medicare |
$42,922.88
|
| Rate for Payer: PACE SWMI |
$45,181.98
|
| Rate for Payer: PHP Medicare Advantage |
$45,181.98
|
| Rate for Payer: Priority Health Medicare |
$45,181.98
|
| Rate for Payer: Railroad Medicare Medicare |
$45,181.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$45,181.98
|
| Rate for Payer: UHC Medicare Advantage |
$45,181.98
|
| Rate for Payer: VA VA |
$45,181.98
|
|
|
MS-DRG 42.00: ACUTE LEUKEMIA WITH OTHER PROCEDURES
|
Facility
|
IP
|
$93,759.18
|
|
|
Service Code
|
MSDRG 850
|
| Min. Negotiated Rate |
$71,256.97 |
| Max. Negotiated Rate |
$93,759.18 |
| Rate for Payer: Aetna Medicare |
$78,007.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93,759.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93,759.18
|
| Rate for Payer: BCBS MAPPO |
$75,007.34
|
| Rate for Payer: BCN Medicare Advantage |
$75,007.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75,007.34
|
| Rate for Payer: Mclaren Medicare |
$75,007.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78,757.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86,258.44
|
| Rate for Payer: PACE Medicare |
$71,256.97
|
| Rate for Payer: PACE SWMI |
$75,007.34
|
| Rate for Payer: PHP Medicare Advantage |
$75,007.34
|
| Rate for Payer: Priority Health Medicare |
$75,007.34
|
| Rate for Payer: Railroad Medicare Medicare |
$75,007.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$75,007.34
|
| Rate for Payer: UHC Medicare Advantage |
$75,007.34
|
| Rate for Payer: VA VA |
$75,007.34
|
|
|
MS-DRG 42.00: ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$13,408.11
|
|
|
Service Code
|
MSDRG 836
|
| Min. Negotiated Rate |
$10,190.17 |
| Max. Negotiated Rate |
$13,408.11 |
| Rate for Payer: Aetna Medicare |
$11,155.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,408.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,408.11
|
| Rate for Payer: BCBS MAPPO |
$10,726.49
|
| Rate for Payer: BCN Medicare Advantage |
$10,726.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,726.49
|
| Rate for Payer: Mclaren Medicare |
$10,726.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,262.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,335.46
|
| Rate for Payer: PACE Medicare |
$10,190.17
|
| Rate for Payer: PACE SWMI |
$10,726.49
|
| Rate for Payer: PHP Medicare Advantage |
$10,726.49
|
| Rate for Payer: Priority Health Medicare |
$10,726.49
|
| Rate for Payer: Railroad Medicare Medicare |
$10,726.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,726.49
|
| Rate for Payer: UHC Medicare Advantage |
$10,726.49
|
| Rate for Payer: VA VA |
$10,726.49
|
|
