|
MORPHINE SULFATE 100 MG/0.5 ML TOPICAL GEL
|
Facility
|
OP
|
$17.49
|
|
|
Service Code
|
NDC 09900000372
|
| Hospital Charge Code |
161534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna American Axle |
$11.37
|
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Aetna Medicare |
$8.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.37
|
| Rate for Payer: BCBS Complete |
$7.00
|
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$15.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.87
|
| Rate for Payer: PHP Commercial |
$14.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.37
|
| Rate for Payer: Priority Health SBD |
$11.02
|
| Rate for Payer: UMR Bronson Commercial |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.12
|
|
|
MORPHINE SULFATE 30 MG/0.5 ML TOPICAL GEL
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 09900000371
|
| Hospital Charge Code |
161533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Aetna American Axle |
$8.58
|
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.58
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$11.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.22
|
| Rate for Payer: PHP Commercial |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.58
|
| Rate for Payer: Priority Health SBD |
$8.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.90
|
|
|
MORPHINE SULFATE 30 MG/0.5 ML TOPICAL GEL
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 09900000371
|
| Hospital Charge Code |
161533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Aetna American Axle |
$8.58
|
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.58
|
| Rate for Payer: BCBS Complete |
$5.28
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$11.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.22
|
| Rate for Payer: PHP Commercial |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.58
|
| Rate for Payer: Priority Health SBD |
$8.32
|
| Rate for Payer: UMR Bronson Commercial |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.90
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: Aetna American Axle |
$7.59
|
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Aetna Medicare |
$5.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.99
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health SBD |
$7.36
|
| Rate for Payer: Priority Health SBD |
$7.32
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: UMR Bronson Commercial |
$4.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
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 |
$8.72
|
| 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 |
$8.72
|
|
|
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 |
$75,678.44
|
| 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
|
|
|
MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,802.89
|
|
|
Service Code
|
HCPCS J9350
|
| Hospital Charge Code |
202489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$343.61 |
| Max. Negotiated Rate |
$2,522.60 |
| Rate for Payer: BCBS MAPPO |
$641.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.50
|
| Rate for Payer: BCN Commercial |
$1,728.50
|
| Rate for Payer: BCN Commercial |
$1,728.50
|
| Rate for Payer: BCN Medicare Advantage |
$641.07
|
| Rate for Payer: BCN Medicare Advantage |
$641.07
|
| Rate for Payer: Cash Price |
$67,269.72
|
| Rate for Payer: Cash Price |
$2,242.31
|
| Rate for Payer: Cash Price |
$67,269.72
|
| Rate for Payer: Cash Price |
$2,242.31
|
| 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 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: Aetna American Axle |
$1,821.88
|
| Rate for Payer: Aetna American Axle |
$54,656.65
|
| Rate for Payer: Aetna Commercial |
$71,474.08
|
| Rate for Payer: Aetna Commercial |
$2,382.46
|
| Rate for Payer: Aetna Medicare |
$666.71
|
| Rate for Payer: Aetna Medicare |
$666.71
|
| 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: Allen County Amish Medical Aid Commercial |
$801.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$801.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$801.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$801.34
|
| Rate for Payer: BCBS Complete |
$360.79
|
| Rate for Payer: BCBS Complete |
$360.79
|
| Rate for Payer: BCBS MAPPO |
$641.07
|
| 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: Health Alliance Plan Medicare Advantage |
$641.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.07
|
| Rate for Payer: Healthscope Commercial |
$2,522.60
|
| Rate for Payer: Healthscope Commercial |
$75,678.44
|
| 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 |
$343.61
|
| Rate for Payer: Mclaren Medicaid |
$343.61
|
| Rate for Payer: Mclaren Medicare |
$641.07
|
| Rate for Payer: Mclaren Medicare |
$641.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.12
|
| Rate for Payer: Meridian Medicaid |
$360.79
|
| Rate for Payer: Meridian Medicaid |
$360.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,382.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71,474.08
|
| Rate for Payer: Nomi Health Commercial |
$1,923.21
|
| Rate for Payer: Nomi Health Commercial |
$1,923.21
|
| Rate for Payer: PACE Medicare |
$609.02
|
| Rate for Payer: PACE Medicare |
$609.02
|
| Rate for Payer: PACE SWMI |
$641.07
|
| Rate for Payer: PACE SWMI |
$641.07
|
| Rate for Payer: PHP Commercial |
$2,382.46
|
| Rate for Payer: PHP Commercial |
$71,474.08
|
| Rate for Payer: PHP Medicare Advantage |
$641.07
|
| Rate for Payer: PHP Medicare Advantage |
$641.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.61
|
| 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 HMO/PPO/Tiered Network |
$1,828.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,828.87
|
| Rate for Payer: Priority Health Medicare |
$641.07
|
| Rate for Payer: Priority Health Medicare |
$641.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,463.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,463.10
|
| Rate for Payer: Priority Health SBD |
$1,765.82
|
| Rate for Payer: Priority Health SBD |
$52,974.90
|
| Rate for Payer: Railroad Medicare Medicare |
$641.07
|
| Rate for Payer: Railroad Medicare Medicare |
$641.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,804.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,804.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.07
|
| Rate for Payer: UHC Exchange |
$1,225.15
|
| Rate for Payer: UHC Exchange |
$1,225.15
|
| Rate for Payer: UHC Medicare Advantage |
$641.07
|
| Rate for Payer: UHC Medicare Advantage |
$641.07
|
| Rate for Payer: UHCCP Medicaid |
$343.61
|
| Rate for Payer: UHCCP Medicaid |
$343.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,037.07
|
| Rate for Payer: UMR Bronson Commercial |
$31,112.25
|
| Rate for Payer: VA VA |
$641.07
|
| Rate for Payer: VA VA |
$641.07
|
| 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
|
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 |
$45.96
|
| 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
|
$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
|
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
|
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
|
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 |
$22.60
|
| 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 |
$22.60
|
|
|
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
|
$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
|
$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 |
$22.60
|
| 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 |
$22.60
|
|
|
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
|
$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
|
$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
|
$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
|
|
|
MS-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$16,824.34
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$6,752.26 |
| Max. Negotiated Rate |
$16,824.34 |
| Rate for Payer: Aetna Medicare |
$9,521.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,444.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,444.18
|
| Rate for Payer: BCBS MAPPO |
$9,155.34
|
| Rate for Payer: BCBS Trust/PPO |
$15,940.47
|
| Rate for Payer: BCN Commercial |
$15,940.47
|
| Rate for Payer: BCN Medicare Advantage |
$9,155.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,155.34
|
| Rate for Payer: Mclaren Medicare |
$9,155.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,613.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,528.64
|
| Rate for Payer: Nomi Health Commercial |
$13,880.40
|
| Rate for Payer: PACE Medicare |
$8,697.57
|
| Rate for Payer: PACE SWMI |
$9,155.34
|
| Rate for Payer: PHP Medicare Advantage |
$9,155.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,440.32
|
| Rate for Payer: Priority Health Medicare |
$9,155.34
|
| Rate for Payer: Priority Health Narrow Network |
$6,752.26
|
| Rate for Payer: Railroad Medicare Medicare |
$9,155.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,824.34
|
| Rate for Payer: UHC Core |
$13,458.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,155.34
|
| Rate for Payer: UHC Exchange |
$10,699.74
|
| Rate for Payer: UHC Medicare Advantage |
$9,155.34
|
| Rate for Payer: VA VA |
$9,155.34
|
|
|
MS-DRG 42.00: ABORTION WITHOUT D&C
|
Facility
|
IP
|
$14,616.53
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$5,430.55 |
| Max. Negotiated Rate |
$14,616.53 |
| Rate for Payer: Aetna Medicare |
$8,332.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,014.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,014.69
|
| Rate for Payer: BCBS MAPPO |
$8,011.75
|
| Rate for Payer: BCBS Trust/PPO |
$10,210.58
|
| Rate for Payer: BCN Commercial |
$10,210.58
|
| Rate for Payer: BCN Medicare Advantage |
$8,011.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,011.75
|
| Rate for Payer: Mclaren Medicare |
$8,011.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,412.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,213.51
|
| Rate for Payer: Nomi Health Commercial |
$12,058.92
|
| Rate for Payer: PACE Medicare |
$7,611.16
|
| Rate for Payer: PACE SWMI |
$8,011.75
|
| Rate for Payer: PHP Medicare Advantage |
$8,011.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,788.18
|
| Rate for Payer: Priority Health Medicare |
$8,011.75
|
| Rate for Payer: Priority Health Narrow Network |
$5,430.55
|
| Rate for Payer: Railroad Medicare Medicare |
$8,011.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,616.53
|
| Rate for Payer: UHC Core |
$11,692.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,011.75
|
| Rate for Payer: UHC Exchange |
$9,295.65
|
| Rate for Payer: UHC Medicare Advantage |
$8,011.75
|
| Rate for Payer: VA VA |
$8,011.75
|
|
|
MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$19,269.89
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$19,269.89 |
| Rate for Payer: Aetna Medicare |
$8,532.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,255.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,255.66
|
| Rate for Payer: BCBS MAPPO |
$8,204.53
|
| Rate for Payer: BCBS Trust/PPO |
$19,269.89
|
| Rate for Payer: BCN Commercial |
$19,269.89
|
| Rate for Payer: BCN Medicare Advantage |
$8,204.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,204.53
|
| Rate for Payer: Mclaren Medicare |
$8,204.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,614.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,435.21
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$7,794.30
|
| Rate for Payer: PACE SWMI |
$8,204.53
|
| Rate for Payer: PHP Medicare Advantage |
$8,204.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,718.74
|
| Rate for Payer: Priority Health Medicare |
$8,204.53
|
| Rate for Payer: Priority Health Narrow Network |
$11,774.99
|
| Rate for Payer: Railroad Medicare Medicare |
$8,204.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,988.67
|
| Rate for Payer: UHC Core |
$11,990.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,204.53
|
| Rate for Payer: UHC Exchange |
$9,532.32
|
| Rate for Payer: UHC Medicare Advantage |
$8,204.53
|
| Rate for Payer: VA VA |
$8,204.53
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$25,386.19
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$12,550.05 |
| Max. Negotiated Rate |
$25,386.19 |
| Rate for Payer: Aetna Medicare |
$13,739.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,513.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,513.22
|
| Rate for Payer: BCBS MAPPO |
$13,210.58
|
| Rate for Payer: BCBS Trust/PPO |
$25,386.19
|
| Rate for Payer: BCN Commercial |
$25,386.19
|
| Rate for Payer: BCN Medicare Advantage |
$13,210.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,210.58
|
| Rate for Payer: Mclaren Medicare |
$13,210.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,871.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,192.17
|
| Rate for Payer: Nomi Health Commercial |
$20,339.43
|
| Rate for Payer: PACE Medicare |
$12,550.05
|
| Rate for Payer: PACE SWMI |
$13,210.58
|
| Rate for Payer: PHP Medicare Advantage |
$13,210.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,207.76
|
| Rate for Payer: Priority Health Medicare |
$13,210.58
|
| Rate for Payer: Priority Health Narrow Network |
$19,366.21
|
| Rate for Payer: Railroad Medicare Medicare |
$13,210.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,653.28
|
| Rate for Payer: UHC Core |
$19,721.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,210.58
|
| Rate for Payer: UHC Exchange |
$15,678.70
|
| Rate for Payer: UHC Medicare Advantage |
$13,210.58
|
| Rate for Payer: VA VA |
$13,210.58
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$71,558.77
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$21,435.29 |
| Max. Negotiated Rate |
$71,558.77 |
| Rate for Payer: Aetna Medicare |
$23,466.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,204.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,204.32
|
| Rate for Payer: BCBS MAPPO |
$22,563.46
|
| Rate for Payer: BCBS Trust/PPO |
$71,558.77
|
| Rate for Payer: BCN Commercial |
$71,558.77
|
| Rate for Payer: BCN Medicare Advantage |
$22,563.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,563.46
|
| Rate for Payer: Mclaren Medicare |
$22,563.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,691.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,947.98
|
| Rate for Payer: Nomi Health Commercial |
$35,236.35
|
| Rate for Payer: PACE Medicare |
$21,435.29
|
| Rate for Payer: PACE SWMI |
$22,563.46
|
| Rate for Payer: PHP Medicare Advantage |
$22,563.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,937.50
|
| Rate for Payer: Priority Health Medicare |
$22,563.46
|
| Rate for Payer: Priority Health Narrow Network |
$33,550.01
|
| Rate for Payer: Railroad Medicare Medicare |
$22,563.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,709.73
|
| Rate for Payer: UHC Core |
$34,165.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,563.46
|
| Rate for Payer: UHC Exchange |
$27,162.04
|
| Rate for Payer: UHC Medicare Advantage |
$22,563.46
|
| Rate for Payer: VA VA |
$22,563.46
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$21,760.35
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$7,951.24 |
| Max. Negotiated Rate |
$21,760.35 |
| Rate for Payer: Aetna Medicare |
$8,704.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,462.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,462.16
|
| Rate for Payer: BCBS MAPPO |
$8,369.73
|
| Rate for Payer: BCBS Trust/PPO |
$21,760.35
|
| Rate for Payer: BCN Commercial |
$21,760.35
|
| Rate for Payer: BCN Medicare Advantage |
$8,369.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,369.73
|
| Rate for Payer: Mclaren Medicare |
$8,369.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,788.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,625.19
|
| Rate for Payer: Nomi Health Commercial |
$12,629.10
|
| Rate for Payer: PACE Medicare |
$7,951.24
|
| Rate for Payer: PACE SWMI |
$8,369.73
|
| Rate for Payer: PHP Medicare Advantage |
$8,369.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,031.97
|
| Rate for Payer: Priority Health Medicare |
$8,369.73
|
| Rate for Payer: Priority Health Narrow Network |
$12,025.58
|
| Rate for Payer: Railroad Medicare Medicare |
$8,369.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,307.64
|
| Rate for Payer: UHC Core |
$12,245.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,369.73
|
| Rate for Payer: UHC Exchange |
$9,735.18
|
| Rate for Payer: UHC Medicare Advantage |
$8,369.73
|
| Rate for Payer: VA VA |
$8,369.73
|
|
