|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$9.58
|
|
|
Service Code
|
NDC 45802014301
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna American Axle |
$6.23
|
| Rate for Payer: Aetna Commercial |
$8.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.23
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Advantage |
$6.71
|
| Rate for Payer: Cofinity Commercial |
$8.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$8.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.18
|
| Rate for Payer: PHP Commercial |
$8.14
|
| Rate for Payer: Priority Health SBD |
$6.04
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.18
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$11.97
|
|
|
Service Code
|
NDC 59390002714
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna American Axle |
$7.78
|
| Rate for Payer: Aetna Commercial |
$10.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.78
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cofinity Advantage |
$8.38
|
| Rate for Payer: Cofinity Commercial |
$10.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$10.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.98
|
| Rate for Payer: PHP Commercial |
$10.17
|
| Rate for Payer: Priority Health SBD |
$7.54
|
| Rate for Payer: UMR Bronson Commercial |
$5.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.98
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$399.32
|
|
|
Service Code
|
NDC 00904880567
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$359.39 |
| Rate for Payer: Aetna American Axle |
$259.56
|
| Rate for Payer: Aetna Commercial |
$339.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.56
|
| Rate for Payer: Cash Price |
$319.46
|
| Rate for Payer: Cofinity Advantage |
$279.52
|
| Rate for Payer: Cofinity Commercial |
$343.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.46
|
| Rate for Payer: Healthscope Commercial |
$359.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.49
|
| Rate for Payer: PHP Commercial |
$339.42
|
| Rate for Payer: Priority Health SBD |
$251.57
|
| Rate for Payer: UMR Bronson Commercial |
$175.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.49
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$399.32
|
|
|
Service Code
|
NDC 00904880567
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$359.39 |
| Rate for Payer: Aetna American Axle |
$259.56
|
| Rate for Payer: Aetna Commercial |
$339.42
|
| Rate for Payer: Aetna Medicare |
$199.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.56
|
| Rate for Payer: BCBS Complete |
$159.73
|
| Rate for Payer: Cash Price |
$319.46
|
| Rate for Payer: Cofinity Advantage |
$279.52
|
| Rate for Payer: Cofinity Commercial |
$343.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.46
|
| Rate for Payer: Healthscope Commercial |
$359.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.49
|
| Rate for Payer: PHP Commercial |
$339.42
|
| Rate for Payer: Priority Health SBD |
$251.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.56
|
| Rate for Payer: UHC Core |
$208.05
|
| Rate for Payer: UHC Exchange |
$156.93
|
| Rate for Payer: UMR Bronson Commercial |
$147.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.49
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$51.73
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Aetna American Axle |
$33.62
|
| Rate for Payer: Aetna Commercial |
$43.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.62
|
| Rate for Payer: Cash Price |
$41.38
|
| Rate for Payer: Cofinity Advantage |
$36.21
|
| Rate for Payer: Cofinity Commercial |
$44.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.38
|
| Rate for Payer: Healthscope Commercial |
$46.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.80
|
| Rate for Payer: PHP Commercial |
$43.97
|
| Rate for Payer: Priority Health SBD |
$32.59
|
| Rate for Payer: UMR Bronson Commercial |
$22.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.80
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$36.51
|
|
|
Service Code
|
NDC 61314063006
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$32.86 |
| Rate for Payer: Aetna American Axle |
$23.73
|
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.73
|
| Rate for Payer: Cash Price |
$29.21
|
| Rate for Payer: Cofinity Advantage |
$25.56
|
| Rate for Payer: Cofinity Commercial |
$31.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$32.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.38
|
| Rate for Payer: PHP Commercial |
$31.03
|
| Rate for Payer: Priority Health SBD |
$23.00
|
| Rate for Payer: UMR Bronson Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.38
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
OP
|
$36.51
|
|
|
Service Code
|
NDC 61314063006
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$32.86 |
| Rate for Payer: Aetna American Axle |
$23.73
|
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$18.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.73
|
| Rate for Payer: BCBS Complete |
$14.60
|
| Rate for Payer: Cash Price |
$29.21
|
| Rate for Payer: Cofinity Advantage |
$25.56
|
| Rate for Payer: Cofinity Commercial |
$31.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$32.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.38
|
| Rate for Payer: PHP Commercial |
$31.03
|
| Rate for Payer: Priority Health SBD |
$23.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.73
|
| Rate for Payer: UHC Core |
$19.02
|
| Rate for Payer: UHC Exchange |
$14.35
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.38
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
OP
|
$51.73
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Aetna American Axle |
$33.62
|
| Rate for Payer: Aetna Commercial |
$43.97
|
| Rate for Payer: Aetna Medicare |
$25.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.62
|
| Rate for Payer: BCBS Complete |
$20.69
|
| Rate for Payer: Cash Price |
$41.38
|
| Rate for Payer: Cofinity Advantage |
$36.21
|
| Rate for Payer: Cofinity Commercial |
$44.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.38
|
| Rate for Payer: Healthscope Commercial |
$46.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.80
|
| Rate for Payer: PHP Commercial |
$43.97
|
| Rate for Payer: Priority Health SBD |
$32.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.62
|
| Rate for Payer: UHC Core |
$26.95
|
| Rate for Payer: UHC Exchange |
$20.33
|
| Rate for Payer: UMR Bronson Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.80
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$157.82
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$142.04 |
| Rate for Payer: Aetna American Axle |
$102.58
|
| Rate for Payer: Aetna Commercial |
$134.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.58
|
| Rate for Payer: Cash Price |
$126.26
|
| Rate for Payer: Cofinity Advantage |
$110.47
|
| Rate for Payer: Cofinity Commercial |
$135.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$142.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.36
|
| Rate for Payer: PHP Commercial |
$134.15
|
| Rate for Payer: Priority Health SBD |
$99.43
|
| Rate for Payer: UMR Bronson Commercial |
$69.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.36
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
OP
|
$157.82
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$142.04 |
| Rate for Payer: Aetna American Axle |
$102.58
|
| Rate for Payer: Aetna Commercial |
$134.15
|
| Rate for Payer: Aetna Medicare |
$78.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.58
|
| Rate for Payer: BCBS Complete |
$63.13
|
| Rate for Payer: Cash Price |
$126.26
|
| Rate for Payer: Cofinity Advantage |
$110.47
|
| Rate for Payer: Cofinity Commercial |
$135.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$142.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.36
|
| Rate for Payer: PHP Commercial |
$134.15
|
| Rate for Payer: Priority Health SBD |
$99.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.58
|
| Rate for Payer: UHC Core |
$82.22
|
| Rate for Payer: UHC Exchange |
$62.02
|
| Rate for Payer: UMR Bronson Commercial |
$58.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.36
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
OP
|
$278.99
|
|
|
Service Code
|
NDC 61314064610
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.23 |
| Max. Negotiated Rate |
$251.09 |
| Rate for Payer: Aetna American Axle |
$181.34
|
| Rate for Payer: Aetna Commercial |
$237.14
|
| Rate for Payer: Aetna Medicare |
$139.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.34
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: Cash Price |
$223.19
|
| Rate for Payer: Cofinity Advantage |
$195.29
|
| Rate for Payer: Cofinity Commercial |
$239.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.19
|
| Rate for Payer: Healthscope Commercial |
$251.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.24
|
| Rate for Payer: PHP Commercial |
$237.14
|
| Rate for Payer: Priority Health SBD |
$175.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.34
|
| Rate for Payer: UHC Core |
$145.35
|
| Rate for Payer: UHC Exchange |
$109.64
|
| Rate for Payer: UMR Bronson Commercial |
$103.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.24
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$164.15
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.23 |
| Max. Negotiated Rate |
$147.74 |
| Rate for Payer: Aetna American Axle |
$106.70
|
| Rate for Payer: Aetna Commercial |
$139.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.70
|
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: Cofinity Advantage |
$114.91
|
| Rate for Payer: Cofinity Commercial |
$141.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.32
|
| Rate for Payer: Healthscope Commercial |
$147.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.11
|
| Rate for Payer: PHP Commercial |
$139.53
|
| Rate for Payer: Priority Health SBD |
$103.41
|
| Rate for Payer: UMR Bronson Commercial |
$72.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.11
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
OP
|
$164.15
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.74 |
| Max. Negotiated Rate |
$147.74 |
| Rate for Payer: Aetna American Axle |
$106.70
|
| Rate for Payer: Aetna Commercial |
$139.53
|
| Rate for Payer: Aetna Medicare |
$82.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.70
|
| Rate for Payer: BCBS Complete |
$65.66
|
| Rate for Payer: Cash Price |
$131.32
|
| Rate for Payer: Cofinity Advantage |
$114.91
|
| Rate for Payer: Cofinity Commercial |
$141.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.32
|
| Rate for Payer: Healthscope Commercial |
$147.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.11
|
| Rate for Payer: PHP Commercial |
$139.53
|
| Rate for Payer: Priority Health SBD |
$103.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.70
|
| Rate for Payer: UHC Core |
$85.52
|
| Rate for Payer: UHC Exchange |
$64.51
|
| Rate for Payer: UMR Bronson Commercial |
$60.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.11
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$278.99
|
|
|
Service Code
|
NDC 61314064610
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.76 |
| Max. Negotiated Rate |
$251.09 |
| Rate for Payer: Aetna American Axle |
$181.34
|
| Rate for Payer: Aetna Commercial |
$237.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.34
|
| Rate for Payer: Cash Price |
$223.19
|
| Rate for Payer: Cofinity Advantage |
$195.29
|
| Rate for Payer: Cofinity Commercial |
$239.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.19
|
| Rate for Payer: Healthscope Commercial |
$251.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.24
|
| Rate for Payer: PHP Commercial |
$237.14
|
| Rate for Payer: Priority Health SBD |
$175.76
|
| Rate for Payer: UMR Bronson Commercial |
$122.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.24
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$14,320.78
|
|
|
Service Code
|
APR-DRG 8632
|
| Min. Negotiated Rate |
$13,638.84 |
| Max. Negotiated Rate |
$14,320.78 |
| Rate for Payer: BCBS Complete |
$14,320.78
|
| Rate for Payer: Mclaren Medicaid |
$13,638.84
|
| Rate for Payer: Meridian Medicaid |
$14,320.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,638.84
|
| Rate for Payer: UHC Medicaid |
$13,638.84
|
| Rate for Payer: UHCCP Medicaid |
$13,638.84
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$58,059.75
|
|
|
Service Code
|
APR-DRG 8634
|
| Min. Negotiated Rate |
$55,295.00 |
| Max. Negotiated Rate |
$58,059.75 |
| Rate for Payer: BCBS Complete |
$58,059.75
|
| Rate for Payer: Mclaren Medicaid |
$55,295.00
|
| Rate for Payer: Meridian Medicaid |
$58,059.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$55,295.00
|
| Rate for Payer: UHC Medicaid |
$55,295.00
|
| Rate for Payer: UHCCP Medicaid |
$55,295.00
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$7,354.70
|
|
|
Service Code
|
APR-DRG 8631
|
| Min. Negotiated Rate |
$7,004.48 |
| Max. Negotiated Rate |
$7,354.70 |
| Rate for Payer: BCBS Complete |
$7,354.70
|
| Rate for Payer: Mclaren Medicaid |
$7,004.48
|
| Rate for Payer: Meridian Medicaid |
$7,354.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,004.48
|
| Rate for Payer: UHC Medicaid |
$7,004.48
|
| Rate for Payer: UHCCP Medicaid |
$7,004.48
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$24,522.93
|
|
|
Service Code
|
APR-DRG 8633
|
| Min. Negotiated Rate |
$23,355.17 |
| Max. Negotiated Rate |
$24,522.93 |
| Rate for Payer: BCBS Complete |
$24,522.93
|
| Rate for Payer: Mclaren Medicaid |
$23,355.17
|
| Rate for Payer: Meridian Medicaid |
$24,522.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,355.17
|
| Rate for Payer: UHC Medicaid |
$23,355.17
|
| Rate for Payer: UHCCP Medicaid |
$23,355.17
|
|
|
NEONATAL PARENTERAL NUTRITION (2 IN 1) CUSTOM
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
NDC 00090000235
|
| Hospital Charge Code |
158489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna American Axle |
$234.00
|
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna Medicare |
$180.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.00
|
| Rate for Payer: BCBS Complete |
$144.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Advantage |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$288.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.00
|
| Rate for Payer: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health SBD |
$226.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.00
|
| Rate for Payer: UHC Core |
$187.56
|
| Rate for Payer: UHC Exchange |
$141.48
|
| Rate for Payer: UMR Bronson Commercial |
$133.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
NEONATAL PARENTERAL NUTRITION (2 IN 1) CUSTOM
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 00090000235
|
| Hospital Charge Code |
158489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna American Axle |
$234.00
|
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Advantage |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.00
|
| Rate for Payer: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health SBD |
$226.80
|
| Rate for Payer: UMR Bronson Commercial |
$158.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$103,374.98
|
|
|
Service Code
|
APR-DRG 6034
|
| Min. Negotiated Rate |
$98,452.36 |
| Max. Negotiated Rate |
$103,374.98 |
| Rate for Payer: BCBS Complete |
$103,374.98
|
| Rate for Payer: Mclaren Medicaid |
$98,452.36
|
| Rate for Payer: Meridian Medicaid |
$103,374.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$98,452.36
|
| Rate for Payer: UHC Medicaid |
$98,452.36
|
| Rate for Payer: UHCCP Medicaid |
$98,452.36
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$13,700.93
|
|
|
Service Code
|
APR-DRG 6031
|
| Min. Negotiated Rate |
$13,048.50 |
| Max. Negotiated Rate |
$13,700.93 |
| Rate for Payer: BCBS Complete |
$13,700.93
|
| Rate for Payer: Mclaren Medicaid |
$13,048.50
|
| Rate for Payer: Meridian Medicaid |
$13,700.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,048.50
|
| Rate for Payer: UHC Medicaid |
$13,048.50
|
| Rate for Payer: UHCCP Medicaid |
$13,048.50
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$72,763.09
|
|
|
Service Code
|
APR-DRG 6033
|
| Min. Negotiated Rate |
$69,298.18 |
| Max. Negotiated Rate |
$72,763.09 |
| Rate for Payer: BCBS Complete |
$72,763.09
|
| Rate for Payer: Mclaren Medicaid |
$69,298.18
|
| Rate for Payer: Meridian Medicaid |
$72,763.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69,298.18
|
| Rate for Payer: UHC Medicaid |
$69,298.18
|
| Rate for Payer: UHCCP Medicaid |
$69,298.18
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$36,961.14
|
|
|
Service Code
|
APR-DRG 6032
|
| Min. Negotiated Rate |
$35,201.09 |
| Max. Negotiated Rate |
$36,961.14 |
| Rate for Payer: BCBS Complete |
$36,961.14
|
| Rate for Payer: Mclaren Medicaid |
$35,201.09
|
| Rate for Payer: Meridian Medicaid |
$36,961.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$35,201.09
|
| Rate for Payer: UHC Medicaid |
$35,201.09
|
| Rate for Payer: UHCCP Medicaid |
$35,201.09
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ
|
Facility
|
IP
|
$79,446.48
|
|
|
Service Code
|
APR-DRG 6023
|
| Min. Negotiated Rate |
$75,663.32 |
| Max. Negotiated Rate |
$79,446.48 |
| Rate for Payer: BCBS Complete |
$79,446.48
|
| Rate for Payer: Mclaren Medicaid |
$75,663.32
|
| Rate for Payer: Meridian Medicaid |
$79,446.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$75,663.32
|
| Rate for Payer: UHC Medicaid |
$75,663.32
|
| Rate for Payer: UHCCP Medicaid |
$75,663.32
|
|
