|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$16,694.53
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$12,687.84 |
| Max. Negotiated Rate |
$16,694.53 |
| Rate for Payer: Aetna Medicare |
$13,889.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,694.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,694.53
|
| Rate for Payer: BCBS MAPPO |
$13,355.62
|
| Rate for Payer: BCN Medicare Advantage |
$13,355.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,355.62
|
| Rate for Payer: Mclaren Medicare |
$13,355.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,023.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,358.96
|
| Rate for Payer: PACE Medicare |
$12,687.84
|
| Rate for Payer: PACE SWMI |
$13,355.62
|
| Rate for Payer: PHP Medicare Advantage |
$13,355.62
|
| Rate for Payer: Priority Health Medicare |
$13,355.62
|
| Rate for Payer: Railroad Medicare Medicare |
$13,355.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,355.62
|
| Rate for Payer: UHC Medicare Advantage |
$13,355.62
|
| Rate for Payer: VA VA |
$13,355.62
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$15,484.38
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$11,768.12 |
| Max. Negotiated Rate |
$15,484.38 |
| Rate for Payer: Aetna Medicare |
$12,883.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,484.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,484.38
|
| Rate for Payer: BCBS MAPPO |
$12,387.50
|
| Rate for Payer: BCN Medicare Advantage |
$12,387.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,387.50
|
| Rate for Payer: Mclaren Medicare |
$12,387.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,006.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,245.62
|
| Rate for Payer: PACE Medicare |
$11,768.12
|
| Rate for Payer: PACE SWMI |
$12,387.50
|
| Rate for Payer: PHP Medicare Advantage |
$12,387.50
|
| Rate for Payer: Priority Health Medicare |
$12,387.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12,387.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,387.50
|
| Rate for Payer: UHC Medicare Advantage |
$12,387.50
|
| Rate for Payer: VA VA |
$12,387.50
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$9,503.50
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$7,222.66 |
| Max. Negotiated Rate |
$9,503.50 |
| Rate for Payer: Aetna Medicare |
$7,906.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,503.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,503.50
|
| Rate for Payer: BCBS MAPPO |
$7,602.80
|
| Rate for Payer: BCN Medicare Advantage |
$7,602.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,602.80
|
| Rate for Payer: Mclaren Medicare |
$7,602.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,982.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,743.22
|
| Rate for Payer: PACE Medicare |
$7,222.66
|
| Rate for Payer: PACE SWMI |
$7,602.80
|
| Rate for Payer: PHP Medicare Advantage |
$7,602.80
|
| Rate for Payer: Priority Health Medicare |
$7,602.80
|
| Rate for Payer: Railroad Medicare Medicare |
$7,602.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,602.80
|
| Rate for Payer: UHC Medicare Advantage |
$7,602.80
|
| Rate for Payer: VA VA |
$7,602.80
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$17,978.54
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$13,663.69 |
| Max. Negotiated Rate |
$17,978.54 |
| Rate for Payer: Aetna Medicare |
$14,958.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,978.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,978.54
|
| Rate for Payer: BCBS MAPPO |
$14,382.83
|
| Rate for Payer: BCN Medicare Advantage |
$14,382.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,382.83
|
| Rate for Payer: Mclaren Medicare |
$14,382.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,101.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,540.25
|
| Rate for Payer: PACE Medicare |
$13,663.69
|
| Rate for Payer: PACE SWMI |
$14,382.83
|
| Rate for Payer: PHP Medicare Advantage |
$14,382.83
|
| Rate for Payer: Priority Health Medicare |
$14,382.83
|
| Rate for Payer: Railroad Medicare Medicare |
$14,382.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,382.83
|
| Rate for Payer: UHC Medicare Advantage |
$14,382.83
|
| Rate for Payer: VA VA |
$14,382.83
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,828.30
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$7,469.51 |
| Max. Negotiated Rate |
$9,828.30 |
| Rate for Payer: Aetna Medicare |
$8,177.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,828.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,828.30
|
| Rate for Payer: BCBS MAPPO |
$7,862.64
|
| Rate for Payer: BCN Medicare Advantage |
$7,862.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,862.64
|
| Rate for Payer: Mclaren Medicare |
$7,862.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,255.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,042.04
|
| Rate for Payer: PACE Medicare |
$7,469.51
|
| Rate for Payer: PACE SWMI |
$7,862.64
|
| Rate for Payer: PHP Medicare Advantage |
$7,862.64
|
| Rate for Payer: Priority Health Medicare |
$7,862.64
|
| Rate for Payer: Railroad Medicare Medicare |
$7,862.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,862.64
|
| Rate for Payer: UHC Medicare Advantage |
$7,862.64
|
| Rate for Payer: VA VA |
$7,862.64
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$30,385.54
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$23,093.01 |
| Max. Negotiated Rate |
$30,385.54 |
| Rate for Payer: Aetna Medicare |
$25,280.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,385.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,385.54
|
| Rate for Payer: BCBS MAPPO |
$24,308.43
|
| Rate for Payer: BCN Medicare Advantage |
$24,308.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,308.43
|
| Rate for Payer: Mclaren Medicare |
$24,308.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,523.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,954.69
|
| Rate for Payer: PACE Medicare |
$23,093.01
|
| Rate for Payer: PACE SWMI |
$24,308.43
|
| Rate for Payer: PHP Medicare Advantage |
$24,308.43
|
| Rate for Payer: Priority Health Medicare |
$24,308.43
|
| Rate for Payer: Railroad Medicare Medicare |
$24,308.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,308.43
|
| Rate for Payer: UHC Medicare Advantage |
$24,308.43
|
| Rate for Payer: VA VA |
$24,308.43
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$55,199.53
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$41,951.64 |
| Max. Negotiated Rate |
$55,199.53 |
| Rate for Payer: Aetna Medicare |
$45,926.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,199.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,199.53
|
| Rate for Payer: BCBS MAPPO |
$44,159.62
|
| Rate for Payer: BCN Medicare Advantage |
$44,159.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,159.62
|
| Rate for Payer: Mclaren Medicare |
$44,159.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46,367.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,783.56
|
| Rate for Payer: PACE Medicare |
$41,951.64
|
| Rate for Payer: PACE SWMI |
$44,159.62
|
| Rate for Payer: PHP Medicare Advantage |
$44,159.62
|
| Rate for Payer: Priority Health Medicare |
$44,159.62
|
| Rate for Payer: Railroad Medicare Medicare |
$44,159.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$44,159.62
|
| Rate for Payer: UHC Medicare Advantage |
$44,159.62
|
| Rate for Payer: VA VA |
$44,159.62
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,117.15
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$13,769.03 |
| Max. Negotiated Rate |
$18,117.15 |
| Rate for Payer: Aetna Medicare |
$15,073.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,117.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,117.15
|
| Rate for Payer: BCBS MAPPO |
$14,493.72
|
| Rate for Payer: BCN Medicare Advantage |
$14,493.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,493.72
|
| Rate for Payer: Mclaren Medicare |
$14,493.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,218.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,667.78
|
| Rate for Payer: PACE Medicare |
$13,769.03
|
| Rate for Payer: PACE SWMI |
$14,493.72
|
| Rate for Payer: PHP Medicare Advantage |
$14,493.72
|
| Rate for Payer: Priority Health Medicare |
$14,493.72
|
| Rate for Payer: Railroad Medicare Medicare |
$14,493.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,493.72
|
| Rate for Payer: UHC Medicare Advantage |
$14,493.72
|
| Rate for Payer: VA VA |
$14,493.72
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$19,751.24
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$15,010.94 |
| Max. Negotiated Rate |
$19,751.24 |
| Rate for Payer: Aetna Medicare |
$16,433.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,751.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,751.24
|
| Rate for Payer: BCBS MAPPO |
$15,800.99
|
| Rate for Payer: BCN Medicare Advantage |
$15,800.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,800.99
|
| Rate for Payer: Mclaren Medicare |
$15,800.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,591.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,171.14
|
| Rate for Payer: PACE Medicare |
$15,010.94
|
| Rate for Payer: PACE SWMI |
$15,800.99
|
| Rate for Payer: PHP Medicare Advantage |
$15,800.99
|
| Rate for Payer: Priority Health Medicare |
$15,800.99
|
| Rate for Payer: Railroad Medicare Medicare |
$15,800.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,800.99
|
| Rate for Payer: UHC Medicare Advantage |
$15,800.99
|
| Rate for Payer: VA VA |
$15,800.99
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$45,379.75
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$34,488.61 |
| Max. Negotiated Rate |
$45,379.75 |
| Rate for Payer: Aetna Medicare |
$37,755.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,379.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,379.75
|
| Rate for Payer: BCBS MAPPO |
$36,303.80
|
| Rate for Payer: BCN Medicare Advantage |
$36,303.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,303.80
|
| Rate for Payer: Mclaren Medicare |
$36,303.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38,118.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,749.37
|
| Rate for Payer: PACE Medicare |
$34,488.61
|
| Rate for Payer: PACE SWMI |
$36,303.80
|
| Rate for Payer: PHP Medicare Advantage |
$36,303.80
|
| Rate for Payer: Priority Health Medicare |
$36,303.80
|
| Rate for Payer: Railroad Medicare Medicare |
$36,303.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$36,303.80
|
| Rate for Payer: UHC Medicare Advantage |
$36,303.80
|
| Rate for Payer: VA VA |
$36,303.80
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$12,886.04
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$9,793.39 |
| Max. Negotiated Rate |
$12,886.04 |
| Rate for Payer: Aetna Medicare |
$10,721.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,886.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,886.04
|
| Rate for Payer: BCBS MAPPO |
$10,308.83
|
| Rate for Payer: BCN Medicare Advantage |
$10,308.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,308.83
|
| Rate for Payer: Mclaren Medicare |
$10,308.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,824.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,855.15
|
| Rate for Payer: PACE Medicare |
$9,793.39
|
| Rate for Payer: PACE SWMI |
$10,308.83
|
| Rate for Payer: PHP Medicare Advantage |
$10,308.83
|
| Rate for Payer: Priority Health Medicare |
$10,308.83
|
| Rate for Payer: Railroad Medicare Medicare |
$10,308.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,308.83
|
| Rate for Payer: UHC Medicare Advantage |
$10,308.83
|
| Rate for Payer: VA VA |
$10,308.83
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
NDC 00536466110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$545.60 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna American Axle |
$806.00
|
| Rate for Payer: Aetna Commercial |
$1,054.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.00
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cofinity Commercial |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$868.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$868.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.00
|
| Rate for Payer: Healthscope Commercial |
$1,116.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$868.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$930.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,054.00
|
| Rate for Payer: PHP Commercial |
$1,054.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.00
|
| Rate for Payer: Priority Health SBD |
$781.20
|
| Rate for Payer: UMR Bronson Commercial |
$545.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$930.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
NDC 00536466110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$458.80 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna American Axle |
$806.00
|
| Rate for Payer: Aetna Commercial |
$1,054.00
|
| Rate for Payer: Aetna Medicare |
$620.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.00
|
| Rate for Payer: BCBS Complete |
$496.00
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cofinity Commercial |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$868.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$868.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.00
|
| Rate for Payer: Healthscope Commercial |
$1,116.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$868.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$930.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,054.00
|
| Rate for Payer: PHP Commercial |
$1,054.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.00
|
| Rate for Payer: Priority Health SBD |
$781.20
|
| Rate for Payer: UMR Bronson Commercial |
$458.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$930.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.26 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna American Axle |
$179.14
|
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.14
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$192.92
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: Priority Health SBD |
$173.63
|
| Rate for Payer: UMR Bronson Commercial |
$121.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UMR Bronson Commercial |
$66.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.97 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna American Axle |
$179.14
|
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: Aetna Medicare |
$137.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.14
|
| Rate for Payer: BCBS Complete |
$110.24
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$192.92
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: Priority Health SBD |
$173.63
|
| Rate for Payer: UMR Bronson Commercial |
$101.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UMR Bronson Commercial |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
NDC 57896062101
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
NDC 57896062101
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$59.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
NDC 96295012782
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UMR Bronson Commercial |
$91.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
NDC 96295012782
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UMR Bronson Commercial |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$196.56
|
|
|
Service Code
|
NDC 80681000300
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.49 |
| Max. Negotiated Rate |
$176.90 |
| Rate for Payer: Aetna American Axle |
$127.76
|
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.76
|
| Rate for Payer: Cash Price |
$157.25
|
| Rate for Payer: Cofinity Commercial |
$137.59
|
| Rate for Payer: Cofinity Commercial |
$169.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.25
|
| Rate for Payer: Healthscope Commercial |
$176.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.08
|
| Rate for Payer: PHP Commercial |
$167.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.76
|
| Rate for Payer: Priority Health SBD |
$123.83
|
| Rate for Payer: UMR Bronson Commercial |
$86.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.42
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$176.40
|
|
|
Service Code
|
NDC 00904053061
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna American Axle |
$114.66
|
| Rate for Payer: Aetna Commercial |
$149.94
|
| Rate for Payer: Aetna Medicare |
$88.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.66
|
| Rate for Payer: BCBS Complete |
$70.56
|
| Rate for Payer: Cash Price |
$141.12
|
| Rate for Payer: Cofinity Commercial |
$123.48
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.12
|
| Rate for Payer: Healthscope Commercial |
$158.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.94
|
| Rate for Payer: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| Rate for Payer: Priority Health SBD |
$111.13
|
| Rate for Payer: UMR Bronson Commercial |
$65.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.30
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$196.56
|
|
|
Service Code
|
NDC 80681000300
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$176.90 |
| Rate for Payer: Aetna American Axle |
$127.76
|
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna Medicare |
$98.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.76
|
| Rate for Payer: BCBS Complete |
$78.62
|
| Rate for Payer: Cash Price |
$157.25
|
| Rate for Payer: Cofinity Commercial |
$137.59
|
| Rate for Payer: Cofinity Commercial |
$169.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.25
|
| Rate for Payer: Healthscope Commercial |
$176.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.08
|
| Rate for Payer: PHP Commercial |
$167.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.76
|
| Rate for Payer: Priority Health SBD |
$123.83
|
| Rate for Payer: UMR Bronson Commercial |
$72.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.42
|
|
|
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$176.40
|
|
|
Service Code
|
NDC 00904053061
|
| Hospital Charge Code |
159994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.62 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna American Axle |
$114.66
|
| Rate for Payer: Aetna Commercial |
$149.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.66
|
| Rate for Payer: Cash Price |
$141.12
|
| Rate for Payer: Cofinity Commercial |
$123.48
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.12
|
| Rate for Payer: Healthscope Commercial |
$158.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.94
|
| Rate for Payer: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| Rate for Payer: Priority Health SBD |
$111.13
|
| Rate for Payer: UMR Bronson Commercial |
$77.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.30
|
|
