|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$34,359.46
|
|
|
Service Code
|
APR-DRG 1622
|
| Min. Negotiated Rate |
$32,723.29 |
| Max. Negotiated Rate |
$34,359.46 |
| Rate for Payer: BCBS Complete |
$34,359.46
|
| Rate for Payer: Mclaren Medicaid |
$32,723.29
|
| Rate for Payer: Meridian Medicaid |
$34,359.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$32,723.29
|
| Rate for Payer: UHC Medicaid |
$32,723.29
|
| Rate for Payer: UHCCP Medicaid |
$32,723.29
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$55,649.95
|
|
|
Service Code
|
APR-DRG 1624
|
| Min. Negotiated Rate |
$52,999.95 |
| Max. Negotiated Rate |
$55,649.95 |
| Rate for Payer: BCBS Complete |
$55,649.95
|
| Rate for Payer: Mclaren Medicaid |
$52,999.95
|
| Rate for Payer: Meridian Medicaid |
$55,649.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$52,999.95
|
| Rate for Payer: UHC Medicaid |
$52,999.95
|
| Rate for Payer: UHCCP Medicaid |
$52,999.95
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$28,067.10
|
|
|
Service Code
|
APR-DRG 1621
|
| Min. Negotiated Rate |
$26,730.58 |
| Max. Negotiated Rate |
$28,067.10 |
| Rate for Payer: BCBS Complete |
$28,067.10
|
| Rate for Payer: Mclaren Medicaid |
$26,730.58
|
| Rate for Payer: Meridian Medicaid |
$28,067.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,730.58
|
| Rate for Payer: UHC Medicaid |
$26,730.58
|
| Rate for Payer: UHCCP Medicaid |
$26,730.58
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$54,174.77
|
|
|
Service Code
|
APR-DRG 1634
|
| Min. Negotiated Rate |
$51,595.02 |
| Max. Negotiated Rate |
$54,174.77 |
| Rate for Payer: BCBS Complete |
$54,174.77
|
| Rate for Payer: Mclaren Medicaid |
$51,595.02
|
| Rate for Payer: Meridian Medicaid |
$54,174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$51,595.02
|
| Rate for Payer: UHC Medicaid |
$51,595.02
|
| Rate for Payer: UHCCP Medicaid |
$51,595.02
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$23,746.29
|
|
|
Service Code
|
APR-DRG 1631
|
| Min. Negotiated Rate |
$22,615.52 |
| Max. Negotiated Rate |
$23,746.29 |
| Rate for Payer: BCBS Complete |
$23,746.29
|
| Rate for Payer: Mclaren Medicaid |
$22,615.52
|
| Rate for Payer: Meridian Medicaid |
$23,746.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,615.52
|
| Rate for Payer: UHC Medicaid |
$22,615.52
|
| Rate for Payer: UHCCP Medicaid |
$22,615.52
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$25,755.37
|
|
|
Service Code
|
APR-DRG 1632
|
| Min. Negotiated Rate |
$24,528.92 |
| Max. Negotiated Rate |
$25,755.37 |
| Rate for Payer: BCBS Complete |
$25,755.37
|
| Rate for Payer: Mclaren Medicaid |
$24,528.92
|
| Rate for Payer: Meridian Medicaid |
$25,755.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,528.92
|
| Rate for Payer: UHC Medicaid |
$24,528.92
|
| Rate for Payer: UHCCP Medicaid |
$24,528.92
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$33,731.13
|
|
|
Service Code
|
APR-DRG 1633
|
| Min. Negotiated Rate |
$32,124.89 |
| Max. Negotiated Rate |
$33,731.13 |
| Rate for Payer: BCBS Complete |
$33,731.13
|
| Rate for Payer: Mclaren Medicaid |
$32,124.89
|
| Rate for Payer: Meridian Medicaid |
$33,731.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$32,124.89
|
| Rate for Payer: UHC Medicaid |
$32,124.89
|
| Rate for Payer: UHCCP Medicaid |
$32,124.89
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$6,492.11
|
|
|
Service Code
|
APR-DRG 2053
|
| Min. Negotiated Rate |
$6,182.96 |
| Max. Negotiated Rate |
$6,492.11 |
| Rate for Payer: BCBS Complete |
$6,492.11
|
| Rate for Payer: Mclaren Medicaid |
$6,182.96
|
| Rate for Payer: Meridian Medicaid |
$6,492.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,182.96
|
| Rate for Payer: UHC Medicaid |
$6,182.96
|
| Rate for Payer: UHCCP Medicaid |
$6,182.96
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$3,719.12
|
|
|
Service Code
|
APR-DRG 2051
|
| Min. Negotiated Rate |
$3,542.02 |
| Max. Negotiated Rate |
$3,719.12 |
| Rate for Payer: BCBS Complete |
$3,719.12
|
| Rate for Payer: Mclaren Medicaid |
$3,542.02
|
| Rate for Payer: Meridian Medicaid |
$3,719.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,542.02
|
| Rate for Payer: UHC Medicaid |
$3,542.02
|
| Rate for Payer: UHCCP Medicaid |
$3,542.02
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$4,777.22
|
|
|
Service Code
|
APR-DRG 2052
|
| Min. Negotiated Rate |
$4,549.74 |
| Max. Negotiated Rate |
$4,777.22 |
| Rate for Payer: BCBS Complete |
$4,777.22
|
| Rate for Payer: Mclaren Medicaid |
$4,549.74
|
| Rate for Payer: Meridian Medicaid |
$4,777.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,549.74
|
| Rate for Payer: UHC Medicaid |
$4,549.74
|
| Rate for Payer: UHCCP Medicaid |
$4,549.74
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$13,357.10
|
|
|
Service Code
|
APR-DRG 2054
|
| Min. Negotiated Rate |
$12,721.05 |
| Max. Negotiated Rate |
$13,357.10 |
| Rate for Payer: BCBS Complete |
$13,357.10
|
| Rate for Payer: Mclaren Medicaid |
$12,721.05
|
| Rate for Payer: Meridian Medicaid |
$13,357.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,721.05
|
| Rate for Payer: UHC Medicaid |
$12,721.05
|
| Rate for Payer: UHCCP Medicaid |
$12,721.05
|
|
|
CARDIOPLEGIC SOLUTION 16 MEQ/L (POTASSIUM) FOR PERFUSION
|
Facility
|
OP
|
$190.24
|
|
|
Service Code
|
NDC 00338034104
|
| Hospital Charge Code |
30275
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$171.22 |
| Rate for Payer: Aetna American Axle |
$123.66
|
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Aetna Medicare |
$95.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.66
|
| Rate for Payer: BCBS Complete |
$76.10
|
| Rate for Payer: Cash Price |
$152.19
|
| Rate for Payer: Cofinity Advantage |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$163.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.19
|
| Rate for Payer: Healthscope Commercial |
$171.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.68
|
| Rate for Payer: PHP Commercial |
$161.70
|
| Rate for Payer: Priority Health SBD |
$119.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.66
|
| Rate for Payer: UHC Core |
$99.12
|
| Rate for Payer: UHC Exchange |
$74.76
|
| Rate for Payer: UMR Bronson Commercial |
$70.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.68
|
|
|
CARDIOPLEGIC SOLUTION 16 MEQ/L (POTASSIUM) FOR PERFUSION
|
Facility
|
IP
|
$190.24
|
|
|
Service Code
|
NDC 00338034104
|
| Hospital Charge Code |
30275
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$171.22 |
| Rate for Payer: Aetna American Axle |
$123.66
|
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.66
|
| Rate for Payer: Cash Price |
$152.19
|
| Rate for Payer: Cofinity Advantage |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$163.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.19
|
| Rate for Payer: Healthscope Commercial |
$171.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.68
|
| Rate for Payer: PHP Commercial |
$161.70
|
| Rate for Payer: Priority Health SBD |
$119.85
|
| Rate for Payer: UMR Bronson Commercial |
$83.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.68
|
|
|
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; EXTERNAL
|
Facility
|
OP
|
$2,129.73
|
|
|
Service Code
|
CPT 92960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$344.43 |
| Max. Negotiated Rate |
$2,129.73 |
| Rate for Payer: Aetna Medicare |
$684.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.21
|
| Rate for Payer: BCBS Complete |
$361.69
|
| Rate for Payer: BCBS MAPPO |
$658.57
|
| Rate for Payer: BCBS Trust/PPO |
$757.31
|
| Rate for Payer: BCN Commercial |
$757.31
|
| Rate for Payer: BCN Medicare Advantage |
$658.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.57
|
| Rate for Payer: Mclaren Medicaid |
$658.57
|
| Rate for Payer: Mclaren Medicare |
$658.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.50
|
| Rate for Payer: Meridian Medicaid |
$691.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$724.43
|
| Rate for Payer: Nomi Health Commercial |
$1,975.71
|
| Rate for Payer: PACE Medicare |
$625.64
|
| Rate for Payer: PACE SWMI |
$658.57
|
| Rate for Payer: PHP Medicare Advantage |
$658.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,129.73
|
| Rate for Payer: Priority Health Medicare |
$658.57
|
| Rate for Payer: Priority Health Tiered Network |
$1,703.78
|
| Rate for Payer: Railroad Medicare Medicare |
$658.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$658.57
|
| Rate for Payer: UHC Medicaid |
$344.43
|
| Rate for Payer: UHCCP Medicaid |
$344.43
|
| Rate for Payer: VA VA |
$658.57
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,993.71
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$15,294.34 |
| Rate for Payer: Aetna American Axle |
$11,045.91
|
| Rate for Payer: Aetna Commercial |
$14,444.65
|
| Rate for Payer: Aetna Medicare |
$58.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,045.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.30
|
| Rate for Payer: BCBS Complete |
$30.89
|
| Rate for Payer: BCBS MAPPO |
$56.24
|
| Rate for Payer: BCBS Trust/PPO |
$176.95
|
| Rate for Payer: BCN Commercial |
$176.95
|
| Rate for Payer: BCN Medicare Advantage |
$56.24
|
| Rate for Payer: Cash Price |
$13,594.97
|
| Rate for Payer: Cash Price |
$13,594.97
|
| Rate for Payer: Cofinity Advantage |
$11,895.60
|
| Rate for Payer: Cofinity Commercial |
$14,614.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,594.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$15,294.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,895.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,745.28
|
| Rate for Payer: Mclaren Medicaid |
$56.24
|
| Rate for Payer: Mclaren Medicare |
$56.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.05
|
| Rate for Payer: Meridian Medicaid |
$59.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,444.65
|
| Rate for Payer: Nomi Health Commercial |
$168.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,745.28
|
| Rate for Payer: PACE Medicare |
$53.43
|
| Rate for Payer: PACE SWMI |
$56.24
|
| Rate for Payer: PHP Commercial |
$14,444.65
|
| Rate for Payer: PHP Medicare Advantage |
$56.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$56.24
|
| Rate for Payer: Priority Health SBD |
$10,706.04
|
| Rate for Payer: Priority Health Tiered Network |
$140.40
|
| Rate for Payer: Railroad Medicare Medicare |
$56.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.76
|
| Rate for Payer: UHC Core |
$91.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.24
|
| Rate for Payer: UHC Exchange |
$91.76
|
| Rate for Payer: UHC Medicaid |
$29.41
|
| Rate for Payer: UHCCP Medicaid |
$29.41
|
| Rate for Payer: UMR Bronson Commercial |
$6,287.67
|
| Rate for Payer: VA VA |
$56.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,745.28
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,993.71
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,477.23 |
| Max. Negotiated Rate |
$15,294.34 |
| Rate for Payer: Aetna American Axle |
$11,045.91
|
| Rate for Payer: Aetna Commercial |
$14,444.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,045.91
|
| Rate for Payer: Cash Price |
$13,594.97
|
| Rate for Payer: Cofinity Advantage |
$11,895.60
|
| Rate for Payer: Cofinity Commercial |
$14,614.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,594.97
|
| Rate for Payer: Healthscope Commercial |
$15,294.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,895.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,745.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,444.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,745.28
|
| Rate for Payer: PHP Commercial |
$14,444.65
|
| Rate for Payer: Priority Health SBD |
$10,706.04
|
| Rate for Payer: UMR Bronson Commercial |
$7,477.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,745.28
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$1,828.36
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$804.48 |
| Max. Negotiated Rate |
$1,645.52 |
| Rate for Payer: Aetna American Axle |
$1,188.43
|
| Rate for Payer: Aetna Commercial |
$1,554.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.43
|
| Rate for Payer: Cash Price |
$1,462.69
|
| Rate for Payer: Cofinity Advantage |
$1,279.85
|
| Rate for Payer: Cofinity Commercial |
$1,572.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.69
|
| Rate for Payer: Healthscope Commercial |
$1,645.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,279.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,371.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.27
|
| Rate for Payer: PHP Commercial |
$1,554.11
|
| Rate for Payer: Priority Health SBD |
$1,151.87
|
| Rate for Payer: UMR Bronson Commercial |
$804.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,371.27
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$5,485.07
|
|
|
Service Code
|
NDC 61874011530
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,413.43 |
| Max. Negotiated Rate |
$4,936.56 |
| Rate for Payer: Aetna American Axle |
$3,565.30
|
| Rate for Payer: Aetna Commercial |
$4,662.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,565.30
|
| Rate for Payer: Cash Price |
$4,388.06
|
| Rate for Payer: Cofinity Advantage |
$3,839.55
|
| Rate for Payer: Cofinity Commercial |
$4,717.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,388.06
|
| Rate for Payer: Healthscope Commercial |
$4,936.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,839.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,113.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,662.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,113.80
|
| Rate for Payer: PHP Commercial |
$4,662.31
|
| Rate for Payer: Priority Health SBD |
$3,455.59
|
| Rate for Payer: UMR Bronson Commercial |
$2,413.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,113.80
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$3,656.71
|
|
|
Service Code
|
NDC 61874011520
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,608.95 |
| Max. Negotiated Rate |
$3,291.04 |
| Rate for Payer: Aetna American Axle |
$2,376.86
|
| Rate for Payer: Aetna Commercial |
$3,108.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.86
|
| Rate for Payer: Cash Price |
$2,925.37
|
| Rate for Payer: Cofinity Advantage |
$2,559.70
|
| Rate for Payer: Cofinity Commercial |
$3,144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,925.37
|
| Rate for Payer: Healthscope Commercial |
$3,291.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,559.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,742.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,108.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,742.53
|
| Rate for Payer: PHP Commercial |
$3,108.20
|
| Rate for Payer: Priority Health SBD |
$2,303.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,608.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,742.53
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$3,656.71
|
|
|
Service Code
|
NDC 61874011520
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,352.98 |
| Max. Negotiated Rate |
$3,291.04 |
| Rate for Payer: Aetna American Axle |
$2,376.86
|
| Rate for Payer: Aetna Commercial |
$3,108.20
|
| Rate for Payer: Aetna Medicare |
$1,828.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.86
|
| Rate for Payer: BCBS Complete |
$1,462.68
|
| Rate for Payer: Cash Price |
$2,925.37
|
| Rate for Payer: Cofinity Advantage |
$2,559.70
|
| Rate for Payer: Cofinity Commercial |
$3,144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,925.37
|
| Rate for Payer: Healthscope Commercial |
$3,291.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,559.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,742.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,925.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,108.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,742.53
|
| Rate for Payer: PHP Commercial |
$3,108.20
|
| Rate for Payer: Priority Health SBD |
$2,303.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,376.86
|
| Rate for Payer: UHC Core |
$1,905.15
|
| Rate for Payer: UHC Exchange |
$1,437.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,352.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,742.53
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$5,485.07
|
|
|
Service Code
|
NDC 61874011530
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,029.48 |
| Max. Negotiated Rate |
$4,936.56 |
| Rate for Payer: Aetna American Axle |
$3,565.30
|
| Rate for Payer: Aetna Commercial |
$4,662.31
|
| Rate for Payer: Aetna Medicare |
$2,742.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,565.30
|
| Rate for Payer: BCBS Complete |
$2,194.03
|
| Rate for Payer: Cash Price |
$4,388.06
|
| Rate for Payer: Cofinity Advantage |
$3,839.55
|
| Rate for Payer: Cofinity Commercial |
$4,717.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,388.06
|
| Rate for Payer: Healthscope Commercial |
$4,936.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,839.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,113.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,388.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,662.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,113.80
|
| Rate for Payer: PHP Commercial |
$4,662.31
|
| Rate for Payer: Priority Health SBD |
$3,455.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,565.30
|
| Rate for Payer: UHC Core |
$2,857.72
|
| Rate for Payer: UHC Exchange |
$2,155.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,029.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,113.80
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$1,828.36
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$676.49 |
| Max. Negotiated Rate |
$1,645.52 |
| Rate for Payer: Aetna American Axle |
$1,188.43
|
| Rate for Payer: Aetna Commercial |
$1,554.11
|
| Rate for Payer: Aetna Medicare |
$914.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.43
|
| Rate for Payer: BCBS Complete |
$731.34
|
| Rate for Payer: Cash Price |
$1,462.69
|
| Rate for Payer: Cofinity Advantage |
$1,279.85
|
| Rate for Payer: Cofinity Commercial |
$1,572.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.69
|
| Rate for Payer: Healthscope Commercial |
$1,645.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,279.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,371.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,462.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.27
|
| Rate for Payer: PHP Commercial |
$1,554.11
|
| Rate for Payer: Priority Health SBD |
$1,151.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.43
|
| Rate for Payer: UHC Core |
$952.58
|
| Rate for Payer: UHC Exchange |
$718.55
|
| Rate for Payer: UMR Bronson Commercial |
$676.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,371.27
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$5,485.07
|
|
|
Service Code
|
NDC 61874013030
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,413.43 |
| Max. Negotiated Rate |
$4,936.56 |
| Rate for Payer: Aetna American Axle |
$3,565.30
|
| Rate for Payer: Aetna Commercial |
$4,662.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,565.30
|
| Rate for Payer: Cash Price |
$4,388.06
|
| Rate for Payer: Cofinity Advantage |
$3,839.55
|
| Rate for Payer: Cofinity Commercial |
$4,717.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,388.06
|
| Rate for Payer: Healthscope Commercial |
$4,936.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,839.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,113.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,662.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,113.80
|
| Rate for Payer: PHP Commercial |
$4,662.31
|
| Rate for Payer: Priority Health SBD |
$3,455.59
|
| Rate for Payer: UMR Bronson Commercial |
$2,413.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,113.80
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$1,828.36
|
|
|
Service Code
|
NDC 61874013011
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$676.49 |
| Max. Negotiated Rate |
$1,645.52 |
| Rate for Payer: Aetna American Axle |
$1,188.43
|
| Rate for Payer: Aetna Commercial |
$1,554.11
|
| Rate for Payer: Aetna Medicare |
$914.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.43
|
| Rate for Payer: BCBS Complete |
$731.34
|
| Rate for Payer: Cash Price |
$1,462.69
|
| Rate for Payer: Cofinity Advantage |
$1,279.85
|
| Rate for Payer: Cofinity Commercial |
$1,572.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.69
|
| Rate for Payer: Healthscope Commercial |
$1,645.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,279.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,371.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,462.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.27
|
| Rate for Payer: PHP Commercial |
$1,554.11
|
| Rate for Payer: Priority Health SBD |
$1,151.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.43
|
| Rate for Payer: UHC Core |
$952.58
|
| Rate for Payer: UHC Exchange |
$718.55
|
| Rate for Payer: UMR Bronson Commercial |
$676.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,371.27
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$3,656.71
|
|
|
Service Code
|
NDC 61874013020
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,352.98 |
| Max. Negotiated Rate |
$3,291.04 |
| Rate for Payer: Aetna American Axle |
$2,376.86
|
| Rate for Payer: Aetna Commercial |
$3,108.20
|
| Rate for Payer: Aetna Medicare |
$1,828.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.86
|
| Rate for Payer: BCBS Complete |
$1,462.68
|
| Rate for Payer: Cash Price |
$2,925.37
|
| Rate for Payer: Cofinity Advantage |
$2,559.70
|
| Rate for Payer: Cofinity Commercial |
$3,144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,925.37
|
| Rate for Payer: Healthscope Commercial |
$3,291.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,559.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,742.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,925.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,108.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,742.53
|
| Rate for Payer: PHP Commercial |
$3,108.20
|
| Rate for Payer: Priority Health SBD |
$2,303.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,376.86
|
| Rate for Payer: UHC Core |
$1,905.15
|
| Rate for Payer: UHC Exchange |
$1,437.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,352.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,742.53
|
|
