|
SIMPLE SYRUP
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
NDC 38779177908
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.81 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Medicare |
$99.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.70
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Advantage |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$178.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.50
|
| Rate for Payer: PHP Commercial |
$168.30
|
| Rate for Payer: Priority Health SBD |
$124.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.70
|
| Rate for Payer: UHC Core |
$103.16
|
| Rate for Payer: UHC Exchange |
$77.81
|
|
|
SIMPLE SYRUP
|
Facility
|
IP
|
$190.08
|
|
|
Service Code
|
NDC 00395266116
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.75 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Aetna Commercial |
$161.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.55
|
| Rate for Payer: Cash Price |
$152.06
|
| Rate for Payer: Cofinity Advantage |
$133.06
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.06
|
| Rate for Payer: Healthscope Commercial |
$171.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.56
|
| Rate for Payer: PHP Commercial |
$161.57
|
| Rate for Payer: Priority Health SBD |
$119.75
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$90,771.54
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$41,698.01 |
| Max. Negotiated Rate |
$90,771.54 |
| Rate for Payer: Aetna Medicare |
$45,648.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54,865.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54,865.80
|
| Rate for Payer: BCBS MAPPO |
$43,892.64
|
| Rate for Payer: BCBS Trust/PPO |
$90,771.54
|
| Rate for Payer: BCN Commercial |
$90,771.54
|
| Rate for Payer: BCN Medicare Advantage |
$43,892.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43,892.64
|
| Rate for Payer: Mclaren Medicare |
$43,892.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46,087.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,476.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$48,281.90
|
| Rate for Payer: Nomi Health Commercial |
$72,299.34
|
| Rate for Payer: PACE Medicare |
$41,698.01
|
| Rate for Payer: PACE SWMI |
$43,892.64
|
| Rate for Payer: PHP Medicare Advantage |
$43,892.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$90,358.15
|
| Rate for Payer: Priority Health Medicare |
$43,892.64
|
| Rate for Payer: Priority Health Tiered Network |
$72,286.51
|
| Rate for Payer: Railroad Medicare Medicare |
$43,892.64
|
| Rate for Payer: VA VA |
$43,892.64
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
|
IP
|
$137,898.87
|
|
|
Service Code
|
MSDRG 019
|
| Min. Negotiated Rate |
$52,930.96 |
| Max. Negotiated Rate |
$137,898.87 |
| Rate for Payer: Aetna Medicare |
$57,945.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69,646.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69,646.00
|
| Rate for Payer: BCBS MAPPO |
$55,716.80
|
| Rate for Payer: BCBS Trust/PPO |
$137,898.87
|
| Rate for Payer: BCN Commercial |
$137,898.87
|
| Rate for Payer: BCN Medicare Advantage |
$55,716.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55,716.80
|
| Rate for Payer: Mclaren Medicare |
$55,716.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58,502.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64,074.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$61,288.48
|
| Rate for Payer: Nomi Health Commercial |
$85,490.88
|
| Rate for Payer: PACE Medicare |
$52,930.96
|
| Rate for Payer: PACE SWMI |
$55,716.80
|
| Rate for Payer: PHP Medicare Advantage |
$55,716.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115,025.02
|
| Rate for Payer: Priority Health Medicare |
$55,716.80
|
| Rate for Payer: Priority Health Tiered Network |
$92,020.00
|
| Rate for Payer: Railroad Medicare Medicare |
$55,716.80
|
| Rate for Payer: VA VA |
$55,716.80
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$452.52
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
11368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.01 |
| Max. Negotiated Rate |
$407.27 |
| Rate for Payer: Aetna Commercial |
$384.64
|
| Rate for Payer: Aetna Commercial |
$194.06
|
| Rate for Payer: Aetna Medicare |
$114.16
|
| Rate for Payer: Aetna Medicare |
$226.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.40
|
| Rate for Payer: BCBS Complete |
$91.32
|
| Rate for Payer: BCBS Complete |
$181.01
|
| Rate for Payer: BCBS Trust/PPO |
$276.28
|
| Rate for Payer: BCBS Trust/PPO |
$276.28
|
| Rate for Payer: BCN Commercial |
$276.28
|
| Rate for Payer: BCN Commercial |
$276.28
|
| Rate for Payer: Cash Price |
$362.02
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cash Price |
$362.02
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cofinity Advantage |
$316.76
|
| Rate for Payer: Cofinity Advantage |
$159.82
|
| Rate for Payer: Cofinity Commercial |
$389.17
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.02
|
| Rate for Payer: Healthscope Commercial |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$407.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.23
|
| Rate for Payer: PHP Commercial |
$384.64
|
| Rate for Payer: PHP Commercial |
$194.06
|
| Rate for Payer: Priority Health SBD |
$285.09
|
| Rate for Payer: Priority Health SBD |
$143.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.71
|
| Rate for Payer: UHC Core |
$181.71
|
| Rate for Payer: UHC Core |
$181.71
|
| Rate for Payer: UHC Exchange |
$181.71
|
| Rate for Payer: UHC Exchange |
$181.71
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$452.52
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
11368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.09 |
| Max. Negotiated Rate |
$407.27 |
| Rate for Payer: Aetna Commercial |
$384.64
|
| Rate for Payer: Aetna Commercial |
$194.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.14
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cash Price |
$362.02
|
| Rate for Payer: Cofinity Advantage |
$316.76
|
| Rate for Payer: Cofinity Advantage |
$159.82
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$389.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.02
|
| Rate for Payer: Healthscope Commercial |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$407.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.23
|
| Rate for Payer: PHP Commercial |
$194.06
|
| Rate for Payer: PHP Commercial |
$384.64
|
| Rate for Payer: Priority Health SBD |
$143.84
|
| Rate for Payer: Priority Health SBD |
$285.09
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$20,869.27
|
|
|
Service Code
|
APR-DRG 3003
|
| Min. Negotiated Rate |
$19,875.49 |
| Max. Negotiated Rate |
$20,869.27 |
| Rate for Payer: BCBS Complete |
$20,869.27
|
| Rate for Payer: Mclaren Medicaid |
$19,875.49
|
| Rate for Payer: Meridian Medicaid |
$20,869.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,875.49
|
| Rate for Payer: UHC Medicaid |
$19,875.49
|
| Rate for Payer: UHCCP Medicaid |
$19,875.49
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$13,774.11
|
|
|
Service Code
|
APR-DRG 3001
|
| Min. Negotiated Rate |
$13,118.20 |
| Max. Negotiated Rate |
$13,774.11 |
| Rate for Payer: BCBS Complete |
$13,774.11
|
| Rate for Payer: Mclaren Medicaid |
$13,118.20
|
| Rate for Payer: Meridian Medicaid |
$13,774.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,118.20
|
| Rate for Payer: UHC Medicaid |
$13,118.20
|
| Rate for Payer: UHCCP Medicaid |
$13,118.20
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$27,361.32
|
|
|
Service Code
|
APR-DRG 3004
|
| Min. Negotiated Rate |
$26,058.40 |
| Max. Negotiated Rate |
$27,361.32 |
| Rate for Payer: BCBS Complete |
$27,361.32
|
| Rate for Payer: Mclaren Medicaid |
$26,058.40
|
| Rate for Payer: Meridian Medicaid |
$27,361.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,058.40
|
| Rate for Payer: UHC Medicaid |
$26,058.40
|
| Rate for Payer: UHCCP Medicaid |
$26,058.40
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$65,534.15
|
|
|
Service Code
|
MSDRG 402
|
| Min. Negotiated Rate |
$30,067.82 |
| Max. Negotiated Rate |
$65,534.15 |
| Rate for Payer: Aetna Medicare |
$32,916.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,562.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,562.93
|
| Rate for Payer: BCBS MAPPO |
$31,650.34
|
| Rate for Payer: BCBS Trust/PPO |
$57,787.33
|
| Rate for Payer: BCN Commercial |
$57,787.33
|
| Rate for Payer: BCN Medicare Advantage |
$31,650.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,650.34
|
| Rate for Payer: Mclaren Medicare |
$31,650.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33,232.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,397.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$34,815.37
|
| Rate for Payer: Nomi Health Commercial |
$51,864.45
|
| Rate for Payer: PACE Medicare |
$30,067.82
|
| Rate for Payer: PACE SWMI |
$31,650.34
|
| Rate for Payer: PHP Medicare Advantage |
$31,650.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$64,819.06
|
| Rate for Payer: Priority Health Medicare |
$31,650.34
|
| Rate for Payer: Priority Health Tiered Network |
$51,855.24
|
| Rate for Payer: Railroad Medicare Medicare |
$31,650.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65,534.15
|
| Rate for Payer: UHC Core |
$54,827.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,650.34
|
| Rate for Payer: UHC Exchange |
$44,776.31
|
| Rate for Payer: VA VA |
$31,650.34
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$15,748.55
|
|
|
Service Code
|
APR-DRG 3002
|
| Min. Negotiated Rate |
$14,998.62 |
| Max. Negotiated Rate |
$15,748.55 |
| Rate for Payer: BCBS Complete |
$15,748.55
|
| Rate for Payer: Mclaren Medicaid |
$14,998.62
|
| Rate for Payer: Meridian Medicaid |
$15,748.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,998.62
|
| Rate for Payer: UHC Medicaid |
$14,998.62
|
| Rate for Payer: UHCCP Medicaid |
$14,998.62
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$86,872.48
|
|
|
Service Code
|
MSDRG 450
|
| Min. Negotiated Rate |
$39,678.98 |
| Max. Negotiated Rate |
$86,872.48 |
| Rate for Payer: Aetna Medicare |
$43,438.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,209.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,209.19
|
| Rate for Payer: BCBS MAPPO |
$41,767.35
|
| Rate for Payer: BCBS Trust/PPO |
$80,024.93
|
| Rate for Payer: BCN Commercial |
$80,024.93
|
| Rate for Payer: BCN Medicare Advantage |
$41,767.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,767.35
|
| Rate for Payer: Mclaren Medicare |
$41,767.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43,855.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,032.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$45,944.08
|
| Rate for Payer: Nomi Health Commercial |
$68,751.84
|
| Rate for Payer: PACE Medicare |
$39,678.98
|
| Rate for Payer: PACE SWMI |
$41,767.35
|
| Rate for Payer: PHP Medicare Advantage |
$41,767.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$85,924.56
|
| Rate for Payer: Priority Health Medicare |
$41,767.35
|
| Rate for Payer: Priority Health Tiered Network |
$68,739.64
|
| Rate for Payer: Railroad Medicare Medicare |
$41,767.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86,872.48
|
| Rate for Payer: UHC Core |
$72,679.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41,767.35
|
| Rate for Payer: UHC Exchange |
$59,355.76
|
| Rate for Payer: VA VA |
$41,767.35
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$52,728.86
|
|
|
Service Code
|
MSDRG 451
|
| Min. Negotiated Rate |
$24,267.06 |
| Max. Negotiated Rate |
$52,728.86 |
| Rate for Payer: Aetna Medicare |
$26,566.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,930.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,930.34
|
| Rate for Payer: BCBS MAPPO |
$25,544.27
|
| Rate for Payer: BCBS Trust/PPO |
$52,728.86
|
| Rate for Payer: BCN Commercial |
$52,728.86
|
| Rate for Payer: BCN Medicare Advantage |
$25,544.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,544.27
|
| Rate for Payer: Mclaren Medicare |
$25,544.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,821.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,375.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,098.70
|
| Rate for Payer: Nomi Health Commercial |
$41,672.16
|
| Rate for Payer: PACE Medicare |
$24,267.06
|
| Rate for Payer: PACE SWMI |
$25,544.27
|
| Rate for Payer: PHP Medicare Advantage |
$25,544.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$52,080.96
|
| Rate for Payer: Priority Health Medicare |
$25,544.27
|
| Rate for Payer: Priority Health Tiered Network |
$41,664.76
|
| Rate for Payer: Railroad Medicare Medicare |
$25,544.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,655.52
|
| Rate for Payer: UHC Core |
$44,052.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25,544.27
|
| Rate for Payer: UHC Exchange |
$35,976.96
|
| Rate for Payer: VA VA |
$25,544.27
|
|
|
SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$34,985.04
|
|
|
Service Code
|
MSDRG 135
|
| Min. Negotiated Rate |
$16,481.79 |
| Max. Negotiated Rate |
$34,985.04 |
| Rate for Payer: Aetna Medicare |
$18,043.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,686.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,686.56
|
| Rate for Payer: BCBS MAPPO |
$17,349.25
|
| Rate for Payer: BCBS Trust/PPO |
$32,878.88
|
| Rate for Payer: BCN Commercial |
$32,878.88
|
| Rate for Payer: BCN Medicare Advantage |
$17,349.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,349.25
|
| Rate for Payer: Mclaren Medicare |
$17,349.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,216.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,951.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,084.17
|
| Rate for Payer: Nomi Health Commercial |
$27,286.08
|
| Rate for Payer: PACE Medicare |
$16,481.79
|
| Rate for Payer: PACE SWMI |
$17,349.25
|
| Rate for Payer: PHP Medicare Advantage |
$17,349.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,985.04
|
| Rate for Payer: Priority Health Medicare |
$17,349.25
|
| Rate for Payer: Priority Health Tiered Network |
$27,988.03
|
| Rate for Payer: Railroad Medicare Medicare |
$17,349.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,477.76
|
| Rate for Payer: UHC Core |
$28,844.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,349.25
|
| Rate for Payer: UHC Exchange |
$23,556.98
|
| Rate for Payer: VA VA |
$17,349.25
|
|
|
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,494.18
|
|
|
Service Code
|
MSDRG 136
|
| Min. Negotiated Rate |
$8,004.20 |
| Max. Negotiated Rate |
$19,494.18 |
| Rate for Payer: Aetna Medicare |
$8,762.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,531.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,531.84
|
| Rate for Payer: BCBS MAPPO |
$8,425.47
|
| Rate for Payer: BCBS Trust/PPO |
$19,494.18
|
| Rate for Payer: BCN Commercial |
$19,494.18
|
| Rate for Payer: BCN Medicare Advantage |
$8,425.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,425.47
|
| Rate for Payer: Mclaren Medicare |
$8,425.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,846.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,689.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,268.02
|
| Rate for Payer: Nomi Health Commercial |
$13,097.37
|
| Rate for Payer: PACE Medicare |
$8,004.20
|
| Rate for Payer: PACE SWMI |
$8,425.47
|
| Rate for Payer: PHP Medicare Advantage |
$8,425.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,368.81
|
| Rate for Payer: Priority Health Medicare |
$8,425.47
|
| Rate for Payer: Priority Health Tiered Network |
$13,095.04
|
| Rate for Payer: Railroad Medicare Medicare |
$8,425.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,549.39
|
| Rate for Payer: UHC Core |
$13,845.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,425.47
|
| Rate for Payer: UHC Exchange |
$11,307.40
|
| Rate for Payer: VA VA |
$8,425.47
|
|
|
SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION
|
Facility
|
OP
|
$344,544.64
|
|
|
Service Code
|
HCPCS Q2043
|
| Hospital Charge Code |
104852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29,428.79 |
| Max. Negotiated Rate |
$310,090.18 |
| Rate for Payer: Aetna Commercial |
$292,862.94
|
| Rate for Payer: Aetna Medicare |
$58,519.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223,954.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70,336.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70,336.49
|
| Rate for Payer: BCBS Complete |
$30,903.04
|
| Rate for Payer: BCBS MAPPO |
$56,269.19
|
| Rate for Payer: BCBS Trust/PPO |
$159,686.64
|
| Rate for Payer: BCN Commercial |
$159,686.64
|
| Rate for Payer: BCN Medicare Advantage |
$56,269.19
|
| Rate for Payer: Cash Price |
$275,635.71
|
| Rate for Payer: Cash Price |
$275,635.71
|
| Rate for Payer: Cofinity Advantage |
$241,181.25
|
| Rate for Payer: Cofinity Commercial |
$296,308.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275,635.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,269.19
|
| Rate for Payer: Healthscope Commercial |
$310,090.18
|
| Rate for Payer: Mclaren Medicaid |
$29,428.79
|
| Rate for Payer: Mclaren Medicare |
$56,269.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59,082.65
|
| Rate for Payer: Meridian Medicaid |
$59,082.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64,709.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$61,896.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292,862.94
|
| Rate for Payer: Nomi Health Commercial |
$168,807.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258,408.48
|
| Rate for Payer: PACE Medicare |
$53,455.73
|
| Rate for Payer: PACE SWMI |
$56,269.19
|
| Rate for Payer: PHP Commercial |
$292,862.94
|
| Rate for Payer: PHP Medicare Advantage |
$56,269.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,428.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$174,327.15
|
| Rate for Payer: Priority Health Medicare |
$56,269.19
|
| Rate for Payer: Priority Health SBD |
$217,063.12
|
| Rate for Payer: Priority Health Tiered Network |
$139,461.72
|
| Rate for Payer: Railroad Medicare Medicare |
$56,269.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89,766.78
|
| Rate for Payer: UHC Core |
$89,766.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56,269.19
|
| Rate for Payer: UHC Exchange |
$89,766.78
|
| Rate for Payer: UHC Medicaid |
$29,428.79
|
| Rate for Payer: UHCCP Medicaid |
$29,428.79
|
| Rate for Payer: VA VA |
$56,269.19
|
|
|
SKIN CARE CONSULT
|
Professional
|
Both
|
$27.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
|
|
SKIN CLEANSER,GENERAL
|
Facility
|
IP
|
$8.54
|
|
|
Service Code
|
NDC 61924019908
|
| Hospital Charge Code |
111083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Aetna Commercial |
$7.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.55
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cofinity Advantage |
$5.98
|
| Rate for Payer: Cofinity Commercial |
$7.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.83
|
| Rate for Payer: Healthscope Commercial |
$7.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.41
|
| Rate for Payer: PHP Commercial |
$7.26
|
| Rate for Payer: Priority Health SBD |
$5.38
|
|
|
SKIN CLEANSER,GENERAL
|
Facility
|
OP
|
$8.54
|
|
|
Service Code
|
NDC 61924019908
|
| Hospital Charge Code |
111083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Aetna Commercial |
$7.26
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.55
|
| Rate for Payer: BCBS Complete |
$3.42
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cofinity Advantage |
$5.98
|
| Rate for Payer: Cofinity Commercial |
$7.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.83
|
| Rate for Payer: Healthscope Commercial |
$7.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.41
|
| Rate for Payer: PHP Commercial |
$7.26
|
| Rate for Payer: Priority Health SBD |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.55
|
| Rate for Payer: UHC Core |
$4.45
|
| Rate for Payer: UHC Exchange |
$3.36
|
|
|
SKIN DEBRIDEMENT WITH CC
|
Facility
|
IP
|
$28,162.16
|
|
|
Service Code
|
MSDRG 571
|
| Min. Negotiated Rate |
$12,954.04 |
| Max. Negotiated Rate |
$28,162.16 |
| Rate for Payer: Aetna Medicare |
$14,181.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,044.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,044.79
|
| Rate for Payer: BCBS MAPPO |
$13,635.83
|
| Rate for Payer: BCBS Trust/PPO |
$28,162.16
|
| Rate for Payer: BCN Commercial |
$28,162.16
|
| Rate for Payer: BCN Medicare Advantage |
$13,635.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,635.83
|
| Rate for Payer: Mclaren Medicare |
$13,635.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,317.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,681.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,999.41
|
| Rate for Payer: Nomi Health Commercial |
$21,794.55
|
| Rate for Payer: PACE Medicare |
$12,954.04
|
| Rate for Payer: PACE SWMI |
$13,635.83
|
| Rate for Payer: PHP Medicare Advantage |
$13,635.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,238.36
|
| Rate for Payer: Priority Health Medicare |
$13,635.83
|
| Rate for Payer: Priority Health Tiered Network |
$21,790.68
|
| Rate for Payer: Railroad Medicare Medicare |
$13,635.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,538.85
|
| Rate for Payer: UHC Core |
$23,039.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,635.83
|
| Rate for Payer: UHC Exchange |
$18,815.96
|
| Rate for Payer: VA VA |
$13,635.83
|
|
|
SKIN DEBRIDEMENT WITH MCC
|
Facility
|
IP
|
$47,939.93
|
|
|
Service Code
|
MSDRG 570
|
| Min. Negotiated Rate |
$22,143.05 |
| Max. Negotiated Rate |
$47,939.93 |
| Rate for Payer: Aetna Medicare |
$24,240.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,135.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,135.59
|
| Rate for Payer: BCBS MAPPO |
$23,308.47
|
| Rate for Payer: BCBS Trust/PPO |
$36,095.14
|
| Rate for Payer: BCN Commercial |
$36,095.14
|
| Rate for Payer: BCN Medicare Advantage |
$23,308.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,308.47
|
| Rate for Payer: Mclaren Medicare |
$23,308.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,473.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,804.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,639.32
|
| Rate for Payer: Nomi Health Commercial |
$37,940.19
|
| Rate for Payer: PACE Medicare |
$22,143.05
|
| Rate for Payer: PACE SWMI |
$23,308.47
|
| Rate for Payer: PHP Medicare Advantage |
$23,308.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47,416.83
|
| Rate for Payer: Priority Health Medicare |
$23,308.47
|
| Rate for Payer: Priority Health Tiered Network |
$37,933.45
|
| Rate for Payer: Railroad Medicare Medicare |
$23,308.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,939.93
|
| Rate for Payer: UHC Core |
$40,107.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,308.47
|
| Rate for Payer: UHC Exchange |
$32,755.03
|
| Rate for Payer: VA VA |
$23,308.47
|
|
|
SKIN DEBRIDEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$18,967.50
|
|
|
Service Code
|
MSDRG 572
|
| Min. Negotiated Rate |
$8,965.97 |
| Max. Negotiated Rate |
$18,967.50 |
| Rate for Payer: Aetna Medicare |
$9,815.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,797.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,797.33
|
| Rate for Payer: BCBS MAPPO |
$9,437.86
|
| Rate for Payer: BCBS Trust/PPO |
$18,967.50
|
| Rate for Payer: BCN Commercial |
$18,967.50
|
| Rate for Payer: BCN Medicare Advantage |
$9,437.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,437.86
|
| Rate for Payer: Mclaren Medicare |
$9,437.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,909.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,853.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,381.65
|
| Rate for Payer: Nomi Health Commercial |
$14,787.27
|
| Rate for Payer: PACE Medicare |
$8,965.97
|
| Rate for Payer: PACE SWMI |
$9,437.86
|
| Rate for Payer: PHP Medicare Advantage |
$9,437.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,480.81
|
| Rate for Payer: Priority Health Medicare |
$9,437.86
|
| Rate for Payer: Priority Health Tiered Network |
$14,784.64
|
| Rate for Payer: Railroad Medicare Medicare |
$9,437.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,684.69
|
| Rate for Payer: UHC Core |
$15,632.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,437.86
|
| Rate for Payer: UHC Exchange |
$12,766.34
|
| Rate for Payer: VA VA |
$9,437.86
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$68,393.49
|
|
|
Service Code
|
MSDRG 577
|
| Min. Negotiated Rate |
$20,011.01 |
| Max. Negotiated Rate |
$68,393.49 |
| Rate for Payer: Aetna Medicare |
$21,906.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,330.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,330.28
|
| Rate for Payer: BCBS MAPPO |
$21,064.22
|
| Rate for Payer: BCBS Trust/PPO |
$68,393.49
|
| Rate for Payer: BCN Commercial |
$68,393.49
|
| Rate for Payer: BCN Medicare Advantage |
$21,064.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,064.22
|
| Rate for Payer: Mclaren Medicare |
$21,064.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,117.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,223.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,170.64
|
| Rate for Payer: Nomi Health Commercial |
$34,194.03
|
| Rate for Payer: PACE Medicare |
$20,011.01
|
| Rate for Payer: PACE SWMI |
$21,064.22
|
| Rate for Payer: PHP Medicare Advantage |
$21,064.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42,734.96
|
| Rate for Payer: Priority Health Medicare |
$21,064.22
|
| Rate for Payer: Priority Health Tiered Network |
$34,187.96
|
| Rate for Payer: Railroad Medicare Medicare |
$21,064.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,206.41
|
| Rate for Payer: UHC Core |
$36,147.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,064.22
|
| Rate for Payer: UHC Exchange |
$29,520.85
|
| Rate for Payer: VA VA |
$21,064.22
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$106,644.51
|
|
|
Service Code
|
MSDRG 576
|
| Min. Negotiated Rate |
$36,533.77 |
| Max. Negotiated Rate |
$106,644.51 |
| Rate for Payer: Aetna Medicare |
$39,994.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,070.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,070.75
|
| Rate for Payer: BCBS MAPPO |
$38,456.60
|
| Rate for Payer: BCBS Trust/PPO |
$106,644.51
|
| Rate for Payer: BCN Commercial |
$106,644.51
|
| Rate for Payer: BCN Medicare Advantage |
$38,456.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,456.60
|
| Rate for Payer: Mclaren Medicare |
$38,456.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40,379.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,225.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$42,302.26
|
| Rate for Payer: Nomi Health Commercial |
$63,225.48
|
| Rate for Payer: PACE Medicare |
$36,533.77
|
| Rate for Payer: PACE SWMI |
$38,456.60
|
| Rate for Payer: PHP Medicare Advantage |
$38,456.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$79,017.83
|
| Rate for Payer: Priority Health Medicare |
$38,456.60
|
| Rate for Payer: Priority Health Tiered Network |
$63,214.26
|
| Rate for Payer: Railroad Medicare Medicare |
$38,456.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79,889.56
|
| Rate for Payer: UHC Core |
$66,837.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38,456.60
|
| Rate for Payer: UHC Exchange |
$54,584.66
|
| Rate for Payer: VA VA |
$38,456.60
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$33,972.03
|
|
|
Service Code
|
MSDRG 578
|
| Min. Negotiated Rate |
$12,343.96 |
| Max. Negotiated Rate |
$33,972.03 |
| Rate for Payer: Aetna Medicare |
$13,513.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,242.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,242.05
|
| Rate for Payer: BCBS MAPPO |
$12,993.64
|
| Rate for Payer: BCBS Trust/PPO |
$33,972.03
|
| Rate for Payer: BCN Commercial |
$33,972.03
|
| Rate for Payer: BCN Medicare Advantage |
$12,993.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,993.64
|
| Rate for Payer: Mclaren Medicare |
$12,993.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,643.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,942.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,293.00
|
| Rate for Payer: Nomi Health Commercial |
$20,722.56
|
| Rate for Payer: PACE Medicare |
$12,343.96
|
| Rate for Payer: PACE SWMI |
$12,993.64
|
| Rate for Payer: PHP Medicare Advantage |
$12,993.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,898.61
|
| Rate for Payer: Priority Health Medicare |
$12,993.64
|
| Rate for Payer: Priority Health Tiered Network |
$20,718.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,993.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,184.32
|
| Rate for Payer: UHC Core |
$21,906.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,993.64
|
| Rate for Payer: UHC Exchange |
$17,890.48
|
| Rate for Payer: VA VA |
$12,993.64
|
|
