|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,433.65
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$6,690.28 |
| Rate for Payer: Aetna Commercial |
$6,318.60
|
| Rate for Payer: Aetna Medicare |
$83.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,831.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.58
|
| Rate for Payer: BCBS Complete |
$44.19
|
| Rate for Payer: BCBS MAPPO |
$80.46
|
| Rate for Payer: BCBS Trust/PPO |
$197.83
|
| Rate for Payer: BCN Commercial |
$197.83
|
| Rate for Payer: BCN Medicare Advantage |
$80.46
|
| Rate for Payer: Cash Price |
$5,946.92
|
| Rate for Payer: Cash Price |
$5,946.92
|
| Rate for Payer: Cofinity Advantage |
$5,203.56
|
| Rate for Payer: Cofinity Commercial |
$6,392.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,946.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.46
|
| Rate for Payer: Healthscope Commercial |
$6,690.28
|
| Rate for Payer: Mclaren Medicaid |
$42.08
|
| Rate for Payer: Mclaren Medicare |
$80.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.48
|
| Rate for Payer: Meridian Medicaid |
$84.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,318.60
|
| Rate for Payer: Nomi Health Commercial |
$241.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,575.24
|
| Rate for Payer: PACE Medicare |
$76.44
|
| Rate for Payer: PACE SWMI |
$80.46
|
| Rate for Payer: PHP Commercial |
$6,318.60
|
| Rate for Payer: PHP Medicare Advantage |
$80.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$247.18
|
| Rate for Payer: Priority Health Medicare |
$80.46
|
| Rate for Payer: Priority Health SBD |
$4,683.20
|
| Rate for Payer: Priority Health Tiered Network |
$197.74
|
| Rate for Payer: Railroad Medicare Medicare |
$80.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.56
|
| Rate for Payer: UHC Core |
$132.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.46
|
| Rate for Payer: UHC Exchange |
$132.56
|
| Rate for Payer: UHC Medicaid |
$42.08
|
| Rate for Payer: UHCCP Medicaid |
$42.08
|
| Rate for Payer: VA VA |
$80.46
|
|
|
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$2,246.88
|
|
|
Service Code
|
CPT 51710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$363.38 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$396.60
|
| Rate for Payer: BCN Commercial |
$396.60
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$805.08
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$177.16
|
| Rate for Payer: BCN Commercial |
$177.16
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$79.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.25
|
|
|
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,855.91
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$3,855.91 |
| Rate for Payer: Aetna Medicare |
$1,240.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,536.77
|
| Rate for Payer: BCN Commercial |
$1,536.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Mclaren Medicaid |
$623.59
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$1,251.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Nomi Health Commercial |
$3,577.02
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,855.91
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health Tiered Network |
$3,084.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$15,773.78
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$15,022.64 |
| Max. Negotiated Rate |
$15,773.78 |
| Rate for Payer: BCBS Complete |
$15,773.78
|
| Rate for Payer: Mclaren Medicaid |
$15,022.64
|
| Rate for Payer: Meridian Medicaid |
$15,773.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,022.64
|
| Rate for Payer: UHC Medicaid |
$15,022.64
|
| Rate for Payer: UHCCP Medicaid |
$15,022.64
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$34,604.39
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$32,956.56 |
| Max. Negotiated Rate |
$34,604.39 |
| Rate for Payer: BCBS Complete |
$34,604.39
|
| Rate for Payer: Mclaren Medicaid |
$32,956.56
|
| Rate for Payer: Meridian Medicaid |
$34,604.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$32,956.56
|
| Rate for Payer: UHC Medicaid |
$32,956.56
|
| Rate for Payer: UHCCP Medicaid |
$32,956.56
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$6,575.75
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$6,262.62 |
| Max. Negotiated Rate |
$6,575.75 |
| Rate for Payer: BCBS Complete |
$6,575.75
|
| Rate for Payer: Mclaren Medicaid |
$6,262.62
|
| Rate for Payer: Meridian Medicaid |
$6,575.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,262.62
|
| Rate for Payer: UHC Medicaid |
$6,262.62
|
| Rate for Payer: UHCCP Medicaid |
$6,262.62
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$5,115.56
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$4,871.96 |
| Max. Negotiated Rate |
$5,115.56 |
| Rate for Payer: BCBS Complete |
$5,115.56
|
| Rate for Payer: Mclaren Medicaid |
$4,871.96
|
| Rate for Payer: Meridian Medicaid |
$5,115.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,871.96
|
| Rate for Payer: UHC Medicaid |
$4,871.96
|
| Rate for Payer: UHCCP Medicaid |
$4,871.96
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$94,748.56
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$35,822.32 |
| Max. Negotiated Rate |
$94,748.56 |
| Rate for Payer: Aetna Medicare |
$39,216.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,134.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,134.64
|
| Rate for Payer: BCBS MAPPO |
$37,707.71
|
| Rate for Payer: BCBS Trust/PPO |
$94,748.56
|
| Rate for Payer: BCN Commercial |
$94,748.56
|
| Rate for Payer: BCN Medicare Advantage |
$37,707.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,707.71
|
| Rate for Payer: Mclaren Medicare |
$37,707.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39,593.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43,363.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$41,478.48
|
| Rate for Payer: Nomi Health Commercial |
$61,975.47
|
| Rate for Payer: PACE Medicare |
$35,822.32
|
| Rate for Payer: PACE SWMI |
$37,707.71
|
| Rate for Payer: PHP Medicare Advantage |
$37,707.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$77,455.60
|
| Rate for Payer: Priority Health Medicare |
$37,707.71
|
| Rate for Payer: Priority Health Tiered Network |
$61,964.47
|
| Rate for Payer: Railroad Medicare Medicare |
$37,707.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78,310.09
|
| Rate for Payer: UHC Core |
$65,516.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37,707.71
|
| Rate for Payer: UHC Exchange |
$53,505.49
|
| Rate for Payer: VA VA |
$37,707.71
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$42,288.89
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$15,875.36 |
| Max. Negotiated Rate |
$42,288.89 |
| Rate for Payer: Aetna Medicare |
$17,379.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,888.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,888.64
|
| Rate for Payer: BCBS MAPPO |
$16,710.91
|
| Rate for Payer: BCBS Trust/PPO |
$42,288.89
|
| Rate for Payer: BCN Commercial |
$42,288.89
|
| Rate for Payer: BCN Medicare Advantage |
$16,710.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,710.91
|
| Rate for Payer: Mclaren Medicare |
$16,710.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,546.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,217.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,382.00
|
| Rate for Payer: Nomi Health Commercial |
$26,927.46
|
| Rate for Payer: PACE Medicare |
$15,875.36
|
| Rate for Payer: PACE SWMI |
$16,710.91
|
| Rate for Payer: PHP Medicare Advantage |
$16,710.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,653.36
|
| Rate for Payer: Priority Health Medicare |
$16,710.91
|
| Rate for Payer: Priority Health Tiered Network |
$26,922.68
|
| Rate for Payer: Railroad Medicare Medicare |
$16,710.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,024.62
|
| Rate for Payer: UHC Core |
$28,465.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,710.91
|
| Rate for Payer: UHC Exchange |
$23,247.37
|
| Rate for Payer: VA VA |
$16,710.91
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$23,535.57
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$11,150.90 |
| Max. Negotiated Rate |
$23,535.57 |
| Rate for Payer: Aetna Medicare |
$12,207.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,672.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,672.24
|
| Rate for Payer: BCBS MAPPO |
$11,737.79
|
| Rate for Payer: BCBS Trust/PPO |
$21,020.38
|
| Rate for Payer: BCN Commercial |
$21,020.38
|
| Rate for Payer: BCN Medicare Advantage |
$11,737.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,737.79
|
| Rate for Payer: Mclaren Medicare |
$11,737.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,324.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,498.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,911.57
|
| Rate for Payer: Nomi Health Commercial |
$18,626.31
|
| Rate for Payer: PACE Medicare |
$11,150.90
|
| Rate for Payer: PACE SWMI |
$11,737.79
|
| Rate for Payer: PHP Medicare Advantage |
$11,737.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,278.76
|
| Rate for Payer: Priority Health Medicare |
$11,737.79
|
| Rate for Payer: Priority Health Tiered Network |
$18,623.00
|
| Rate for Payer: Railroad Medicare Medicare |
$11,737.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,535.57
|
| Rate for Payer: UHC Core |
$19,690.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,737.79
|
| Rate for Payer: UHC Exchange |
$16,080.71
|
| Rate for Payer: VA VA |
$11,737.79
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$21,987.13
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$10,154.62 |
| Max. Negotiated Rate |
$21,987.13 |
| Rate for Payer: Aetna Medicare |
$11,116.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,361.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,361.34
|
| Rate for Payer: BCBS MAPPO |
$10,689.07
|
| Rate for Payer: BCBS Trust/PPO |
$21,987.13
|
| Rate for Payer: BCN Commercial |
$21,987.13
|
| Rate for Payer: BCN Medicare Advantage |
$10,689.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,689.07
|
| Rate for Payer: Mclaren Medicare |
$10,689.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,223.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,292.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,757.98
|
| Rate for Payer: Nomi Health Commercial |
$16,875.78
|
| Rate for Payer: PACE Medicare |
$10,154.62
|
| Rate for Payer: PACE SWMI |
$10,689.07
|
| Rate for Payer: PHP Medicare Advantage |
$10,689.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,090.98
|
| Rate for Payer: Priority Health Medicare |
$10,689.07
|
| Rate for Payer: Priority Health Tiered Network |
$16,872.78
|
| Rate for Payer: Railroad Medicare Medicare |
$10,689.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,323.66
|
| Rate for Payer: UHC Core |
$17,839.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,689.07
|
| Rate for Payer: UHC Exchange |
$14,569.42
|
| Rate for Payer: VA VA |
$10,689.07
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$42,257.75
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$19,583.71 |
| Max. Negotiated Rate |
$42,257.75 |
| Rate for Payer: Aetna Medicare |
$21,439.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,768.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,768.04
|
| Rate for Payer: BCBS MAPPO |
$20,614.43
|
| Rate for Payer: BCBS Trust/PPO |
$41,366.62
|
| Rate for Payer: BCN Commercial |
$41,366.62
|
| Rate for Payer: BCN Medicare Advantage |
$20,614.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,614.43
|
| Rate for Payer: Mclaren Medicare |
$20,614.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,645.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,706.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,675.87
|
| Rate for Payer: Nomi Health Commercial |
$33,443.25
|
| Rate for Payer: PACE Medicare |
$19,583.71
|
| Rate for Payer: PACE SWMI |
$20,614.43
|
| Rate for Payer: PHP Medicare Advantage |
$20,614.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,796.65
|
| Rate for Payer: Priority Health Medicare |
$20,614.43
|
| Rate for Payer: Priority Health Tiered Network |
$33,437.31
|
| Rate for Payer: Railroad Medicare Medicare |
$20,614.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,257.75
|
| Rate for Payer: UHC Core |
$35,353.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,614.43
|
| Rate for Payer: UHC Exchange |
$28,872.67
|
| Rate for Payer: VA VA |
$20,614.43
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$13,845.22
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$6,786.19 |
| Max. Negotiated Rate |
$13,845.22 |
| Rate for Payer: Aetna Medicare |
$7,429.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,929.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,929.20
|
| Rate for Payer: BCBS MAPPO |
$7,143.36
|
| Rate for Payer: BCBS Trust/PPO |
$12,577.12
|
| Rate for Payer: BCN Commercial |
$12,577.12
|
| Rate for Payer: BCN Medicare Advantage |
$7,143.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,143.36
|
| Rate for Payer: Mclaren Medicare |
$7,143.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,500.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,214.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,857.70
|
| Rate for Payer: Nomi Health Commercial |
$10,957.26
|
| Rate for Payer: PACE Medicare |
$6,786.19
|
| Rate for Payer: PACE SWMI |
$7,143.36
|
| Rate for Payer: PHP Medicare Advantage |
$7,143.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,694.15
|
| Rate for Payer: Priority Health Medicare |
$7,143.36
|
| Rate for Payer: Priority Health Tiered Network |
$10,955.31
|
| Rate for Payer: Railroad Medicare Medicare |
$7,143.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,845.22
|
| Rate for Payer: UHC Core |
$11,583.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,143.36
|
| Rate for Payer: UHC Exchange |
$9,459.77
|
| Rate for Payer: VA VA |
$7,143.36
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
IP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Advantage |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.94
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health SBD |
$96.55
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
OP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna Medicare |
$76.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: BCBS Complete |
$61.30
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Advantage |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.94
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health SBD |
$96.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.62
|
| Rate for Payer: UHC Core |
$79.85
|
| Rate for Payer: UHC Exchange |
$60.23
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$4,265.93
|
|
|
Service Code
|
APR-DRG 2031
|
| Min. Negotiated Rate |
$4,062.79 |
| Max. Negotiated Rate |
$4,265.93 |
| Rate for Payer: BCBS Complete |
$4,265.93
|
| Rate for Payer: Mclaren Medicaid |
$4,062.79
|
| Rate for Payer: Meridian Medicaid |
$4,265.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,062.79
|
| Rate for Payer: UHC Medicaid |
$4,062.79
|
| Rate for Payer: UHCCP Medicaid |
$4,062.79
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$4,790.49
|
|
|
Service Code
|
APR-DRG 2032
|
| Min. Negotiated Rate |
$4,562.38 |
| Max. Negotiated Rate |
$4,790.49 |
| Rate for Payer: BCBS Complete |
$4,790.49
|
| Rate for Payer: Mclaren Medicaid |
$4,562.38
|
| Rate for Payer: Meridian Medicaid |
$4,790.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,562.38
|
| Rate for Payer: UHC Medicaid |
$4,562.38
|
| Rate for Payer: UHCCP Medicaid |
$4,562.38
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$13,782.63
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$5,836.16 |
| Max. Negotiated Rate |
$13,782.63 |
| Rate for Payer: Aetna Medicare |
$6,389.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,679.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,679.16
|
| Rate for Payer: BCBS MAPPO |
$6,143.33
|
| Rate for Payer: BCBS Trust/PPO |
$13,782.63
|
| Rate for Payer: BCN Commercial |
$13,782.63
|
| Rate for Payer: BCN Medicare Advantage |
$6,143.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,143.33
|
| Rate for Payer: Mclaren Medicare |
$6,143.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,450.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,064.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,757.66
|
| Rate for Payer: Nomi Health Commercial |
$9,288.00
|
| Rate for Payer: PACE Medicare |
$5,836.16
|
| Rate for Payer: PACE SWMI |
$6,143.33
|
| Rate for Payer: PHP Medicare Advantage |
$6,143.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,607.94
|
| Rate for Payer: Priority Health Medicare |
$6,143.33
|
| Rate for Payer: Priority Health Tiered Network |
$9,286.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,143.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,736.00
|
| Rate for Payer: UHC Core |
$9,818.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,143.33
|
| Rate for Payer: UHC Exchange |
$8,018.64
|
| Rate for Payer: VA VA |
$6,143.33
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$8,839.71
|
|
|
Service Code
|
APR-DRG 2034
|
| Min. Negotiated Rate |
$8,418.77 |
| Max. Negotiated Rate |
$8,839.71 |
| Rate for Payer: BCBS Complete |
$8,839.71
|
| Rate for Payer: Mclaren Medicaid |
$8,418.77
|
| Rate for Payer: Meridian Medicaid |
$8,839.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,418.77
|
| Rate for Payer: UHC Medicaid |
$8,418.77
|
| Rate for Payer: UHCCP Medicaid |
$8,418.77
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$5,374.11
|
|
|
Service Code
|
APR-DRG 2033
|
| Min. Negotiated Rate |
$5,118.20 |
| Max. Negotiated Rate |
$5,374.11 |
| Rate for Payer: BCBS Complete |
$5,374.11
|
| Rate for Payer: Mclaren Medicaid |
$5,118.20
|
| Rate for Payer: Meridian Medicaid |
$5,374.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,118.20
|
| Rate for Payer: UHC Medicaid |
$5,118.20
|
| Rate for Payer: UHCCP Medicaid |
$5,118.20
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$457.04 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$612.43
|
| Rate for Payer: Aetna Commercial |
$612.43
|
| Rate for Payer: Aetna Medicare |
$475.32
|
| Rate for Payer: Aetna Medicare |
$475.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.43
|
| Rate for Payer: BCBS MAPPO |
$457.04
|
| Rate for Payer: BCBS MAPPO |
$457.04
|
| Rate for Payer: BCN Commercial |
$707.55
|
| Rate for Payer: BCN Commercial |
$707.55
|
| Rate for Payer: BCN Medicare Advantage |
$457.04
|
| Rate for Payer: BCN Medicare Advantage |
$457.04
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cofinity Commercial |
$658.14
|
| Rate for Payer: Cofinity Commercial |
$612.43
|
| Rate for Payer: Cofinity Commercial |
$612.43
|
| Rate for Payer: Cofinity Commercial |
$658.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.04
|
| Rate for Payer: Healthscope Commercial |
$845.52
|
| Rate for Payer: Healthscope Commercial |
$845.52
|
| Rate for Payer: Healthscope Commercial |
$731.26
|
| Rate for Payer: Healthscope Commercial |
$731.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$479.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$479.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$502.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$502.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.88
|
| Rate for Payer: Nomi Health Commercial |
$548.45
|
| Rate for Payer: Nomi Health Commercial |
$548.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,060.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.00
|
| Rate for Payer: PACE SWMI |
$457.04
|
| Rate for Payer: PACE SWMI |
$457.04
|
| Rate for Payer: PHP Medicare Advantage |
$457.04
|
| Rate for Payer: PHP Medicare Advantage |
$457.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$732.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$732.03
|
| Rate for Payer: Priority Health Medicare |
$457.04
|
| Rate for Payer: Priority Health Medicare |
$457.04
|
| Rate for Payer: Priority Health SBD |
$732.03
|
| Rate for Payer: Priority Health SBD |
$732.03
|
| Rate for Payer: Priority Health Tiered Network |
$732.03
|
| Rate for Payer: Priority Health Tiered Network |
$732.03
|
| Rate for Payer: Railroad Medicare Medicare |
$457.04
|
| Rate for Payer: Railroad Medicare Medicare |
$457.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.09
|
| Rate for Payer: UHC Core |
$699.09
|
| Rate for Payer: UHC Core |
$699.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$457.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$457.04
|
| Rate for Payer: UHC Exchange |
$699.09
|
| Rate for Payer: UHC Exchange |
$699.09
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$74.71 |
| Max. Negotiated Rate |
$138.21 |
| Rate for Payer: Aetna Commercial |
$100.11
|
| Rate for Payer: Aetna Medicare |
$77.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: BCBS MAPPO |
$74.71
|
| Rate for Payer: BCN Commercial |
$118.52
|
| Rate for Payer: BCN Medicare Advantage |
$74.71
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$107.58
|
| Rate for Payer: Cofinity Commercial |
$100.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$138.21
|
| Rate for Payer: Healthscope Commercial |
$119.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: Nomi Health Commercial |
$89.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PACE SWMI |
$74.71
|
| Rate for Payer: PHP Medicare Advantage |
$74.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$119.40
|
| Rate for Payer: Priority Health Medicare |
$74.71
|
| Rate for Payer: Priority Health SBD |
$119.40
|
| Rate for Payer: Priority Health Tiered Network |
$119.40
|
| Rate for Payer: Railroad Medicare Medicare |
$74.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.69
|
| Rate for Payer: UHC Core |
$103.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.71
|
| Rate for Payer: UHC Exchange |
$103.69
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$44.22 |
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna Medicare |
$24.86
|
| Rate for Payer: Aetna Medicare |
$24.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.42
|
| Rate for Payer: BCBS MAPPO |
$23.90
|
| Rate for Payer: BCBS MAPPO |
$23.90
|
| Rate for Payer: BCN Commercial |
$38.34
|
| Rate for Payer: BCN Commercial |
$38.34
|
| Rate for Payer: BCN Medicare Advantage |
$23.90
|
| Rate for Payer: BCN Medicare Advantage |
$23.90
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Cofinity Commercial |
$34.42
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Cofinity Commercial |
$34.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.90
|
| Rate for Payer: Healthscope Commercial |
$44.22
|
| Rate for Payer: Healthscope Commercial |
$44.22
|
| Rate for Payer: Healthscope Commercial |
$38.24
|
| Rate for Payer: Healthscope Commercial |
$38.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.29
|
| Rate for Payer: Nomi Health Commercial |
$28.68
|
| Rate for Payer: Nomi Health Commercial |
$28.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: PACE SWMI |
$23.90
|
| Rate for Payer: PACE SWMI |
$23.90
|
| Rate for Payer: PHP Medicare Advantage |
$23.90
|
| Rate for Payer: PHP Medicare Advantage |
$23.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.64
|
| Rate for Payer: Priority Health Medicare |
$23.90
|
| Rate for Payer: Priority Health Medicare |
$23.90
|
| Rate for Payer: Priority Health SBD |
$38.64
|
| Rate for Payer: Priority Health SBD |
$38.64
|
| Rate for Payer: Priority Health Tiered Network |
$38.64
|
| Rate for Payer: Priority Health Tiered Network |
$38.64
|
| Rate for Payer: Railroad Medicare Medicare |
$23.90
|
| Rate for Payer: Railroad Medicare Medicare |
$23.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.97
|
| Rate for Payer: UHC Core |
$32.97
|
| Rate for Payer: UHC Core |
$32.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.90
|
| Rate for Payer: UHC Exchange |
$32.97
|
| Rate for Payer: UHC Exchange |
$32.97
|
|
