|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 14000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,050.16 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.16
|
| Rate for Payer: BCN Commercial |
$1,050.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$6,692.13
|
|
|
Service Code
|
APR-DRG 7554
|
| Min. Negotiated Rate |
$6,373.46 |
| Max. Negotiated Rate |
$6,692.13 |
| Rate for Payer: BCBS Complete |
$6,692.13
|
| Rate for Payer: Mclaren Medicaid |
$6,373.46
|
| Rate for Payer: Meridian Medicaid |
$6,692.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,373.46
|
| Rate for Payer: UHC Medicaid |
$6,373.46
|
| Rate for Payer: UHCCP Medicaid |
$6,373.46
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$3,633.00
|
|
|
Service Code
|
APR-DRG 7552
|
| Min. Negotiated Rate |
$3,460.00 |
| Max. Negotiated Rate |
$3,633.00 |
| Rate for Payer: BCBS Complete |
$3,633.00
|
| Rate for Payer: Mclaren Medicaid |
$3,460.00
|
| Rate for Payer: Meridian Medicaid |
$3,633.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,460.00
|
| Rate for Payer: UHC Medicaid |
$3,460.00
|
| Rate for Payer: UHCCP Medicaid |
$3,460.00
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$6,533.90
|
|
|
Service Code
|
APR-DRG 7553
|
| Min. Negotiated Rate |
$6,222.76 |
| Max. Negotiated Rate |
$6,533.90 |
| Rate for Payer: BCBS Complete |
$6,533.90
|
| Rate for Payer: Mclaren Medicaid |
$6,222.76
|
| Rate for Payer: Meridian Medicaid |
$6,533.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,222.76
|
| Rate for Payer: UHC Medicaid |
$6,222.76
|
| Rate for Payer: UHCCP Medicaid |
$6,222.76
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$3,015.56
|
|
|
Service Code
|
APR-DRG 7551
|
| Min. Negotiated Rate |
$2,871.96 |
| Max. Negotiated Rate |
$3,015.56 |
| Rate for Payer: BCBS Complete |
$3,015.56
|
| Rate for Payer: Mclaren Medicaid |
$2,871.96
|
| Rate for Payer: Meridian Medicaid |
$3,015.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,871.96
|
| Rate for Payer: UHC Medicaid |
$2,871.96
|
| Rate for Payer: UHCCP Medicaid |
$2,871.96
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18,630.00
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$16,767.00 |
| Rate for Payer: Aetna Commercial |
$15,835.50
|
| Rate for Payer: Aetna Medicare |
$43.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,109.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.75
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS MAPPO |
$42.20
|
| Rate for Payer: BCBS Trust/PPO |
$103.89
|
| Rate for Payer: BCN Commercial |
$103.89
|
| Rate for Payer: BCN Medicare Advantage |
$42.20
|
| Rate for Payer: Cash Price |
$14,904.00
|
| Rate for Payer: Cash Price |
$14,904.00
|
| Rate for Payer: Cofinity Advantage |
$13,041.00
|
| Rate for Payer: Cofinity Commercial |
$16,021.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,904.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.20
|
| Rate for Payer: Healthscope Commercial |
$16,767.00
|
| Rate for Payer: Mclaren Medicaid |
$22.07
|
| Rate for Payer: Mclaren Medicare |
$42.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.31
|
| Rate for Payer: Meridian Medicaid |
$44.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,835.50
|
| Rate for Payer: Nomi Health Commercial |
$126.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,972.50
|
| Rate for Payer: PACE Medicare |
$40.09
|
| Rate for Payer: PACE SWMI |
$42.20
|
| Rate for Payer: PHP Commercial |
$15,835.50
|
| Rate for Payer: PHP Medicare Advantage |
$42.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$132.97
|
| Rate for Payer: Priority Health Medicare |
$42.20
|
| Rate for Payer: Priority Health SBD |
$11,736.90
|
| Rate for Payer: Priority Health Tiered Network |
$106.38
|
| Rate for Payer: Railroad Medicare Medicare |
$42.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.61
|
| Rate for Payer: UHC Core |
$69.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.20
|
| Rate for Payer: UHC Exchange |
$69.61
|
| Rate for Payer: UHC Medicaid |
$22.07
|
| Rate for Payer: UHCCP Medicaid |
$22.07
|
| Rate for Payer: VA VA |
$42.20
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18,630.00
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,736.90 |
| Max. Negotiated Rate |
$16,767.00 |
| Rate for Payer: Aetna Commercial |
$15,835.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,109.50
|
| Rate for Payer: Cash Price |
$14,904.00
|
| Rate for Payer: Cofinity Advantage |
$13,041.00
|
| Rate for Payer: Cofinity Commercial |
$16,021.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,904.00
|
| Rate for Payer: Healthscope Commercial |
$16,767.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,835.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,972.50
|
| Rate for Payer: PHP Commercial |
$15,835.50
|
| Rate for Payer: Priority Health SBD |
$11,736.90
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29,807.95
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$26,827.15 |
| Rate for Payer: Aetna Commercial |
$25,336.76
|
| Rate for Payer: Aetna Medicare |
$43.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,375.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.75
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS MAPPO |
$42.20
|
| Rate for Payer: BCBS Trust/PPO |
$103.89
|
| Rate for Payer: BCN Commercial |
$103.89
|
| Rate for Payer: BCN Medicare Advantage |
$42.20
|
| Rate for Payer: Cash Price |
$23,846.36
|
| Rate for Payer: Cash Price |
$23,846.36
|
| Rate for Payer: Cofinity Advantage |
$20,865.56
|
| Rate for Payer: Cofinity Commercial |
$25,634.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,846.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.20
|
| Rate for Payer: Healthscope Commercial |
$26,827.15
|
| Rate for Payer: Mclaren Medicaid |
$22.07
|
| Rate for Payer: Mclaren Medicare |
$42.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.31
|
| Rate for Payer: Meridian Medicaid |
$44.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,336.76
|
| Rate for Payer: Nomi Health Commercial |
$126.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,355.96
|
| Rate for Payer: PACE Medicare |
$40.09
|
| Rate for Payer: PACE SWMI |
$42.20
|
| Rate for Payer: PHP Commercial |
$25,336.76
|
| Rate for Payer: PHP Medicare Advantage |
$42.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$132.97
|
| Rate for Payer: Priority Health Medicare |
$42.20
|
| Rate for Payer: Priority Health SBD |
$18,779.01
|
| Rate for Payer: Priority Health Tiered Network |
$106.38
|
| Rate for Payer: Railroad Medicare Medicare |
$42.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.61
|
| Rate for Payer: UHC Core |
$69.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.20
|
| Rate for Payer: UHC Exchange |
$69.61
|
| Rate for Payer: UHC Medicaid |
$22.07
|
| Rate for Payer: UHCCP Medicaid |
$22.07
|
| Rate for Payer: VA VA |
$42.20
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$56,783.13
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$16,641.83 |
| Max. Negotiated Rate |
$56,783.13 |
| Rate for Payer: Aetna Medicare |
$18,218.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,897.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,897.15
|
| Rate for Payer: BCBS MAPPO |
$17,517.72
|
| Rate for Payer: BCBS Trust/PPO |
$56,783.13
|
| Rate for Payer: BCN Commercial |
$56,783.13
|
| Rate for Payer: BCN Medicare Advantage |
$17,517.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,517.72
|
| Rate for Payer: Mclaren Medicare |
$17,517.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,393.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,145.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,269.49
|
| Rate for Payer: Nomi Health Commercial |
$28,274.22
|
| Rate for Payer: PACE Medicare |
$16,641.83
|
| Rate for Payer: PACE SWMI |
$17,517.72
|
| Rate for Payer: PHP Medicare Advantage |
$17,517.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,336.51
|
| Rate for Payer: Priority Health Medicare |
$17,517.72
|
| Rate for Payer: Priority Health Tiered Network |
$28,269.20
|
| Rate for Payer: Railroad Medicare Medicare |
$17,517.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,726.34
|
| Rate for Payer: UHC Core |
$29,889.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,517.72
|
| Rate for Payer: UHC Exchange |
$24,410.08
|
| Rate for Payer: VA VA |
$17,517.72
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,648.52
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$10,823.44 |
| Max. Negotiated Rate |
$34,648.52 |
| Rate for Payer: Aetna Medicare |
$11,848.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,241.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,241.38
|
| Rate for Payer: BCBS MAPPO |
$11,393.10
|
| Rate for Payer: BCBS Trust/PPO |
$34,648.52
|
| Rate for Payer: BCN Commercial |
$34,648.52
|
| Rate for Payer: BCN Medicare Advantage |
$11,393.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,393.10
|
| Rate for Payer: Mclaren Medicare |
$11,393.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,962.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,102.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,532.41
|
| Rate for Payer: Nomi Health Commercial |
$18,050.97
|
| Rate for Payer: PACE Medicare |
$10,823.44
|
| Rate for Payer: PACE SWMI |
$11,393.10
|
| Rate for Payer: PHP Medicare Advantage |
$11,393.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,559.71
|
| Rate for Payer: Priority Health Medicare |
$11,393.10
|
| Rate for Payer: Priority Health Tiered Network |
$18,047.77
|
| Rate for Payer: Railroad Medicare Medicare |
$11,393.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,808.59
|
| Rate for Payer: UHC Core |
$19,082.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,393.10
|
| Rate for Payer: UHC Exchange |
$15,584.00
|
| Rate for Payer: VA VA |
$11,393.10
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$12,485.33
|
|
|
Service Code
|
APR-DRG 4012
|
| Min. Negotiated Rate |
$11,890.79 |
| Max. Negotiated Rate |
$12,485.33 |
| Rate for Payer: BCBS Complete |
$12,485.33
|
| Rate for Payer: Mclaren Medicaid |
$11,890.79
|
| Rate for Payer: Meridian Medicaid |
$12,485.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,890.79
|
| Rate for Payer: UHC Medicaid |
$11,890.79
|
| Rate for Payer: UHCCP Medicaid |
$11,890.79
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$29,213.07
|
|
|
Service Code
|
APR-DRG 4014
|
| Min. Negotiated Rate |
$27,821.98 |
| Max. Negotiated Rate |
$29,213.07 |
| Rate for Payer: BCBS Complete |
$29,213.07
|
| Rate for Payer: Mclaren Medicaid |
$27,821.98
|
| Rate for Payer: Meridian Medicaid |
$29,213.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,821.98
|
| Rate for Payer: UHC Medicaid |
$27,821.98
|
| Rate for Payer: UHCCP Medicaid |
$27,821.98
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$8,618.42
|
|
|
Service Code
|
APR-DRG 4011
|
| Min. Negotiated Rate |
$8,208.02 |
| Max. Negotiated Rate |
$8,618.42 |
| Rate for Payer: BCBS Complete |
$8,618.42
|
| Rate for Payer: Mclaren Medicaid |
$8,208.02
|
| Rate for Payer: Meridian Medicaid |
$8,618.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,208.02
|
| Rate for Payer: UHC Medicaid |
$8,208.02
|
| Rate for Payer: UHCCP Medicaid |
$8,208.02
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$17,720.70
|
|
|
Service Code
|
APR-DRG 4013
|
| Min. Negotiated Rate |
$16,876.86 |
| Max. Negotiated Rate |
$17,720.70 |
| Rate for Payer: BCBS Complete |
$17,720.70
|
| Rate for Payer: Mclaren Medicaid |
$16,876.86
|
| Rate for Payer: Meridian Medicaid |
$17,720.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,876.86
|
| Rate for Payer: UHC Medicaid |
$16,876.86
|
| Rate for Payer: UHCCP Medicaid |
$16,876.86
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$18,355.43
|
|
|
Service Code
|
MSDRG 560
|
| Min. Negotiated Rate |
$8,817.65 |
| Max. Negotiated Rate |
$18,355.43 |
| Rate for Payer: Aetna Medicare |
$9,653.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,602.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,602.17
|
| Rate for Payer: BCBS MAPPO |
$9,281.74
|
| Rate for Payer: BCBS Trust/PPO |
$17,897.76
|
| Rate for Payer: BCN Commercial |
$17,897.76
|
| Rate for Payer: BCN Medicare Advantage |
$9,281.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,281.74
|
| Rate for Payer: Mclaren Medicare |
$9,281.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,745.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,674.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,209.91
|
| Rate for Payer: Nomi Health Commercial |
$14,526.69
|
| Rate for Payer: PACE Medicare |
$8,817.65
|
| Rate for Payer: PACE SWMI |
$9,281.74
|
| Rate for Payer: PHP Medicare Advantage |
$9,281.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,155.14
|
| Rate for Payer: Priority Health Medicare |
$9,281.74
|
| Rate for Payer: Priority Health Tiered Network |
$14,524.11
|
| Rate for Payer: Railroad Medicare Medicare |
$9,281.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,355.43
|
| Rate for Payer: UHC Core |
$15,356.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,281.74
|
| Rate for Payer: UHC Exchange |
$12,541.38
|
| Rate for Payer: VA VA |
$9,281.74
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$44,526.70
|
|
|
Service Code
|
MSDRG 559
|
| Min. Negotiated Rate |
$14,241.81 |
| Max. Negotiated Rate |
$44,526.70 |
| Rate for Payer: Aetna Medicare |
$15,591.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,739.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,739.22
|
| Rate for Payer: BCBS MAPPO |
$14,991.38
|
| Rate for Payer: BCBS Trust/PPO |
$44,526.70
|
| Rate for Payer: BCN Commercial |
$44,526.70
|
| Rate for Payer: BCN Medicare Advantage |
$14,991.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,991.38
|
| Rate for Payer: Mclaren Medicare |
$14,991.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,740.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,240.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,490.52
|
| Rate for Payer: Nomi Health Commercial |
$24,057.21
|
| Rate for Payer: PACE Medicare |
$14,241.81
|
| Rate for Payer: PACE SWMI |
$14,991.38
|
| Rate for Payer: PHP Medicare Advantage |
$14,991.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,066.18
|
| Rate for Payer: Priority Health Medicare |
$14,991.38
|
| Rate for Payer: Priority Health Tiered Network |
$24,052.94
|
| Rate for Payer: Railroad Medicare Medicare |
$14,991.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,397.87
|
| Rate for Payer: UHC Core |
$25,431.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,991.38
|
| Rate for Payer: UHC Exchange |
$20,769.39
|
| Rate for Payer: VA VA |
$14,991.38
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$13,637.50
|
|
|
Service Code
|
MSDRG 561
|
| Min. Negotiated Rate |
$6,452.14 |
| Max. Negotiated Rate |
$13,637.50 |
| Rate for Payer: Aetna Medicare |
$7,063.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,489.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,489.66
|
| Rate for Payer: BCBS MAPPO |
$6,791.73
|
| Rate for Payer: BCBS Trust/PPO |
$13,637.50
|
| Rate for Payer: BCN Commercial |
$13,637.50
|
| Rate for Payer: BCN Medicare Advantage |
$6,791.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,791.73
|
| Rate for Payer: Mclaren Medicare |
$6,791.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,131.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,810.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,470.90
|
| Rate for Payer: Nomi Health Commercial |
$10,370.31
|
| Rate for Payer: PACE Medicare |
$6,452.14
|
| Rate for Payer: PACE SWMI |
$6,791.73
|
| Rate for Payer: PHP Medicare Advantage |
$6,791.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,960.59
|
| Rate for Payer: Priority Health Medicare |
$6,791.73
|
| Rate for Payer: Priority Health Tiered Network |
$10,368.47
|
| Rate for Payer: Railroad Medicare Medicare |
$6,791.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,103.57
|
| Rate for Payer: UHC Core |
$10,962.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,791.73
|
| Rate for Payer: UHC Exchange |
$8,953.03
|
| Rate for Payer: VA VA |
$6,791.73
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
|
IP
|
$19,392.11
|
|
|
Service Code
|
MSDRG 949
|
| Min. Negotiated Rate |
$9,284.61 |
| Max. Negotiated Rate |
$19,392.11 |
| Rate for Payer: Aetna Medicare |
$10,164.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,216.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,216.59
|
| Rate for Payer: BCBS MAPPO |
$9,773.27
|
| Rate for Payer: BCBS Trust/PPO |
$16,256.86
|
| Rate for Payer: BCN Commercial |
$16,256.86
|
| Rate for Payer: BCN Medicare Advantage |
$9,773.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,773.27
|
| Rate for Payer: Mclaren Medicare |
$9,773.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,261.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,239.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,750.60
|
| Rate for Payer: Nomi Health Commercial |
$15,347.13
|
| Rate for Payer: PACE Medicare |
$9,284.61
|
| Rate for Payer: PACE SWMI |
$9,773.27
|
| Rate for Payer: PHP Medicare Advantage |
$9,773.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,180.51
|
| Rate for Payer: Priority Health Medicare |
$9,773.27
|
| Rate for Payer: Priority Health Tiered Network |
$15,344.41
|
| Rate for Payer: Railroad Medicare Medicare |
$9,773.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,392.11
|
| Rate for Payer: UHC Core |
$16,223.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,773.27
|
| Rate for Payer: UHC Exchange |
$13,249.69
|
| Rate for Payer: VA VA |
$9,773.27
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
|
IP
|
$10,231.51
|
|
|
Service Code
|
MSDRG 950
|
| Min. Negotiated Rate |
$5,158.50 |
| Max. Negotiated Rate |
$10,231.51 |
| Rate for Payer: Aetna Medicare |
$5,647.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,787.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,787.50
|
| Rate for Payer: BCBS MAPPO |
$5,430.00
|
| Rate for Payer: BCBS Trust/PPO |
$9,857.11
|
| Rate for Payer: BCN Commercial |
$9,857.11
|
| Rate for Payer: BCN Medicare Advantage |
$5,430.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,430.00
|
| Rate for Payer: Mclaren Medicare |
$5,430.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,701.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,244.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,973.00
|
| Rate for Payer: Nomi Health Commercial |
$8,097.33
|
| Rate for Payer: PACE Medicare |
$5,158.50
|
| Rate for Payer: PACE SWMI |
$5,430.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,430.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,119.87
|
| Rate for Payer: Priority Health Medicare |
$5,430.00
|
| Rate for Payer: Priority Health Tiered Network |
$8,095.89
|
| Rate for Payer: Railroad Medicare Medicare |
$5,430.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,231.51
|
| Rate for Payer: UHC Core |
$8,559.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,430.00
|
| Rate for Payer: UHC Exchange |
$6,990.69
|
| Rate for Payer: VA VA |
$5,430.00
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
|
IP
|
$85,703.71
|
|
|
Service Code
|
MSDRG 245
|
| Min. Negotiated Rate |
$34,046.36 |
| Max. Negotiated Rate |
$85,703.71 |
| Rate for Payer: Aetna Medicare |
$37,271.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,797.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,797.84
|
| Rate for Payer: BCBS MAPPO |
$35,838.27
|
| Rate for Payer: BCBS Trust/PPO |
$85,703.71
|
| Rate for Payer: BCN Commercial |
$85,703.71
|
| Rate for Payer: BCN Medicare Advantage |
$35,838.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,838.27
|
| Rate for Payer: Mclaren Medicare |
$35,838.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,630.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,214.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,422.10
|
| Rate for Payer: Nomi Health Commercial |
$58,854.96
|
| Rate for Payer: PACE Medicare |
$34,046.36
|
| Rate for Payer: PACE SWMI |
$35,838.27
|
| Rate for Payer: PHP Medicare Advantage |
$35,838.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73,555.65
|
| Rate for Payer: Priority Health Medicare |
$35,838.27
|
| Rate for Payer: Priority Health Tiered Network |
$58,844.51
|
| Rate for Payer: Railroad Medicare Medicare |
$35,838.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74,367.12
|
| Rate for Payer: UHC Core |
$62,217.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,838.27
|
| Rate for Payer: UHC Exchange |
$50,811.45
|
| Rate for Payer: VA VA |
$35,838.27
|
|
|
AICD LEAD PROCEDURES
|
Facility
|
IP
|
$70,916.88
|
|
|
Service Code
|
MSDRG 265
|
| Min. Negotiated Rate |
$27,114.20 |
| Max. Negotiated Rate |
$70,916.88 |
| Rate for Payer: Aetna Medicare |
$29,682.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,676.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,676.57
|
| Rate for Payer: BCBS MAPPO |
$28,541.26
|
| Rate for Payer: BCBS Trust/PPO |
$70,916.88
|
| Rate for Payer: BCN Commercial |
$70,916.88
|
| Rate for Payer: BCN Medicare Advantage |
$28,541.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,541.26
|
| Rate for Payer: Mclaren Medicare |
$28,541.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,968.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,822.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,395.39
|
| Rate for Payer: Nomi Health Commercial |
$46,674.78
|
| Rate for Payer: PACE Medicare |
$27,114.20
|
| Rate for Payer: PACE SWMI |
$28,541.26
|
| Rate for Payer: PHP Medicare Advantage |
$28,541.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$58,333.13
|
| Rate for Payer: Priority Health Medicare |
$28,541.26
|
| Rate for Payer: Priority Health Tiered Network |
$46,666.49
|
| Rate for Payer: Railroad Medicare Medicare |
$28,541.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58,976.66
|
| Rate for Payer: UHC Core |
$49,341.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,541.26
|
| Rate for Payer: UHC Exchange |
$40,295.89
|
| Rate for Payer: VA VA |
$28,541.26
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna Commercial |
$241.40
|
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna Medicare |
$55.20
|
| Rate for Payer: Aetna Medicare |
$55.20
|
| Rate for Payer: Aetna Medicare |
$55.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.35
|
| Rate for Payer: BCBS Complete |
$29.15
|
| Rate for Payer: BCBS Complete |
$29.15
|
| Rate for Payer: BCBS Complete |
$29.15
|
| Rate for Payer: BCBS MAPPO |
$53.08
|
| Rate for Payer: BCBS MAPPO |
$53.08
|
| Rate for Payer: BCBS MAPPO |
$53.08
|
| Rate for Payer: BCBS Trust/PPO |
$133.17
|
| Rate for Payer: BCBS Trust/PPO |
$133.17
|
| Rate for Payer: BCBS Trust/PPO |
$133.17
|
| Rate for Payer: BCN Commercial |
$133.17
|
| Rate for Payer: BCN Commercial |
$133.17
|
| Rate for Payer: BCN Commercial |
$133.17
|
| Rate for Payer: BCN Medicare Advantage |
$53.08
|
| Rate for Payer: BCN Medicare Advantage |
$53.08
|
| Rate for Payer: BCN Medicare Advantage |
$53.08
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cofinity Advantage |
$198.80
|
| Rate for Payer: Cofinity Advantage |
$126.01
|
| Rate for Payer: Cofinity Advantage |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$244.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.08
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Healthscope Commercial |
$255.60
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Mclaren Medicaid |
$27.76
|
| Rate for Payer: Mclaren Medicaid |
$27.76
|
| Rate for Payer: Mclaren Medicaid |
$27.76
|
| Rate for Payer: Mclaren Medicare |
$53.08
|
| Rate for Payer: Mclaren Medicare |
$53.08
|
| Rate for Payer: Mclaren Medicare |
$53.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.73
|
| Rate for Payer: Meridian Medicaid |
$55.73
|
| Rate for Payer: Meridian Medicaid |
$55.73
|
| Rate for Payer: Meridian Medicaid |
$55.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: Nomi Health Commercial |
$159.24
|
| Rate for Payer: Nomi Health Commercial |
$159.24
|
| Rate for Payer: Nomi Health Commercial |
$159.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.00
|
| Rate for Payer: PACE Medicare |
$50.43
|
| Rate for Payer: PACE Medicare |
$50.43
|
| Rate for Payer: PACE Medicare |
$50.43
|
| Rate for Payer: PACE SWMI |
$53.08
|
| Rate for Payer: PACE SWMI |
$53.08
|
| Rate for Payer: PACE SWMI |
$53.08
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$241.40
|
| Rate for Payer: PHP Medicare Advantage |
$53.08
|
| Rate for Payer: PHP Medicare Advantage |
$53.08
|
| Rate for Payer: PHP Medicare Advantage |
$53.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.40
|
| Rate for Payer: Priority Health Medicare |
$53.08
|
| Rate for Payer: Priority Health Medicare |
$53.08
|
| Rate for Payer: Priority Health Medicare |
$53.08
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: Priority Health SBD |
$178.92
|
| Rate for Payer: Priority Health SBD |
$180.94
|
| Rate for Payer: Priority Health Tiered Network |
$133.92
|
| Rate for Payer: Priority Health Tiered Network |
$133.92
|
| Rate for Payer: Priority Health Tiered Network |
$133.92
|
| Rate for Payer: Railroad Medicare Medicare |
$53.08
|
| Rate for Payer: Railroad Medicare Medicare |
$53.08
|
| Rate for Payer: Railroad Medicare Medicare |
$53.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.58
|
| Rate for Payer: UHC Core |
$87.58
|
| Rate for Payer: UHC Core |
$87.58
|
| Rate for Payer: UHC Core |
$87.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53.08
|
| Rate for Payer: UHC Exchange |
$87.58
|
| Rate for Payer: UHC Exchange |
$87.58
|
| Rate for Payer: UHC Exchange |
$87.58
|
| Rate for Payer: UHC Medicaid |
$27.76
|
| Rate for Payer: UHC Medicaid |
$27.76
|
| Rate for Payer: UHC Medicaid |
$27.76
|
| Rate for Payer: UHCCP Medicaid |
$27.76
|
| Rate for Payer: UHCCP Medicaid |
$27.76
|
| Rate for Payer: UHCCP Medicaid |
$27.76
|
| Rate for Payer: VA VA |
$53.08
|
| Rate for Payer: VA VA |
$53.08
|
| Rate for Payer: VA VA |
$53.08
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.92 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna Commercial |
$241.40
|
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cofinity Advantage |
$198.80
|
| Rate for Payer: Cofinity Advantage |
$126.01
|
| Rate for Payer: Cofinity Advantage |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$244.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Healthscope Commercial |
$255.60
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.00
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$241.40
|
| Rate for Payer: Priority Health SBD |
$180.94
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: Priority Health SBD |
$178.92
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION 100 ML
|
Facility
|
IP
|
$287.20
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
180336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.94 |
| Max. Negotiated Rate |
$258.48 |
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cofinity Advantage |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.40
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: Priority Health SBD |
$180.94
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION 100 ML
|
Facility
|
OP
|
$287.20
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
180336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$258.48 |
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna Medicare |
$55.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.35
|
| Rate for Payer: BCBS Complete |
$29.15
|
| Rate for Payer: BCBS MAPPO |
$53.08
|
| Rate for Payer: BCBS Trust/PPO |
$133.17
|
| Rate for Payer: BCN Commercial |
$133.17
|
| Rate for Payer: BCN Medicare Advantage |
$53.08
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cofinity Advantage |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.08
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Mclaren Medicaid |
$27.76
|
| Rate for Payer: Mclaren Medicare |
$53.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.73
|
| Rate for Payer: Meridian Medicaid |
$55.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: Nomi Health Commercial |
$159.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.40
|
| Rate for Payer: PACE Medicare |
$50.43
|
| Rate for Payer: PACE SWMI |
$53.08
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: PHP Medicare Advantage |
$53.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.40
|
| Rate for Payer: Priority Health Medicare |
$53.08
|
| Rate for Payer: Priority Health SBD |
$180.94
|
| Rate for Payer: Priority Health Tiered Network |
$133.92
|
| Rate for Payer: Railroad Medicare Medicare |
$53.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.58
|
| Rate for Payer: UHC Core |
$87.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53.08
|
| Rate for Payer: UHC Exchange |
$87.58
|
| Rate for Payer: UHC Medicaid |
$27.76
|
| Rate for Payer: UHCCP Medicaid |
$27.76
|
| Rate for Payer: VA VA |
$53.08
|
|
