|
PR XEOMIN
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 00085
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 94617
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$124.68 |
| Rate for Payer: Aetna Commercial |
$100.14
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.78
|
| Rate for Payer: Priority Health Narrow Network |
$41.78
|
| Rate for Payer: Priority Health SBD |
$116.78
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 94619
|
| Min. Negotiated Rate |
$29.65 |
| Max. Negotiated Rate |
$225.12 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS Trust/PPO |
$225.12
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.65
|
| Rate for Payer: Priority Health Narrow Network |
$29.65
|
| Rate for Payer: Priority Health SBD |
$102.40
|
| Rate for Payer: UMR Bronson Commercial |
$72.22
|
|
|
PR XTRNL ECG & 48 HR RECORDING
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 93225
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$2,547.99 |
| Rate for Payer: Aetna Commercial |
$24.92
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,547.99
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.01
|
| Rate for Payer: Priority Health Narrow Network |
$26.01
|
| Rate for Payer: Priority Health SBD |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$54.28
|
|
|
PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 93224
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$1,872.30 |
| Rate for Payer: Aetna Commercial |
$100.86
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.62
|
| Rate for Payer: Priority Health Narrow Network |
$102.62
|
| Rate for Payer: Priority Health SBD |
$102.62
|
| Rate for Payer: UMR Bronson Commercial |
$105.80
|
|
|
PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 93227
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$2,081.50 |
| Rate for Payer: Aetna Commercial |
$24.84
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.50
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.54
|
| Rate for Payer: Priority Health Narrow Network |
$25.54
|
| Rate for Payer: Priority Health SBD |
$25.54
|
| Rate for Payer: UMR Bronson Commercial |
$90.16
|
|
|
PR XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT
|
Professional
|
Both
|
$3,819.00
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$578.50 |
| Max. Negotiated Rate |
$2,803.47 |
| Rate for Payer: Aetna Commercial |
$2,627.28
|
| Rate for Payer: BCBS Complete |
$1,527.60
|
| Rate for Payer: BCBS Trust/PPO |
$578.50
|
| Rate for Payer: Cash Price |
$3,055.20
|
| Rate for Payer: Cash Price |
$3,055.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,673.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,803.47
|
| Rate for Payer: Priority Health Narrow Network |
$2,803.47
|
| Rate for Payer: Priority Health SBD |
$2,803.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,756.74
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$454.34 |
| Rate for Payer: Aetna Commercial |
$34.49
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$454.34
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.47
|
| Rate for Payer: Priority Health Narrow Network |
$35.47
|
| Rate for Payer: Priority Health SBD |
$35.47
|
| Rate for Payer: UMR Bronson Commercial |
$26.22
|
|
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$206.02 |
| Max. Negotiated Rate |
$867.47 |
| Rate for Payer: Aetna Commercial |
$206.02
|
| Rate for Payer: BCBS Complete |
$256.40
|
| Rate for Payer: BCBS Trust/PPO |
$867.47
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.65
|
| Rate for Payer: Priority Health Narrow Network |
$206.65
|
| Rate for Payer: Priority Health SBD |
$206.65
|
| Rate for Payer: UMR Bronson Commercial |
$294.86
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$1,098.86 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.86
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.82
|
| Rate for Payer: Priority Health Narrow Network |
$11.82
|
| Rate for Payer: Priority Health SBD |
$11.82
|
| Rate for Payer: UMR Bronson Commercial |
$55.66
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 93268
|
| Min. Negotiated Rate |
$250.35 |
| Max. Negotiated Rate |
$869.58 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: BCBS Complete |
$341.60
|
| Rate for Payer: BCBS Trust/PPO |
$869.58
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.04
|
| Rate for Payer: Priority Health Narrow Network |
$252.04
|
| Rate for Payer: Priority Health SBD |
$252.04
|
| Rate for Payer: UMR Bronson Commercial |
$392.84
|
|
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 93272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$934.03 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS Trust/PPO |
$934.03
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.57
|
| Rate for Payer: Priority Health Narrow Network |
$33.57
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 41015
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$1,058.71 |
| Rate for Payer: Aetna Commercial |
$398.41
|
| Rate for Payer: BCBS Complete |
$200.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.71
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Meridian Medicaid |
$200.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$523.30
|
| Rate for Payer: Priority Health Narrow Network |
$523.30
|
| Rate for Payer: Priority Health SBD |
$523.30
|
| Rate for Payer: UMR Bronson Commercial |
$274.16
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 41017
|
| Min. Negotiated Rate |
$219.39 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna Commercial |
$454.51
|
| Rate for Payer: BCBS Complete |
$230.36
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Meridian Medicaid |
$230.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$604.44
|
| Rate for Payer: Priority Health Narrow Network |
$604.44
|
| Rate for Payer: Priority Health SBD |
$604.44
|
| Rate for Payer: UMR Bronson Commercial |
$406.64
|
|
|
PR ZINC PASTE BAND W >=3<5/YD
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS A6456
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
|
|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$221.01 |
| Rate for Payer: Aetna Commercial |
$216.92
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS Trust/PPO |
$221.01
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 0904-5053-59
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna American Axle |
$30.55
|
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UMR Bronson Commercial |
$20.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 9900-0008-82
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$28.79
|
|
|
Service Code
|
NDC 81067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.47
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$12.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$26.41
|
|
|
Service Code
|
NDC 45802-107-52
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$23.77 |
| Rate for Payer: Aetna American Axle |
$17.17
|
| Rate for Payer: Aetna Commercial |
$22.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.17
|
| Rate for Payer: Cash Price |
$21.13
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Commercial |
$22.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.13
|
| Rate for Payer: Healthscope Commercial |
$23.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.45
|
| Rate for Payer: PHP Commercial |
$22.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health SBD |
$16.64
|
| Rate for Payer: UMR Bronson Commercial |
$11.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.81
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$20,843.07
|
|
|
Service Code
|
MS-DRG 885
|
| Min. Negotiated Rate |
$10,489.79 |
| Max. Negotiated Rate |
$20,843.07 |
| Rate for Payer: Aetna Medicare |
$11,483.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,802.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,802.35
|
| Rate for Payer: BCBS MAPPO |
$11,041.88
|
| Rate for Payer: BCBS Trust/PPO |
$17,188.24
|
| Rate for Payer: BCN Medicare Advantage |
$11,041.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,041.88
|
| Rate for Payer: Mclaren Medicare |
$11,041.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,593.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,698.16
|
| Rate for Payer: PACE Medicare |
$10,489.79
|
| Rate for Payer: PACE SWMI |
$11,041.88
|
| Rate for Payer: PHP Medicare Advantage |
$11,041.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,607.73
|
| Rate for Payer: Priority Health Medicare |
$11,041.88
|
| Rate for Payer: Priority Health Narrow Network |
$15,686.18
|
| Rate for Payer: Railroad Medicare Medicare |
$11,041.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,843.07
|
| Rate for Payer: UHC Core |
$17,090.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,041.88
|
| Rate for Payer: UHC Exchange |
$13,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$11,373.14
|
| Rate for Payer: VA VA |
$11,041.88
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000-024-10
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna American Axle |
$5.75
|
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.75
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Cofinity Commercial |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.52
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.20
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$20,869.63
|
|
|
Service Code
|
MS-DRG 189
|
| Min. Negotiated Rate |
$9,505.87 |
| Max. Negotiated Rate |
$20,869.63 |
| Rate for Payer: Aetna Medicare |
$10,406.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,507.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,507.72
|
| Rate for Payer: BCBS MAPPO |
$10,006.18
|
| Rate for Payer: BCBS Trust/PPO |
$20,869.63
|
| Rate for Payer: BCN Medicare Advantage |
$10,006.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,006.18
|
| Rate for Payer: Mclaren Medicare |
$10,006.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,506.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,507.11
|
| Rate for Payer: PACE Medicare |
$9,505.87
|
| Rate for Payer: PACE SWMI |
$10,006.18
|
| Rate for Payer: PHP Medicare Advantage |
$10,006.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,679.10
|
| Rate for Payer: Priority Health Medicare |
$10,006.18
|
| Rate for Payer: Priority Health Narrow Network |
$14,143.28
|
| Rate for Payer: Railroad Medicare Medicare |
$10,006.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,792.93
|
| Rate for Payer: UHC Core |
$15,409.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,006.18
|
| Rate for Payer: UHC Exchange |
$12,251.01
|
| Rate for Payer: UHC Medicare Advantage |
$10,306.37
|
| Rate for Payer: VA VA |
$10,006.18
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$26,269.86
|
|
|
Service Code
|
MS-DRG 175
|
| Min. Negotiated Rate |
$10,757.70 |
| Max. Negotiated Rate |
$26,269.86 |
| Rate for Payer: Aetna Medicare |
$11,776.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,154.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,154.88
|
| Rate for Payer: BCBS MAPPO |
$11,323.90
|
| Rate for Payer: BCBS Trust/PPO |
$26,269.86
|
| Rate for Payer: BCN Medicare Advantage |
$11,323.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,323.90
|
| Rate for Payer: Mclaren Medicare |
$11,323.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,890.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,022.48
|
| Rate for Payer: PACE Medicare |
$10,757.70
|
| Rate for Payer: PACE SWMI |
$11,323.90
|
| Rate for Payer: PHP Medicare Advantage |
$11,323.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,132.94
|
| Rate for Payer: Priority Health Medicare |
$11,323.90
|
| Rate for Payer: Priority Health Narrow Network |
$16,106.35
|
| Rate for Payer: Railroad Medicare Medicare |
$11,323.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,401.36
|
| Rate for Payer: UHC Core |
$17,548.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,323.90
|
| Rate for Payer: UHC Exchange |
$13,951.43
|
| Rate for Payer: UHC Medicare Advantage |
$11,663.62
|
| Rate for Payer: VA VA |
$11,323.90
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$15,052.27
|
|
|
Service Code
|
MS-DRG 176
|
| Min. Negotiated Rate |
$6,457.52 |
| Max. Negotiated Rate |
$15,052.27 |
| Rate for Payer: Aetna Medicare |
$7,069.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,496.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,496.74
|
| Rate for Payer: BCBS MAPPO |
$6,797.39
|
| Rate for Payer: BCBS Trust/PPO |
$15,052.27
|
| Rate for Payer: BCN Medicare Advantage |
$6,797.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,797.39
|
| Rate for Payer: Mclaren Medicare |
$6,797.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,137.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,817.00
|
| Rate for Payer: PACE Medicare |
$6,457.52
|
| Rate for Payer: PACE SWMI |
$6,797.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,797.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,703.79
|
| Rate for Payer: Priority Health Medicare |
$6,797.39
|
| Rate for Payer: Priority Health Narrow Network |
$9,363.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6,797.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,441.16
|
| Rate for Payer: UHC Core |
$10,201.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,797.39
|
| Rate for Payer: UHC Exchange |
$8,110.33
|
| Rate for Payer: UHC Medicare Advantage |
$7,001.31
|
| Rate for Payer: VA VA |
$6,797.39
|
|
