|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$104,541.67
|
|
|
Service Code
|
MS-DRG 458
|
| Min. Negotiated Rate |
$33,656.98 |
| Max. Negotiated Rate |
$104,541.67 |
| Rate for Payer: Aetna Medicare |
$36,845.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,285.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,285.50
|
| Rate for Payer: BCBS MAPPO |
$35,428.40
|
| Rate for Payer: BCBS Trust/PPO |
$104,541.67
|
| Rate for Payer: BCN Medicare Advantage |
$35,428.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,428.40
|
| Rate for Payer: Mclaren Medicare |
$35,428.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,199.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,742.66
|
| Rate for Payer: PACE Medicare |
$33,656.98
|
| Rate for Payer: PACE SWMI |
$35,428.40
|
| Rate for Payer: PHP Medicare Advantage |
$35,428.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65,019.49
|
| Rate for Payer: Priority Health Medicare |
$35,428.40
|
| Rate for Payer: Priority Health Narrow Network |
$52,015.59
|
| Rate for Payer: Railroad Medicare Medicare |
$35,428.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69,115.87
|
| Rate for Payer: UHC Core |
$56,673.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$35,428.40
|
| Rate for Payer: UHC Exchange |
$45,056.26
|
| Rate for Payer: UHC Medicare Advantage |
$36,491.25
|
| Rate for Payer: VA VA |
$35,428.40
|
|
|
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS
|
Facility
|
IP
|
$64,370.45
|
|
|
Service Code
|
MS-DRG 029
|
| Min. Negotiated Rate |
$25,583.67 |
| Max. Negotiated Rate |
$64,370.45 |
| Rate for Payer: Aetna Medicare |
$28,007.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,662.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,662.72
|
| Rate for Payer: BCBS MAPPO |
$26,930.18
|
| Rate for Payer: BCBS Trust/PPO |
$64,370.45
|
| Rate for Payer: BCN Medicare Advantage |
$26,930.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,930.18
|
| Rate for Payer: Mclaren Medicare |
$26,930.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,276.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,969.71
|
| Rate for Payer: PACE Medicare |
$25,583.67
|
| Rate for Payer: PACE SWMI |
$26,930.18
|
| Rate for Payer: PHP Medicare Advantage |
$26,930.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,194.40
|
| Rate for Payer: Priority Health Medicare |
$26,930.18
|
| Rate for Payer: Priority Health Narrow Network |
$39,355.52
|
| Rate for Payer: Railroad Medicare Medicare |
$26,930.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,293.76
|
| Rate for Payer: UHC Core |
$42,879.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$26,930.18
|
| Rate for Payer: UHC Exchange |
$34,090.02
|
| Rate for Payer: UHC Medicare Advantage |
$27,738.09
|
| Rate for Payer: VA VA |
$26,930.18
|
|
|
SPINAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$97,719.14
|
|
|
Service Code
|
MS-DRG 028
|
| Min. Negotiated Rate |
$44,602.21 |
| Max. Negotiated Rate |
$97,719.14 |
| Rate for Payer: Aetna Medicare |
$48,827.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58,687.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58,687.11
|
| Rate for Payer: BCBS MAPPO |
$46,949.69
|
| Rate for Payer: BCBS Trust/PPO |
$97,719.14
|
| Rate for Payer: BCN Medicare Advantage |
$46,949.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,949.69
|
| Rate for Payer: Mclaren Medicare |
$46,949.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49,297.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53,992.14
|
| Rate for Payer: PACE Medicare |
$44,602.21
|
| Rate for Payer: PACE SWMI |
$46,949.69
|
| Rate for Payer: PHP Medicare Advantage |
$46,949.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86,474.05
|
| Rate for Payer: Priority Health Medicare |
$46,949.69
|
| Rate for Payer: Priority Health Narrow Network |
$69,179.24
|
| Rate for Payer: Railroad Medicare Medicare |
$46,949.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91,922.13
|
| Rate for Payer: UHC Core |
$75,374.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$46,949.69
|
| Rate for Payer: UHC Exchange |
$59,923.54
|
| Rate for Payer: UHC Medicare Advantage |
$48,358.18
|
| Rate for Payer: VA VA |
$46,949.69
|
|
|
SPINAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$47,124.41
|
|
|
Service Code
|
MS-DRG 030
|
| Min. Negotiated Rate |
$17,463.51 |
| Max. Negotiated Rate |
$47,124.41 |
| Rate for Payer: Aetna Medicare |
$19,117.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,978.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,978.30
|
| Rate for Payer: BCBS MAPPO |
$18,382.64
|
| Rate for Payer: BCBS Trust/PPO |
$47,124.41
|
| Rate for Payer: BCN Medicare Advantage |
$18,382.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,382.64
|
| Rate for Payer: Mclaren Medicare |
$18,382.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,301.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,140.04
|
| Rate for Payer: PACE Medicare |
$17,463.51
|
| Rate for Payer: PACE SWMI |
$18,382.64
|
| Rate for Payer: PHP Medicare Advantage |
$18,382.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,277.46
|
| Rate for Payer: Priority Health Medicare |
$18,382.64
|
| Rate for Payer: Priority Health Narrow Network |
$26,621.97
|
| Rate for Payer: Railroad Medicare Medicare |
$18,382.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,374.03
|
| Rate for Payer: UHC Core |
$29,006.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,382.64
|
| Rate for Payer: UHC Exchange |
$23,060.14
|
| Rate for Payer: UHC Medicare Advantage |
$18,934.12
|
| Rate for Payer: VA VA |
$18,382.64
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
|
OP
|
$1,935.09
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,935.09 |
| Rate for Payer: Aetna Medicare |
$639.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$907.07
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.09
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.70
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
|
OP
|
$1,935.09
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,935.09 |
| Rate for Payer: Aetna Medicare |
$639.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$907.07
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.09
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.70
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER);
|
Facility
|
OP
|
$1,935.09
|
|
|
Service Code
|
CPT 62272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.05 |
| Max. Negotiated Rate |
$1,935.09 |
| Rate for Payer: Aetna Medicare |
$639.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$407.02
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.09
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.06
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.70
|
| Rate for Payer: UHC Exchange |
$90.05
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687-487-11
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
IP
|
$267.36
|
|
|
Service Code
|
NDC 60687-487-01
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna American Axle |
$173.78
|
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.78
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: Cofinity Commercial |
$187.15
|
| Rate for Payer: Cofinity Commercial |
$229.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.89
|
| Rate for Payer: Healthscope Commercial |
$240.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.26
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.15
|
| Rate for Payer: Priority Health SBD |
$168.44
|
| Rate for Payer: UMR Bronson Commercial |
$117.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.52
|
|
|
SPIRONOLACTONE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,373.11
|
|
|
Service Code
|
NDC 46287-020-04
|
| Hospital Charge Code |
184259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,235.80 |
| Rate for Payer: Aetna American Axle |
$892.52
|
| Rate for Payer: Aetna Commercial |
$1,167.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$892.52
|
| Rate for Payer: Cash Price |
$1,098.49
|
| Rate for Payer: Cofinity Commercial |
$1,180.87
|
| Rate for Payer: Cofinity Commercial |
$961.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,098.49
|
| Rate for Payer: Healthscope Commercial |
$1,235.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$961.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,167.14
|
| Rate for Payer: PHP Commercial |
$1,167.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.18
|
| Rate for Payer: Priority Health SBD |
$865.06
|
| Rate for Payer: UMR Bronson Commercial |
$604.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.83
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 63739-544-10
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.39 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna American Axle |
$197.05
|
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.05
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.68
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.20
|
| Rate for Payer: Priority Health SBD |
$190.98
|
| Rate for Payer: UMR Bronson Commercial |
$133.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 53746-511-01
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$192.46
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.71
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.46
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$3.84
|
|
|
Service Code
|
NDC 51079-103-01
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna American Axle |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.69
|
| Rate for Payer: Priority Health SBD |
$2.42
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.88
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 59746-216-01
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.86
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.83
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UMR Bronson Commercial |
$55.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.18
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$383.05
|
|
|
Service Code
|
NDC 51079-103-20
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.54 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Aetna American Axle |
$248.98
|
| Rate for Payer: Aetna Commercial |
$325.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.98
|
| Rate for Payer: Cash Price |
$306.44
|
| Rate for Payer: Cofinity Commercial |
$268.14
|
| Rate for Payer: Cofinity Commercial |
$329.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.44
|
| Rate for Payer: Healthscope Commercial |
$344.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.59
|
| Rate for Payer: PHP Commercial |
$325.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: Priority Health SBD |
$241.32
|
| Rate for Payer: UMR Bronson Commercial |
$168.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.29
|
|
|
SPLENIC PROCEDURES WITH CC
|
Facility
|
IP
|
$48,310.50
|
|
|
Service Code
|
MS-DRG 800
|
| Min. Negotiated Rate |
$21,114.37 |
| Max. Negotiated Rate |
$48,310.50 |
| Rate for Payer: Aetna Medicare |
$23,114.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,782.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,782.06
|
| Rate for Payer: BCBS MAPPO |
$22,225.65
|
| Rate for Payer: BCBS Trust/PPO |
$48,310.50
|
| Rate for Payer: BCN Medicare Advantage |
$22,225.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,225.65
|
| Rate for Payer: Mclaren Medicare |
$22,225.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,336.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,559.50
|
| Rate for Payer: PACE Medicare |
$21,114.37
|
| Rate for Payer: PACE SWMI |
$22,225.65
|
| Rate for Payer: PHP Medicare Advantage |
$22,225.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,433.77
|
| Rate for Payer: Priority Health Medicare |
$22,225.65
|
| Rate for Payer: Priority Health Narrow Network |
$32,347.02
|
| Rate for Payer: Railroad Medicare Medicare |
$22,225.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,981.20
|
| Rate for Payer: UHC Core |
$35,243.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,225.65
|
| Rate for Payer: UHC Exchange |
$28,019.21
|
| Rate for Payer: UHC Medicare Advantage |
$22,892.42
|
| Rate for Payer: VA VA |
$22,225.65
|
|
|
SPLENIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$75,577.47
|
|
|
Service Code
|
MS-DRG 799
|
| Min. Negotiated Rate |
$36,758.05 |
| Max. Negotiated Rate |
$75,577.47 |
| Rate for Payer: Aetna Medicare |
$40,240.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,365.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,365.85
|
| Rate for Payer: BCBS MAPPO |
$38,692.68
|
| Rate for Payer: BCBS Trust/PPO |
$66,390.82
|
| Rate for Payer: BCN Medicare Advantage |
$38,692.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,692.68
|
| Rate for Payer: Mclaren Medicare |
$38,692.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40,627.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,496.58
|
| Rate for Payer: PACE Medicare |
$36,758.05
|
| Rate for Payer: PACE SWMI |
$38,692.68
|
| Rate for Payer: PHP Medicare Advantage |
$38,692.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71,098.11
|
| Rate for Payer: Priority Health Medicare |
$38,692.68
|
| Rate for Payer: Priority Health Narrow Network |
$56,878.49
|
| Rate for Payer: Railroad Medicare Medicare |
$38,692.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75,577.47
|
| Rate for Payer: UHC Core |
$61,972.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$38,692.68
|
| Rate for Payer: UHC Exchange |
$49,268.54
|
| Rate for Payer: UHC Medicare Advantage |
$39,853.46
|
| Rate for Payer: VA VA |
$38,692.68
|
|
|
SPLENIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$46,749.99
|
|
|
Service Code
|
MS-DRG 801
|
| Min. Negotiated Rate |
$13,588.65 |
| Max. Negotiated Rate |
$46,749.99 |
| Rate for Payer: Aetna Medicare |
$14,875.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,879.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,879.80
|
| Rate for Payer: BCBS MAPPO |
$14,303.84
|
| Rate for Payer: BCBS Trust/PPO |
$46,749.99
|
| Rate for Payer: BCN Medicare Advantage |
$14,303.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,303.84
|
| Rate for Payer: Mclaren Medicare |
$14,303.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,019.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,449.42
|
| Rate for Payer: PACE Medicare |
$13,588.65
|
| Rate for Payer: PACE SWMI |
$14,303.84
|
| Rate for Payer: PHP Medicare Advantage |
$14,303.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,682.05
|
| Rate for Payer: Priority Health Medicare |
$14,303.84
|
| Rate for Payer: Priority Health Narrow Network |
$20,545.64
|
| Rate for Payer: Railroad Medicare Medicare |
$14,303.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,300.08
|
| Rate for Payer: UHC Core |
$22,385.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,303.84
|
| Rate for Payer: UHC Exchange |
$17,796.78
|
| Rate for Payer: UHC Medicare Advantage |
$14,732.96
|
| Rate for Payer: VA VA |
$14,303.84
|
|
|
SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,185.02
|
|
|
Service Code
|
CPT 15121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.36 |
| Max. Negotiated Rate |
$1,185.02 |
| Rate for Payer: BCBS Trust/PPO |
$1,185.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.20
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$128.36
|
|
|
SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$10,039.01
|
|
|
Service Code
|
CPT 15120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$678.79 |
| Max. Negotiated Rate |
$10,039.01 |
| Rate for Payer: Aetna Medicare |
$3,316.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,986.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,986.20
|
| Rate for Payer: BCBS Complete |
$1,831.74
|
| Rate for Payer: BCBS MAPPO |
$3,188.96
|
| Rate for Payer: BCBS Trust/PPO |
$4,575.21
|
| Rate for Payer: BCN Medicare Advantage |
$3,188.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,188.96
|
| Rate for Payer: Mclaren Medicaid |
$1,744.36
|
| Rate for Payer: Mclaren Medicare |
$3,188.96
|
| Rate for Payer: Meridian Medicaid |
$1,831.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,348.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,667.30
|
| Rate for Payer: PACE Medicare |
$3,029.51
|
| Rate for Payer: PACE SWMI |
$3,188.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,188.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,744.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,039.01
|
| Rate for Payer: Priority Health Medicare |
$3,188.96
|
| Rate for Payer: Priority Health Narrow Network |
$8,031.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3,188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.67
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,188.96
|
| Rate for Payer: UHC Exchange |
$678.79
|
| Rate for Payer: UHC Medicare Advantage |
$3,284.63
|
| Rate for Payer: VA VA |
$3,188.96
|
|
|
SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,360.32
|
|
|
Service Code
|
CPT 15101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$1,360.32 |
| Rate for Payer: BCBS Trust/PPO |
$1,360.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.87
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$108.06
|
|
|
SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$5,102.91
|
|
|
Service Code
|
CPT 15100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.33 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,756.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$774.76
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$704.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC
|
Facility
|
IP
|
$30,559.38
|
|
|
Service Code
|
MS-DRG 537
|
| Min. Negotiated Rate |
$7,565.88 |
| Max. Negotiated Rate |
$30,559.38 |
| Rate for Payer: Aetna Medicare |
$8,282.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,955.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,955.10
|
| Rate for Payer: BCBS MAPPO |
$7,964.08
|
| Rate for Payer: BCBS Trust/PPO |
$30,559.38
|
| Rate for Payer: BCN Medicare Advantage |
$7,964.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,964.08
|
| Rate for Payer: Mclaren Medicare |
$7,964.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,362.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,158.69
|
| Rate for Payer: PACE Medicare |
$7,565.88
|
| Rate for Payer: PACE SWMI |
$7,964.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,964.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,876.37
|
| Rate for Payer: Priority Health Medicare |
$7,964.08
|
| Rate for Payer: Priority Health Narrow Network |
$11,101.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7,964.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,750.62
|
| Rate for Payer: UHC Core |
$12,095.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,964.08
|
| Rate for Payer: UHC Exchange |
$9,615.85
|
| Rate for Payer: UHC Medicare Advantage |
$8,203.00
|
| Rate for Payer: VA VA |
$7,964.08
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC
|
Facility
|
IP
|
$15,411.62
|
|
|
Service Code
|
MS-DRG 538
|
| Min. Negotiated Rate |
$5,677.86 |
| Max. Negotiated Rate |
$15,411.62 |
| Rate for Payer: Aetna Medicare |
$6,215.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,470.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,470.86
|
| Rate for Payer: BCBS MAPPO |
$5,976.69
|
| Rate for Payer: BCBS Trust/PPO |
$15,411.62
|
| Rate for Payer: BCN Medicare Advantage |
$5,976.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,976.69
|
| Rate for Payer: Mclaren Medicare |
$5,976.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,275.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,873.19
|
| Rate for Payer: PACE Medicare |
$5,677.86
|
| Rate for Payer: PACE SWMI |
$5,976.69
|
| Rate for Payer: PHP Medicare Advantage |
$5,976.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,175.53
|
| Rate for Payer: Priority Health Medicare |
$5,976.69
|
| Rate for Payer: Priority Health Narrow Network |
$8,140.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,976.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,816.61
|
| Rate for Payer: UHC Core |
$8,869.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,976.69
|
| Rate for Payer: UHC Exchange |
$7,051.29
|
| Rate for Payer: UHC Medicare Advantage |
$6,155.99
|
| Rate for Payer: VA VA |
$5,976.69
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 37765
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$261.30 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,185.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.43
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$261.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
