|
TRANSLUMINAL BALLOON ANGIOPLASTY (EXCEPT DIALYSIS CIRCUIT), OPEN OR PERCUTANEOUS, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME VEIN; INITIAL VEIN
|
Facility
|
OP
|
$15,993.75
|
|
|
Service Code
|
CPT 37248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$283.24 |
| Max. Negotiated Rate |
$15,993.75 |
| Rate for Payer: Aetna Medicare |
$5,283.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,350.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,350.66
|
| Rate for Payer: BCBS Complete |
$2,918.26
|
| Rate for Payer: BCBS MAPPO |
$5,080.53
|
| Rate for Payer: BCBS Trust/PPO |
$7,648.97
|
| Rate for Payer: BCN Medicare Advantage |
$5,080.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,080.53
|
| Rate for Payer: Mclaren Medicaid |
$2,779.05
|
| Rate for Payer: Mclaren Medicare |
$5,080.53
|
| Rate for Payer: Meridian Medicaid |
$2,918.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,334.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,842.61
|
| Rate for Payer: PACE Medicare |
$4,826.50
|
| Rate for Payer: PACE SWMI |
$5,080.53
|
| Rate for Payer: PHP Medicare Advantage |
$5,080.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,993.75
|
| Rate for Payer: Priority Health Medicare |
$5,080.53
|
| Rate for Payer: Priority Health Narrow Network |
$12,795.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,080.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.56
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,080.53
|
| Rate for Payer: UHC Exchange |
$283.24
|
| Rate for Payer: UHC Medicare Advantage |
$5,232.95
|
| Rate for Payer: VA VA |
$5,080.53
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY (EXCEPT LOWER EXTREMITY ARTERY(IES) FOR OCCLUSIVE DISEASE, INTRACRANIAL, CORONARY, PULMONARY, OR DIALYSIS CIRCUIT), OPEN OR PERCUTANEOUS, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY; INITIAL ARTERY
|
Facility
|
OP
|
$15,993.75
|
|
|
Service Code
|
CPT 37246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.03 |
| Max. Negotiated Rate |
$15,993.75 |
| Rate for Payer: Aetna Medicare |
$5,283.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,350.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,350.66
|
| Rate for Payer: BCBS Complete |
$2,918.26
|
| Rate for Payer: BCBS MAPPO |
$5,080.53
|
| Rate for Payer: BCBS Trust/PPO |
$5,165.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,080.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,080.53
|
| Rate for Payer: Mclaren Medicaid |
$2,779.05
|
| Rate for Payer: Mclaren Medicare |
$5,080.53
|
| Rate for Payer: Meridian Medicaid |
$2,918.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,334.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,842.61
|
| Rate for Payer: PACE Medicare |
$4,826.50
|
| Rate for Payer: PACE SWMI |
$5,080.53
|
| Rate for Payer: PHP Medicare Advantage |
$5,080.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,993.75
|
| Rate for Payer: Priority Health Medicare |
$5,080.53
|
| Rate for Payer: Priority Health Narrow Network |
$12,795.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,080.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.23
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,080.53
|
| Rate for Payer: UHC Exchange |
$332.03
|
| Rate for Payer: UHC Medicare Advantage |
$5,232.95
|
| Rate for Payer: VA VA |
$5,080.53
|
|
|
TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL (EG, CANALOPLASTY); WITHOUT RETENTION OF DEVICE OR STENT
|
Facility
|
OP
|
$11,377.15
|
|
|
Service Code
|
CPT 66174
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.06 |
| Max. Negotiated Rate |
$11,377.15 |
| Rate for Payer: Aetna Medicare |
$3,758.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,517.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,517.55
|
| Rate for Payer: BCBS Complete |
$2,075.90
|
| Rate for Payer: BCBS MAPPO |
$3,614.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,597.35
|
| Rate for Payer: BCN Medicare Advantage |
$3,614.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,614.04
|
| Rate for Payer: Mclaren Medicaid |
$1,976.88
|
| Rate for Payer: Mclaren Medicare |
$3,614.04
|
| Rate for Payer: Meridian Medicaid |
$2,075.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,794.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,156.15
|
| Rate for Payer: PACE Medicare |
$3,433.34
|
| Rate for Payer: PACE SWMI |
$3,614.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,614.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,976.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,377.15
|
| Rate for Payer: Priority Health Medicare |
$3,614.04
|
| Rate for Payer: Priority Health Narrow Network |
$9,101.72
|
| Rate for Payer: Railroad Medicare Medicare |
$3,614.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.87
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,614.04
|
| Rate for Payer: UHC Exchange |
$608.06
|
| Rate for Payer: UHC Medicare Advantage |
$3,722.46
|
| Rate for Payer: VA VA |
$3,614.04
|
|
|
TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATED INTERVERTEBRAL DISC), SINGLE SEGMENT; LUMBAR (INCLUDING TRANSFACET, OR LATERAL EXTRAFORAMINAL APPROACH) (EG, FAR LATERAL HERNIATED INTERVERTEBRAL DISC)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 63056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,479.38 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,947.37
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,627.32
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,479.38
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE
|
Facility
|
OP
|
$1,543.71
|
|
|
Service Code
|
CPT 93303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$1,543.71 |
| Rate for Payer: Aetna Medicare |
$509.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$802.63
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,543.71
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,234.97
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.37
|
| Rate for Payer: UHC Exchange |
$215.46
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: VA VA |
$490.37
|
|
|
TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY GENERATED WATER VAPOR THERMOTHERAPY
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 53854
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.90 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.49
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$375.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 53852
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.90 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,917.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.49
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$375.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$14,479.04
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.53 |
| Max. Negotiated Rate |
$14,479.04 |
| Rate for Payer: Aetna Medicare |
$4,783.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,749.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,749.21
|
| Rate for Payer: BCBS Complete |
$2,641.88
|
| Rate for Payer: BCBS MAPPO |
$4,599.37
|
| Rate for Payer: BCBS Trust/PPO |
$3,895.58
|
| Rate for Payer: BCN Medicare Advantage |
$4,599.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,599.37
|
| Rate for Payer: Mclaren Medicaid |
$2,515.86
|
| Rate for Payer: Mclaren Medicare |
$4,599.37
|
| Rate for Payer: Meridian Medicaid |
$2,641.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,829.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,289.28
|
| Rate for Payer: PACE Medicare |
$4,369.40
|
| Rate for Payer: PACE SWMI |
$4,599.37
|
| Rate for Payer: PHP Medicare Advantage |
$4,599.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,515.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,479.04
|
| Rate for Payer: Priority Health Medicare |
$4,599.37
|
| Rate for Payer: Priority Health Narrow Network |
$11,583.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4,599.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$782.68
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,599.37
|
| Rate for Payer: UHC Exchange |
$711.53
|
| Rate for Payer: UHC Medicare Advantage |
$4,737.35
|
| Rate for Payer: VA VA |
$4,599.37
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
|
IP
|
$33,557.27
|
|
|
Service Code
|
MS-DRG 669
|
| Min. Negotiated Rate |
$11,721.12 |
| Max. Negotiated Rate |
$33,557.27 |
| Rate for Payer: Aetna Medicare |
$12,831.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,422.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,422.52
|
| Rate for Payer: BCBS MAPPO |
$12,338.02
|
| Rate for Payer: BCBS Trust/PPO |
$33,557.27
|
| Rate for Payer: BCN Medicare Advantage |
$12,338.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,338.02
|
| Rate for Payer: Mclaren Medicare |
$12,338.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,954.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,188.72
|
| Rate for Payer: PACE Medicare |
$11,721.12
|
| Rate for Payer: PACE SWMI |
$12,338.02
|
| Rate for Payer: PHP Medicare Advantage |
$12,338.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,021.39
|
| Rate for Payer: Priority Health Medicare |
$12,338.02
|
| Rate for Payer: Priority Health Narrow Network |
$17,617.11
|
| Rate for Payer: Railroad Medicare Medicare |
$12,338.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,408.79
|
| Rate for Payer: UHC Core |
$19,194.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,338.02
|
| Rate for Payer: UHC Exchange |
$15,260.06
|
| Rate for Payer: UHC Medicare Advantage |
$12,708.16
|
| Rate for Payer: VA VA |
$12,338.02
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$47,136.98
|
|
|
Service Code
|
MS-DRG 668
|
| Min. Negotiated Rate |
$21,116.56 |
| Max. Negotiated Rate |
$47,136.98 |
| Rate for Payer: Aetna Medicare |
$23,117.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,784.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,784.95
|
| Rate for Payer: BCBS MAPPO |
$22,227.96
|
| Rate for Payer: BCBS Trust/PPO |
$47,136.98
|
| Rate for Payer: BCN Medicare Advantage |
$22,227.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,227.96
|
| Rate for Payer: Mclaren Medicare |
$22,227.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,562.15
|
| Rate for Payer: PACE Medicare |
$21,116.56
|
| Rate for Payer: PACE SWMI |
$22,227.96
|
| Rate for Payer: PHP Medicare Advantage |
$22,227.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,438.07
|
| Rate for Payer: Priority Health Medicare |
$22,227.96
|
| Rate for Payer: Priority Health Narrow Network |
$32,350.46
|
| Rate for Payer: Railroad Medicare Medicare |
$22,227.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,985.77
|
| Rate for Payer: UHC Core |
$35,247.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,227.96
|
| Rate for Payer: UHC Exchange |
$28,022.19
|
| Rate for Payer: UHC Medicare Advantage |
$22,894.80
|
| Rate for Payer: VA VA |
$22,227.96
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$20,022.79
|
|
|
Service Code
|
MS-DRG 670
|
| Min. Negotiated Rate |
$7,533.67 |
| Max. Negotiated Rate |
$20,022.79 |
| Rate for Payer: Aetna Medicare |
$8,247.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,912.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,912.72
|
| Rate for Payer: BCBS MAPPO |
$7,930.18
|
| Rate for Payer: BCBS Trust/PPO |
$20,022.79
|
| Rate for Payer: BCN Medicare Advantage |
$7,930.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,930.18
|
| Rate for Payer: Mclaren Medicare |
$7,930.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,326.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,119.71
|
| Rate for Payer: PACE Medicare |
$7,533.67
|
| Rate for Payer: PACE SWMI |
$7,930.18
|
| Rate for Payer: PHP Medicare Advantage |
$7,930.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,813.23
|
| Rate for Payer: Priority Health Medicare |
$7,930.18
|
| Rate for Payer: Priority Health Narrow Network |
$11,050.58
|
| Rate for Payer: Railroad Medicare Medicare |
$7,930.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,683.50
|
| Rate for Payer: UHC Core |
$12,040.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,930.18
|
| Rate for Payer: UHC Exchange |
$9,572.09
|
| Rate for Payer: UHC Medicare Advantage |
$8,168.09
|
| Rate for Payer: VA VA |
$7,930.18
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$26,872.95
|
|
|
Service Code
|
MS-DRG 713
|
| Min. Negotiated Rate |
$11,106.92 |
| Max. Negotiated Rate |
$26,872.95 |
| Rate for Payer: Aetna Medicare |
$12,159.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,614.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,614.38
|
| Rate for Payer: BCBS MAPPO |
$11,691.50
|
| Rate for Payer: BCBS Trust/PPO |
$26,872.95
|
| Rate for Payer: BCN Medicare Advantage |
$11,691.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,691.50
|
| Rate for Payer: Mclaren Medicare |
$11,691.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,276.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,445.22
|
| Rate for Payer: PACE Medicare |
$11,106.92
|
| Rate for Payer: PACE SWMI |
$11,691.50
|
| Rate for Payer: PHP Medicare Advantage |
$11,691.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,817.43
|
| Rate for Payer: Priority Health Medicare |
$11,691.50
|
| Rate for Payer: Priority Health Narrow Network |
$16,653.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11,691.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,128.98
|
| Rate for Payer: UHC Core |
$18,145.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,691.50
|
| Rate for Payer: UHC Exchange |
$14,425.76
|
| Rate for Payer: UHC Medicare Advantage |
$12,042.24
|
| Rate for Payer: VA VA |
$11,691.50
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$22,837.24
|
|
|
Service Code
|
MS-DRG 714
|
| Min. Negotiated Rate |
$7,503.65 |
| Max. Negotiated Rate |
$22,837.24 |
| Rate for Payer: Aetna Medicare |
$8,214.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,873.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,873.22
|
| Rate for Payer: BCBS MAPPO |
$7,898.58
|
| Rate for Payer: BCBS Trust/PPO |
$22,837.24
|
| Rate for Payer: BCN Medicare Advantage |
$7,898.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,898.58
|
| Rate for Payer: Mclaren Medicare |
$7,898.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,293.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,083.37
|
| Rate for Payer: PACE Medicare |
$7,503.65
|
| Rate for Payer: PACE SWMI |
$7,898.58
|
| Rate for Payer: PHP Medicare Advantage |
$7,898.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,754.40
|
| Rate for Payer: Priority Health Medicare |
$7,898.58
|
| Rate for Payer: Priority Health Narrow Network |
$11,003.52
|
| Rate for Payer: Railroad Medicare Medicare |
$7,898.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,620.96
|
| Rate for Payer: UHC Core |
$11,988.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,898.58
|
| Rate for Payer: UHC Exchange |
$9,531.32
|
| Rate for Payer: UHC Medicare Advantage |
$8,135.54
|
| Rate for Payer: VA VA |
$7,898.58
|
|
|
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 52500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$485.27 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$533.80
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$485.27
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 52640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$318.93 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.82
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$318.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$14,479.04
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$399.48 |
| Max. Negotiated Rate |
$14,479.04 |
| Rate for Payer: Aetna Medicare |
$4,783.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,749.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,749.21
|
| Rate for Payer: BCBS Complete |
$2,641.88
|
| Rate for Payer: BCBS MAPPO |
$4,599.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,373.13
|
| Rate for Payer: BCN Medicare Advantage |
$4,599.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,599.37
|
| Rate for Payer: Mclaren Medicaid |
$2,515.86
|
| Rate for Payer: Mclaren Medicare |
$4,599.37
|
| Rate for Payer: Meridian Medicaid |
$2,641.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,829.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,289.28
|
| Rate for Payer: PACE Medicare |
$4,369.40
|
| Rate for Payer: PACE SWMI |
$4,599.37
|
| Rate for Payer: PHP Medicare Advantage |
$4,599.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,515.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,479.04
|
| Rate for Payer: Priority Health Medicare |
$4,599.37
|
| Rate for Payer: Priority Health Narrow Network |
$11,583.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4,599.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.43
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,599.37
|
| Rate for Payer: UHC Exchange |
$399.48
|
| Rate for Payer: UHC Medicare Advantage |
$4,737.35
|
| Rate for Payer: VA VA |
$4,599.37
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,947.73
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
183257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.01 |
| Max. Negotiated Rate |
$5,352.96 |
| Rate for Payer: Aetna American Axle |
$3,866.02
|
| Rate for Payer: Aetna Commercial |
$5,055.57
|
| Rate for Payer: Aetna Medicare |
$83.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,866.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.58
|
| Rate for Payer: BCBS Complete |
$46.22
|
| Rate for Payer: BCBS MAPPO |
$80.46
|
| Rate for Payer: BCBS Trust/PPO |
$260.02
|
| Rate for Payer: BCN Medicare Advantage |
$80.46
|
| Rate for Payer: Cash Price |
$4,758.18
|
| Rate for Payer: Cash Price |
$4,758.18
|
| Rate for Payer: Cofinity Commercial |
$4,163.41
|
| Rate for Payer: Cofinity Commercial |
$5,115.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,758.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.46
|
| Rate for Payer: Healthscope Commercial |
$5,352.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,163.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,460.80
|
| Rate for Payer: Mclaren Medicaid |
$44.01
|
| Rate for Payer: Mclaren Medicare |
$80.46
|
| Rate for Payer: Meridian Medicaid |
$46.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,055.57
|
| Rate for Payer: PACE Medicare |
$76.44
|
| Rate for Payer: PACE SWMI |
$80.46
|
| Rate for Payer: PHP Commercial |
$5,055.57
|
| Rate for Payer: PHP Medicare Advantage |
$80.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,163.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.25
|
| Rate for Payer: Priority Health Medicare |
$80.46
|
| Rate for Payer: Priority Health Narrow Network |
$189.80
|
| Rate for Payer: Priority Health SBD |
$3,747.07
|
| Rate for Payer: Railroad Medicare Medicare |
$80.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.46
|
| Rate for Payer: UHC Medicare Advantage |
$82.88
|
| Rate for Payer: UMR Bronson Commercial |
$2,200.66
|
| Rate for Payer: VA VA |
$80.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,460.80
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,947.73
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
183257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,617.00 |
| Max. Negotiated Rate |
$5,352.96 |
| Rate for Payer: Aetna American Axle |
$3,866.02
|
| Rate for Payer: Aetna Commercial |
$5,055.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,866.02
|
| Rate for Payer: Cash Price |
$4,758.18
|
| Rate for Payer: Cofinity Commercial |
$4,163.41
|
| Rate for Payer: Cofinity Commercial |
$5,115.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,758.18
|
| Rate for Payer: Healthscope Commercial |
$5,352.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,163.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,460.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,055.57
|
| Rate for Payer: PHP Commercial |
$5,055.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,163.41
|
| Rate for Payer: Priority Health SBD |
$3,747.07
|
| Rate for Payer: UMR Bronson Commercial |
$2,617.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,460.80
|
|
|
TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION
|
Facility
|
OP
|
$17,843.04
|
|
|
Service Code
|
HCPCS J9356
|
| Hospital Charge Code |
190129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$16,058.74 |
| Rate for Payer: Aetna American Axle |
$11,597.98
|
| Rate for Payer: Aetna Commercial |
$15,166.58
|
| Rate for Payer: Aetna Medicare |
$68.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,597.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.53
|
| Rate for Payer: BCBS Complete |
$37.92
|
| Rate for Payer: BCBS MAPPO |
$66.02
|
| Rate for Payer: BCBS Trust/PPO |
$213.33
|
| Rate for Payer: BCN Medicare Advantage |
$66.02
|
| Rate for Payer: Cash Price |
$14,274.43
|
| Rate for Payer: Cash Price |
$14,274.43
|
| Rate for Payer: Cofinity Commercial |
$12,490.13
|
| Rate for Payer: Cofinity Commercial |
$15,345.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,274.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.02
|
| Rate for Payer: Healthscope Commercial |
$16,058.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,490.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,382.28
|
| Rate for Payer: Mclaren Medicaid |
$36.11
|
| Rate for Payer: Mclaren Medicare |
$66.02
|
| Rate for Payer: Meridian Medicaid |
$37.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,166.58
|
| Rate for Payer: PACE Medicare |
$62.72
|
| Rate for Payer: PACE SWMI |
$66.02
|
| Rate for Payer: PHP Commercial |
$15,166.58
|
| Rate for Payer: PHP Medicare Advantage |
$66.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,490.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.83
|
| Rate for Payer: Priority Health Medicare |
$66.02
|
| Rate for Payer: Priority Health Narrow Network |
$155.06
|
| Rate for Payer: Priority Health SBD |
$11,241.12
|
| Rate for Payer: Railroad Medicare Medicare |
$66.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.02
|
| Rate for Payer: UHC Medicare Advantage |
$68.00
|
| Rate for Payer: UMR Bronson Commercial |
$6,601.92
|
| Rate for Payer: VA VA |
$66.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,382.28
|
|
|
TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,834.98
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
191865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,567.39 |
| Max. Negotiated Rate |
$5,251.48 |
| Rate for Payer: Aetna American Axle |
$3,792.74
|
| Rate for Payer: Aetna Commercial |
$4,959.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,792.74
|
| Rate for Payer: Cash Price |
$4,667.98
|
| Rate for Payer: Cofinity Commercial |
$4,084.49
|
| Rate for Payer: Cofinity Commercial |
$5,018.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,667.98
|
| Rate for Payer: Healthscope Commercial |
$5,251.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,084.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,376.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,959.73
|
| Rate for Payer: PHP Commercial |
$4,959.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,084.49
|
| Rate for Payer: Priority Health SBD |
$3,676.04
|
| Rate for Payer: UMR Bronson Commercial |
$2,567.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,376.24
|
|
|
TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,834.98
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
191865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$5,251.48 |
| Rate for Payer: Aetna American Axle |
$3,792.74
|
| Rate for Payer: Aetna Commercial |
$4,959.73
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,792.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.69
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: BCBS MAPPO |
$12.55
|
| Rate for Payer: BCBS Trust/PPO |
$25.25
|
| Rate for Payer: BCN Medicare Advantage |
$12.55
|
| Rate for Payer: Cash Price |
$4,667.98
|
| Rate for Payer: Cash Price |
$4,667.98
|
| Rate for Payer: Cofinity Commercial |
$5,018.08
|
| Rate for Payer: Cofinity Commercial |
$4,084.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,667.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$5,251.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,084.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,376.24
|
| Rate for Payer: Mclaren Medicaid |
$6.86
|
| Rate for Payer: Mclaren Medicare |
$12.55
|
| Rate for Payer: Meridian Medicaid |
$7.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,959.73
|
| Rate for Payer: PACE Medicare |
$11.92
|
| Rate for Payer: PACE SWMI |
$12.55
|
| Rate for Payer: PHP Commercial |
$4,959.73
|
| Rate for Payer: PHP Medicare Advantage |
$12.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,084.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$12.55
|
| Rate for Payer: Priority Health Narrow Network |
$57.20
|
| Rate for Payer: Priority Health SBD |
$3,676.04
|
| Rate for Payer: Railroad Medicare Medicare |
$12.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.55
|
| Rate for Payer: UHC Medicare Advantage |
$12.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,158.94
|
| Rate for Payer: VA VA |
$12.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,376.24
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,337.86
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
190713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$14,704.07 |
| Rate for Payer: Aetna American Axle |
$10,619.61
|
| Rate for Payer: Aetna American Axle |
$10,129.48
|
| Rate for Payer: Aetna Commercial |
$13,246.24
|
| Rate for Payer: Aetna Commercial |
$13,887.18
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,129.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,619.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.69
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: BCBS MAPPO |
$12.55
|
| Rate for Payer: BCBS MAPPO |
$12.55
|
| Rate for Payer: BCBS Trust/PPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$25.25
|
| Rate for Payer: BCN Medicare Advantage |
$12.55
|
| Rate for Payer: BCN Medicare Advantage |
$12.55
|
| Rate for Payer: Cash Price |
$12,467.05
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cash Price |
$12,467.05
|
| Rate for Payer: Cofinity Commercial |
$11,436.50
|
| Rate for Payer: Cofinity Commercial |
$14,050.56
|
| Rate for Payer: Cofinity Commercial |
$10,908.67
|
| Rate for Payer: Cofinity Commercial |
$13,402.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,467.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,070.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$14,025.43
|
| Rate for Payer: Healthscope Commercial |
$14,704.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,908.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,436.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,253.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,687.86
|
| Rate for Payer: Mclaren Medicaid |
$6.86
|
| Rate for Payer: Mclaren Medicaid |
$6.86
|
| Rate for Payer: Mclaren Medicare |
$12.55
|
| Rate for Payer: Mclaren Medicare |
$12.55
|
| Rate for Payer: Meridian Medicaid |
$7.21
|
| Rate for Payer: Meridian Medicaid |
$7.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,246.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,887.18
|
| Rate for Payer: PACE Medicare |
$11.92
|
| Rate for Payer: PACE Medicare |
$11.92
|
| Rate for Payer: PACE SWMI |
$12.55
|
| Rate for Payer: PACE SWMI |
$12.55
|
| Rate for Payer: PHP Commercial |
$13,246.24
|
| Rate for Payer: PHP Commercial |
$13,887.18
|
| Rate for Payer: PHP Medicare Advantage |
$12.55
|
| Rate for Payer: PHP Medicare Advantage |
$12.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,436.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,908.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$12.55
|
| Rate for Payer: Priority Health Medicare |
$12.55
|
| Rate for Payer: Priority Health Narrow Network |
$57.20
|
| Rate for Payer: Priority Health Narrow Network |
$57.20
|
| Rate for Payer: Priority Health SBD |
$9,817.80
|
| Rate for Payer: Priority Health SBD |
$10,292.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.55
|
| Rate for Payer: Railroad Medicare Medicare |
$12.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.55
|
| Rate for Payer: UHC Medicare Advantage |
$12.93
|
| Rate for Payer: UHC Medicare Advantage |
$12.93
|
| Rate for Payer: UMR Bronson Commercial |
$6,045.01
|
| Rate for Payer: UMR Bronson Commercial |
$5,766.01
|
| Rate for Payer: VA VA |
$12.55
|
| Rate for Payer: VA VA |
$12.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,253.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,687.86
|
|
|
TRASTUZUMAB-PKRB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,139.81
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
193057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$5,525.83 |
| Rate for Payer: Aetna American Axle |
$3,990.88
|
| Rate for Payer: Aetna Commercial |
$5,218.84
|
| Rate for Payer: Aetna Medicare |
$41.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,990.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.38
|
| Rate for Payer: BCBS Complete |
$23.15
|
| Rate for Payer: BCBS MAPPO |
$40.31
|
| Rate for Payer: BCBS Trust/PPO |
$117.26
|
| Rate for Payer: BCN Medicare Advantage |
$40.31
|
| Rate for Payer: Cash Price |
$4,911.85
|
| Rate for Payer: Cash Price |
$4,911.85
|
| Rate for Payer: Cofinity Commercial |
$5,280.24
|
| Rate for Payer: Cofinity Commercial |
$4,297.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,911.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.31
|
| Rate for Payer: Healthscope Commercial |
$5,525.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,297.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,604.86
|
| Rate for Payer: Mclaren Medicaid |
$22.05
|
| Rate for Payer: Mclaren Medicare |
$40.31
|
| Rate for Payer: Meridian Medicaid |
$23.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,218.84
|
| Rate for Payer: PACE Medicare |
$38.29
|
| Rate for Payer: PACE SWMI |
$40.31
|
| Rate for Payer: PHP Commercial |
$5,218.84
|
| Rate for Payer: PHP Medicare Advantage |
$40.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,297.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.28
|
| Rate for Payer: Priority Health Medicare |
$40.31
|
| Rate for Payer: Priority Health Narrow Network |
$47.42
|
| Rate for Payer: Priority Health SBD |
$3,868.08
|
| Rate for Payer: Railroad Medicare Medicare |
$40.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.31
|
| Rate for Payer: UHC Medicare Advantage |
$41.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,271.73
|
| Rate for Payer: VA VA |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,604.86
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17,191.45
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,564.24 |
| Max. Negotiated Rate |
$15,472.30 |
| Rate for Payer: Aetna American Axle |
$11,174.44
|
| Rate for Payer: Aetna Commercial |
$14,612.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,174.44
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cofinity Commercial |
$12,034.02
|
| Rate for Payer: Cofinity Commercial |
$14,784.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,753.16
|
| Rate for Payer: Healthscope Commercial |
$15,472.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,034.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,893.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,612.73
|
| Rate for Payer: PHP Commercial |
$14,612.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,034.02
|
| Rate for Payer: Priority Health SBD |
$10,830.61
|
| Rate for Payer: UMR Bronson Commercial |
$7,564.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,893.59
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,191.45
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$15,472.30 |
| Rate for Payer: Aetna American Axle |
$11,174.44
|
| Rate for Payer: Aetna Commercial |
$14,612.73
|
| Rate for Payer: Aetna Medicare |
$41.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,174.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.38
|
| Rate for Payer: BCBS Complete |
$23.15
|
| Rate for Payer: BCBS MAPPO |
$40.31
|
| Rate for Payer: BCBS Trust/PPO |
$117.26
|
| Rate for Payer: BCN Medicare Advantage |
$40.31
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cofinity Commercial |
$14,784.65
|
| Rate for Payer: Cofinity Commercial |
$12,034.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,753.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.31
|
| Rate for Payer: Healthscope Commercial |
$15,472.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,034.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,893.59
|
| Rate for Payer: Mclaren Medicaid |
$22.05
|
| Rate for Payer: Mclaren Medicare |
$40.31
|
| Rate for Payer: Meridian Medicaid |
$23.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,612.73
|
| Rate for Payer: PACE Medicare |
$38.29
|
| Rate for Payer: PACE SWMI |
$40.31
|
| Rate for Payer: PHP Commercial |
$14,612.73
|
| Rate for Payer: PHP Medicare Advantage |
$40.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,034.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.28
|
| Rate for Payer: Priority Health Medicare |
$40.31
|
| Rate for Payer: Priority Health Narrow Network |
$47.42
|
| Rate for Payer: Priority Health SBD |
$10,830.61
|
| Rate for Payer: Railroad Medicare Medicare |
$40.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.31
|
| Rate for Payer: UHC Medicare Advantage |
$41.52
|
| Rate for Payer: UMR Bronson Commercial |
$6,360.84
|
| Rate for Payer: VA VA |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,893.59
|
|
