|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$53,567.88
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$23,968.78 |
| Max. Negotiated Rate |
$53,567.88 |
| Rate for Payer: Aetna Medicare |
$26,239.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,537.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,537.88
|
| Rate for Payer: BCBS MAPPO |
$25,230.30
|
| Rate for Payer: BCBS Trust/PPO |
$53,567.88
|
| Rate for Payer: BCN Commercial |
$53,567.88
|
| Rate for Payer: BCN Medicare Advantage |
$25,230.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,230.30
|
| Rate for Payer: Mclaren Medicare |
$25,230.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,491.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,014.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,753.33
|
| Rate for Payer: Nomi Health Commercial |
$38,004.69
|
| Rate for Payer: PACE Medicare |
$23,968.78
|
| Rate for Payer: PACE SWMI |
$25,230.30
|
| Rate for Payer: PHP Medicare Advantage |
$25,230.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47,497.44
|
| Rate for Payer: Priority Health Medicare |
$25,230.30
|
| Rate for Payer: Priority Health Tiered Network |
$37,997.94
|
| Rate for Payer: Railroad Medicare Medicare |
$25,230.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48,021.43
|
| Rate for Payer: UHC Core |
$40,175.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25,230.30
|
| Rate for Payer: UHC Exchange |
$32,810.72
|
| Rate for Payer: VA VA |
$25,230.30
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$78,707.81
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$38,925.21 |
| Max. Negotiated Rate |
$78,707.81 |
| Rate for Payer: Aetna Medicare |
$42,612.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,217.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,217.39
|
| Rate for Payer: BCBS MAPPO |
$40,973.91
|
| Rate for Payer: BCBS Trust/PPO |
$70,947.11
|
| Rate for Payer: BCN Commercial |
$70,947.11
|
| Rate for Payer: BCN Medicare Advantage |
$40,973.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,973.91
|
| Rate for Payer: Mclaren Medicare |
$40,973.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43,022.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,120.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$45,071.30
|
| Rate for Payer: Nomi Health Commercial |
$62,290.23
|
| Rate for Payer: PACE Medicare |
$38,925.21
|
| Rate for Payer: PACE SWMI |
$40,973.91
|
| Rate for Payer: PHP Medicare Advantage |
$40,973.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$77,848.98
|
| Rate for Payer: Priority Health Medicare |
$40,973.91
|
| Rate for Payer: Priority Health Tiered Network |
$62,279.17
|
| Rate for Payer: Railroad Medicare Medicare |
$40,973.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78,707.81
|
| Rate for Payer: UHC Core |
$65,848.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40,973.91
|
| Rate for Payer: UHC Exchange |
$53,777.23
|
| Rate for Payer: VA VA |
$40,973.91
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$43,800.82
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$19,958.37 |
| Max. Negotiated Rate |
$43,800.82 |
| Rate for Payer: Aetna Medicare |
$21,849.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,261.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,261.01
|
| Rate for Payer: BCBS MAPPO |
$21,008.81
|
| Rate for Payer: BCBS Trust/PPO |
$43,800.82
|
| Rate for Payer: BCN Commercial |
$43,800.82
|
| Rate for Payer: BCN Medicare Advantage |
$21,008.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,008.81
|
| Rate for Payer: Mclaren Medicare |
$21,008.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,059.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,160.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,109.69
|
| Rate for Payer: Nomi Health Commercial |
$31,492.77
|
| Rate for Payer: PACE Medicare |
$19,958.37
|
| Rate for Payer: PACE SWMI |
$21,008.81
|
| Rate for Payer: PHP Medicare Advantage |
$21,008.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39,358.98
|
| Rate for Payer: Priority Health Medicare |
$21,008.81
|
| Rate for Payer: Priority Health Tiered Network |
$31,487.18
|
| Rate for Payer: Railroad Medicare Medicare |
$21,008.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,793.19
|
| Rate for Payer: UHC Core |
$33,292.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,008.81
|
| Rate for Payer: UHC Exchange |
$27,188.76
|
| Rate for Payer: VA VA |
$21,008.81
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$4,817.78
|
|
|
Service Code
|
APR-DRG 5401
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$4,817.78 |
| Rate for Payer: BCBS Complete |
$4,817.78
|
| Rate for Payer: Mclaren Medicaid |
$4,588.36
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,588.36
|
| Rate for Payer: UHC Medicaid |
$4,588.36
|
| Rate for Payer: UHCCP Medicaid |
$4,588.36
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$7,429.15
|
|
|
Service Code
|
APR-DRG 5403
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$7,429.15 |
| Rate for Payer: BCBS Complete |
$7,429.15
|
| Rate for Payer: Mclaren Medicaid |
$7,075.38
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,075.38
|
| Rate for Payer: UHC Medicaid |
$7,075.38
|
| Rate for Payer: UHCCP Medicaid |
$7,075.38
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$18,075.61
|
|
|
Service Code
|
APR-DRG 5404
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$18,075.61 |
| Rate for Payer: BCBS Complete |
$18,075.61
|
| Rate for Payer: Mclaren Medicaid |
$17,214.87
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,214.87
|
| Rate for Payer: UHC Medicaid |
$17,214.87
|
| Rate for Payer: UHCCP Medicaid |
$17,214.87
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$6,222.74
|
|
|
Service Code
|
APR-DRG 5402
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$6,222.74 |
| Rate for Payer: BCBS Complete |
$6,222.74
|
| Rate for Payer: Mclaren Medicaid |
$5,926.42
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,926.42
|
| Rate for Payer: UHC Medicaid |
$5,926.42
|
| Rate for Payer: UHCCP Medicaid |
$5,926.42
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$18,203.84
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$9,435.81 |
| Max. Negotiated Rate |
$18,203.84 |
| Rate for Payer: Aetna Medicare |
$10,329.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,415.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,415.54
|
| Rate for Payer: BCBS MAPPO |
$9,932.43
|
| Rate for Payer: BCBS Trust/PPO |
$17,434.13
|
| Rate for Payer: BCN Commercial |
$17,434.13
|
| Rate for Payer: BCN Medicare Advantage |
$9,932.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,932.43
|
| Rate for Payer: Mclaren Medicare |
$9,932.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,429.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,422.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,925.67
|
| Rate for Payer: Nomi Health Commercial |
$14,406.72
|
| Rate for Payer: PACE Medicare |
$9,435.81
|
| Rate for Payer: PACE SWMI |
$9,932.43
|
| Rate for Payer: PHP Medicare Advantage |
$9,932.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,632.45
|
| Rate for Payer: Priority Health Medicare |
$9,932.43
|
| Rate for Payer: Priority Health Tiered Network |
$11,705.96
|
| Rate for Payer: Railroad Medicare Medicare |
$9,932.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,203.84
|
| Rate for Payer: UHC Core |
$15,229.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,932.43
|
| Rate for Payer: UHC Exchange |
$12,437.80
|
| Rate for Payer: VA VA |
$9,932.43
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$26,886.85
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$13,667.87 |
| Max. Negotiated Rate |
$26,886.85 |
| Rate for Payer: Aetna Medicare |
$14,962.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,984.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,984.04
|
| Rate for Payer: BCBS MAPPO |
$14,387.23
|
| Rate for Payer: BCBS Trust/PPO |
$24,038.84
|
| Rate for Payer: BCN Commercial |
$24,038.84
|
| Rate for Payer: BCN Medicare Advantage |
$14,387.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,387.23
|
| Rate for Payer: Mclaren Medicare |
$14,387.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,106.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,545.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,825.95
|
| Rate for Payer: Nomi Health Commercial |
$21,278.55
|
| Rate for Payer: PACE Medicare |
$13,667.87
|
| Rate for Payer: PACE SWMI |
$14,387.23
|
| Rate for Payer: PHP Medicare Advantage |
$14,387.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,044.23
|
| Rate for Payer: Priority Health Medicare |
$14,387.23
|
| Rate for Payer: Priority Health Tiered Network |
$16,835.38
|
| Rate for Payer: Railroad Medicare Medicare |
$14,387.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,886.85
|
| Rate for Payer: UHC Core |
$22,494.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,387.23
|
| Rate for Payer: UHC Exchange |
$18,370.48
|
| Rate for Payer: VA VA |
$14,387.23
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,938.05
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$8,180.57 |
| Max. Negotiated Rate |
$15,938.05 |
| Rate for Payer: Aetna Medicare |
$8,955.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,763.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,763.91
|
| Rate for Payer: BCBS MAPPO |
$8,611.13
|
| Rate for Payer: BCBS Trust/PPO |
$15,938.05
|
| Rate for Payer: BCN Commercial |
$15,938.05
|
| Rate for Payer: BCN Medicare Advantage |
$8,611.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,611.13
|
| Rate for Payer: Mclaren Medicare |
$8,611.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,041.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,902.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,472.24
|
| Rate for Payer: Nomi Health Commercial |
$12,368.52
|
| Rate for Payer: PACE Medicare |
$8,180.57
|
| Rate for Payer: PACE SWMI |
$8,611.13
|
| Rate for Payer: PHP Medicare Advantage |
$8,611.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,099.24
|
| Rate for Payer: Priority Health Medicare |
$8,611.13
|
| Rate for Payer: Priority Health Tiered Network |
$10,479.39
|
| Rate for Payer: Railroad Medicare Medicare |
$8,611.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,628.44
|
| Rate for Payer: UHC Core |
$13,075.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,611.13
|
| Rate for Payer: UHC Exchange |
$10,678.16
|
| Rate for Payer: VA VA |
$8,611.13
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$16,602.25
|
|
|
Service Code
|
APR-DRG 5394
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$16,602.25 |
| Rate for Payer: BCBS Complete |
$16,602.25
|
| Rate for Payer: Mclaren Medicaid |
$15,811.67
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,811.67
|
| Rate for Payer: UHC Medicaid |
$15,811.67
|
| Rate for Payer: UHCCP Medicaid |
$15,811.67
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$3,078.68
|
|
|
Service Code
|
APR-DRG 5391
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$3,078.68 |
| Rate for Payer: BCBS Complete |
$3,078.68
|
| Rate for Payer: Mclaren Medicaid |
$2,932.08
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,932.08
|
| Rate for Payer: UHC Medicaid |
$2,932.08
|
| Rate for Payer: UHCCP Medicaid |
$2,932.08
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$7,743.92
|
|
|
Service Code
|
APR-DRG 5393
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$7,743.92 |
| Rate for Payer: BCBS Complete |
$7,743.92
|
| Rate for Payer: Mclaren Medicaid |
$7,375.16
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,375.16
|
| Rate for Payer: UHC Medicaid |
$7,375.16
|
| Rate for Payer: UHCCP Medicaid |
$7,375.16
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$4,015.12
|
|
|
Service Code
|
APR-DRG 5392
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$4,015.12 |
| Rate for Payer: BCBS Complete |
$4,015.12
|
| Rate for Payer: Mclaren Medicaid |
$3,823.92
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,823.92
|
| Rate for Payer: UHC Medicaid |
$3,823.92
|
| Rate for Payer: UHCCP Medicaid |
$3,823.92
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$18,309.82
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$8,985.37 |
| Max. Negotiated Rate |
$18,309.82 |
| Rate for Payer: Aetna Medicare |
$9,836.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,822.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,822.85
|
| Rate for Payer: BCBS MAPPO |
$9,458.28
|
| Rate for Payer: BCBS Trust/PPO |
$18,309.82
|
| Rate for Payer: BCN Commercial |
$18,309.82
|
| Rate for Payer: BCN Medicare Advantage |
$9,458.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,458.28
|
| Rate for Payer: Mclaren Medicare |
$9,458.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,931.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,877.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,404.11
|
| Rate for Payer: Nomi Health Commercial |
$13,675.29
|
| Rate for Payer: PACE Medicare |
$8,985.37
|
| Rate for Payer: PACE SWMI |
$9,458.28
|
| Rate for Payer: PHP Medicare Advantage |
$9,458.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,916.20
|
| Rate for Payer: Priority Health Medicare |
$9,458.28
|
| Rate for Payer: Priority Health Tiered Network |
$11,932.96
|
| Rate for Payer: Railroad Medicare Medicare |
$9,458.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,279.63
|
| Rate for Payer: UHC Core |
$14,456.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,458.28
|
| Rate for Payer: UHC Exchange |
$11,806.33
|
| Rate for Payer: VA VA |
$9,458.28
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$40,018.13
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$18,900.30 |
| Max. Negotiated Rate |
$40,018.13 |
| Rate for Payer: Aetna Medicare |
$21,969.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,405.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,405.28
|
| Rate for Payer: BCBS MAPPO |
$21,124.22
|
| Rate for Payer: BCBS Trust/PPO |
$26,575.31
|
| Rate for Payer: BCN Commercial |
$26,575.31
|
| Rate for Payer: BCN Medicare Advantage |
$21,124.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,124.22
|
| Rate for Payer: Mclaren Medicare |
$21,124.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,180.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,292.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,236.64
|
| Rate for Payer: Nomi Health Commercial |
$31,670.79
|
| Rate for Payer: PACE Medicare |
$20,068.01
|
| Rate for Payer: PACE SWMI |
$21,124.22
|
| Rate for Payer: PHP Medicare Advantage |
$21,124.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,625.38
|
| Rate for Payer: Priority Health Medicare |
$21,124.22
|
| Rate for Payer: Priority Health Tiered Network |
$18,900.30
|
| Rate for Payer: Railroad Medicare Medicare |
$21,124.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,018.13
|
| Rate for Payer: UHC Core |
$33,480.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,124.22
|
| Rate for Payer: UHC Exchange |
$27,342.45
|
| Rate for Payer: VA VA |
$21,124.22
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,652.56
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$8,172.60 |
| Max. Negotiated Rate |
$15,652.56 |
| Rate for Payer: Aetna Medicare |
$8,946.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,753.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,753.42
|
| Rate for Payer: BCBS MAPPO |
$8,602.74
|
| Rate for Payer: BCBS Trust/PPO |
$15,652.56
|
| Rate for Payer: BCN Commercial |
$15,652.56
|
| Rate for Payer: BCN Medicare Advantage |
$8,602.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,602.74
|
| Rate for Payer: Mclaren Medicare |
$8,602.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,032.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,893.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,463.01
|
| Rate for Payer: Nomi Health Commercial |
$12,355.62
|
| Rate for Payer: PACE Medicare |
$8,172.60
|
| Rate for Payer: PACE SWMI |
$8,602.74
|
| Rate for Payer: PHP Medicare Advantage |
$8,602.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,296.36
|
| Rate for Payer: Priority Health Medicare |
$8,602.74
|
| Rate for Payer: Priority Health Tiered Network |
$9,837.08
|
| Rate for Payer: Railroad Medicare Medicare |
$8,602.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,612.14
|
| Rate for Payer: UHC Core |
$13,061.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,602.74
|
| Rate for Payer: UHC Exchange |
$10,667.02
|
| Rate for Payer: VA VA |
$8,602.74
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
IP
|
$314.90
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.56 |
| Max. Negotiated Rate |
$283.41 |
| Rate for Payer: Aetna American Axle |
$204.69
|
| Rate for Payer: Aetna Commercial |
$267.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.69
|
| Rate for Payer: Cash Price |
$251.92
|
| Rate for Payer: Cofinity Advantage |
$220.43
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.92
|
| Rate for Payer: Healthscope Commercial |
$283.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.18
|
| Rate for Payer: PHP Commercial |
$267.67
|
| Rate for Payer: Priority Health SBD |
$198.39
|
| Rate for Payer: UMR Bronson Commercial |
$138.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.18
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$249.10
|
|
|
Service Code
|
NDC 904671761
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.91
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna Medicare |
$124.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.91
|
| Rate for Payer: BCBS Complete |
$99.64
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Advantage |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.82
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.91
|
| Rate for Payer: UHC Core |
$129.78
|
| Rate for Payer: UHC Exchange |
$97.90
|
| Rate for Payer: UMR Bronson Commercial |
$92.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$314.90
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.51 |
| Max. Negotiated Rate |
$283.41 |
| Rate for Payer: Aetna American Axle |
$204.69
|
| Rate for Payer: Aetna Commercial |
$267.67
|
| Rate for Payer: Aetna Medicare |
$157.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.69
|
| Rate for Payer: BCBS Complete |
$125.96
|
| Rate for Payer: Cash Price |
$251.92
|
| Rate for Payer: Cofinity Advantage |
$220.43
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.92
|
| Rate for Payer: Healthscope Commercial |
$283.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.18
|
| Rate for Payer: PHP Commercial |
$267.67
|
| Rate for Payer: Priority Health SBD |
$198.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.69
|
| Rate for Payer: UHC Core |
$164.06
|
| Rate for Payer: UHC Exchange |
$123.76
|
| Rate for Payer: UMR Bronson Commercial |
$116.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.18
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,716.83
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,635.41 |
| Max. Negotiated Rate |
$3,345.15 |
| Rate for Payer: Aetna American Axle |
$2,415.94
|
| Rate for Payer: Aetna Commercial |
$3,159.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,415.94
|
| Rate for Payer: Cash Price |
$2,973.46
|
| Rate for Payer: Cofinity Advantage |
$2,601.78
|
| Rate for Payer: Cofinity Commercial |
$3,196.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,973.46
|
| Rate for Payer: Healthscope Commercial |
$3,345.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,601.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,787.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,159.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,787.62
|
| Rate for Payer: PHP Commercial |
$3,159.31
|
| Rate for Payer: Priority Health SBD |
$2,341.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,635.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,787.62
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,716.83
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$3,345.15 |
| Rate for Payer: Aetna American Axle |
$2,415.94
|
| Rate for Payer: Aetna Commercial |
$3,159.31
|
| Rate for Payer: Aetna Medicare |
$83.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,415.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.58
|
| Rate for Payer: BCBS Complete |
$44.19
|
| Rate for Payer: BCBS MAPPO |
$80.46
|
| Rate for Payer: BCBS Trust/PPO |
$255.69
|
| Rate for Payer: BCN Commercial |
$255.69
|
| Rate for Payer: BCN Medicare Advantage |
$80.46
|
| Rate for Payer: Cash Price |
$2,973.46
|
| Rate for Payer: Cash Price |
$2,973.46
|
| Rate for Payer: Cofinity Advantage |
$2,601.78
|
| Rate for Payer: Cofinity Commercial |
$3,196.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,973.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.46
|
| Rate for Payer: Healthscope Commercial |
$3,345.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,601.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,787.62
|
| Rate for Payer: Mclaren Medicaid |
$80.46
|
| Rate for Payer: Mclaren Medicare |
$80.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.48
|
| Rate for Payer: Meridian Medicaid |
$84.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,159.31
|
| Rate for Payer: Nomi Health Commercial |
$241.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,787.62
|
| Rate for Payer: PACE Medicare |
$76.44
|
| Rate for Payer: PACE SWMI |
$80.46
|
| Rate for Payer: PHP Commercial |
$3,159.31
|
| Rate for Payer: PHP Medicare Advantage |
$80.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$247.18
|
| Rate for Payer: Priority Health Medicare |
$80.46
|
| Rate for Payer: Priority Health SBD |
$2,341.60
|
| Rate for Payer: Priority Health Tiered Network |
$197.74
|
| Rate for Payer: Railroad Medicare Medicare |
$80.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.56
|
| Rate for Payer: UHC Core |
$132.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.46
|
| Rate for Payer: UHC Exchange |
$132.56
|
| Rate for Payer: UHC Medicaid |
$42.08
|
| Rate for Payer: UHCCP Medicaid |
$42.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,375.23
|
| Rate for Payer: VA VA |
$80.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,787.62
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,433.65
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$6,690.28 |
| Rate for Payer: Aetna American Axle |
$4,831.87
|
| Rate for Payer: Aetna Commercial |
$6,318.60
|
| Rate for Payer: Aetna Medicare |
$83.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,831.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.58
|
| Rate for Payer: BCBS Complete |
$44.19
|
| Rate for Payer: BCBS MAPPO |
$80.46
|
| Rate for Payer: BCBS Trust/PPO |
$255.69
|
| Rate for Payer: BCN Commercial |
$255.69
|
| Rate for Payer: BCN Medicare Advantage |
$80.46
|
| Rate for Payer: Cash Price |
$5,946.92
|
| Rate for Payer: Cash Price |
$5,946.92
|
| Rate for Payer: Cofinity Advantage |
$5,203.56
|
| Rate for Payer: Cofinity Commercial |
$6,392.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,946.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.46
|
| Rate for Payer: Healthscope Commercial |
$6,690.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,203.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,575.24
|
| Rate for Payer: Mclaren Medicaid |
$80.46
|
| Rate for Payer: Mclaren Medicare |
$80.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.48
|
| Rate for Payer: Meridian Medicaid |
$84.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,318.60
|
| Rate for Payer: Nomi Health Commercial |
$241.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,575.24
|
| Rate for Payer: PACE Medicare |
$76.44
|
| Rate for Payer: PACE SWMI |
$80.46
|
| Rate for Payer: PHP Commercial |
$6,318.60
|
| Rate for Payer: PHP Medicare Advantage |
$80.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$247.18
|
| Rate for Payer: Priority Health Medicare |
$80.46
|
| Rate for Payer: Priority Health SBD |
$4,683.20
|
| Rate for Payer: Priority Health Tiered Network |
$197.74
|
| Rate for Payer: Railroad Medicare Medicare |
$80.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.56
|
| Rate for Payer: UHC Core |
$132.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.46
|
| Rate for Payer: UHC Exchange |
$132.56
|
| Rate for Payer: UHC Medicaid |
$42.08
|
| Rate for Payer: UHCCP Medicaid |
$42.08
|
| Rate for Payer: UMR Bronson Commercial |
$2,750.45
|
| Rate for Payer: VA VA |
$80.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,575.24
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,433.65
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,270.81 |
| Max. Negotiated Rate |
$6,690.28 |
| Rate for Payer: Aetna American Axle |
$4,831.87
|
| Rate for Payer: Aetna Commercial |
$6,318.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,831.87
|
| Rate for Payer: Cash Price |
$5,946.92
|
| Rate for Payer: Cofinity Advantage |
$5,203.56
|
| Rate for Payer: Cofinity Commercial |
$6,392.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,946.92
|
| Rate for Payer: Healthscope Commercial |
$6,690.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,203.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,575.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,318.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,575.24
|
| Rate for Payer: PHP Commercial |
$6,318.60
|
| Rate for Payer: Priority Health SBD |
$4,683.20
|
| Rate for Payer: UMR Bronson Commercial |
$3,270.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,575.24
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$805.08
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$291.15
|
| Rate for Payer: BCN Commercial |
$291.15
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
