|
CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CONDUIT
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 50688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,641.42
|
| Rate for Payer: BCN Commercial |
$1,641.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$79.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.25
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,855.91
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$3,855.91 |
| Rate for Payer: Aetna Medicare |
$1,240.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,525.56
|
| Rate for Payer: BCN Commercial |
$2,525.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Mclaren Medicaid |
$1,192.34
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$1,251.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Nomi Health Commercial |
$3,577.02
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,855.91
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health Tiered Network |
$3,084.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
CHEMODENERVATION OF MUSCLE(S); NECK MUSCLE(S), EXCLUDING MUSCLES OF THE LARYNX, UNILATERAL (EG, FOR CERVICAL DYSTONIA, SPASMODIC TORTICOLLIS)
|
Facility
|
OP
|
$989.08
|
|
|
Service Code
|
CPT 64616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$16,654.91
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$15,861.82 |
| Max. Negotiated Rate |
$16,654.91 |
| Rate for Payer: BCBS Complete |
$16,654.91
|
| Rate for Payer: Mclaren Medicaid |
$15,861.82
|
| Rate for Payer: Meridian Medicaid |
$16,654.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,861.82
|
| Rate for Payer: UHC Medicaid |
$15,861.82
|
| Rate for Payer: UHCCP Medicaid |
$15,861.82
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$5,401.31
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$5,144.11 |
| Max. Negotiated Rate |
$5,401.31 |
| Rate for Payer: BCBS Complete |
$5,401.31
|
| Rate for Payer: Mclaren Medicaid |
$5,144.11
|
| Rate for Payer: Meridian Medicaid |
$5,401.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,144.11
|
| Rate for Payer: UHC Medicaid |
$5,144.11
|
| Rate for Payer: UHCCP Medicaid |
$5,144.11
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$6,943.08
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$6,612.45 |
| Max. Negotiated Rate |
$6,943.08 |
| Rate for Payer: BCBS Complete |
$6,943.08
|
| Rate for Payer: Mclaren Medicaid |
$6,612.45
|
| Rate for Payer: Meridian Medicaid |
$6,943.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,612.45
|
| Rate for Payer: UHC Medicaid |
$6,612.45
|
| Rate for Payer: UHCCP Medicaid |
$6,612.45
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$36,537.42
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$34,797.54 |
| Max. Negotiated Rate |
$36,537.42 |
| Rate for Payer: BCBS Complete |
$36,537.42
|
| Rate for Payer: Mclaren Medicaid |
$34,797.54
|
| Rate for Payer: Meridian Medicaid |
$36,537.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$34,797.54
|
| Rate for Payer: UHC Medicaid |
$34,797.54
|
| Rate for Payer: UHCCP Medicaid |
$34,797.54
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$111,113.41
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$38,731.37 |
| Max. Negotiated Rate |
$111,113.41 |
| Rate for Payer: Aetna Medicare |
$42,400.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50,962.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50,962.32
|
| Rate for Payer: BCBS MAPPO |
$40,769.86
|
| Rate for Payer: BCBS Trust/PPO |
$111,113.41
|
| Rate for Payer: BCN Commercial |
$111,113.41
|
| Rate for Payer: BCN Medicare Advantage |
$40,769.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,769.86
|
| Rate for Payer: Mclaren Medicare |
$40,769.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42,808.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,885.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$44,846.85
|
| Rate for Payer: Nomi Health Commercial |
$61,975.47
|
| Rate for Payer: PACE Medicare |
$38,731.37
|
| Rate for Payer: PACE SWMI |
$40,769.86
|
| Rate for Payer: PHP Medicare Advantage |
$40,769.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$77,455.60
|
| Rate for Payer: Priority Health Medicare |
$40,769.86
|
| Rate for Payer: Priority Health Tiered Network |
$61,964.47
|
| Rate for Payer: Railroad Medicare Medicare |
$40,769.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78,310.09
|
| Rate for Payer: UHC Core |
$65,516.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40,769.86
|
| Rate for Payer: UHC Exchange |
$53,505.49
|
| Rate for Payer: VA VA |
$40,769.86
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$49,592.98
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$17,146.81 |
| Max. Negotiated Rate |
$49,592.98 |
| Rate for Payer: Aetna Medicare |
$18,771.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,561.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,561.59
|
| Rate for Payer: BCBS MAPPO |
$18,049.27
|
| Rate for Payer: BCBS Trust/PPO |
$49,592.98
|
| Rate for Payer: BCN Commercial |
$49,592.98
|
| Rate for Payer: BCN Medicare Advantage |
$18,049.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,049.27
|
| Rate for Payer: Mclaren Medicare |
$18,049.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,951.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,756.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,854.20
|
| Rate for Payer: Nomi Health Commercial |
$26,927.46
|
| Rate for Payer: PACE Medicare |
$17,146.81
|
| Rate for Payer: PACE SWMI |
$18,049.27
|
| Rate for Payer: PHP Medicare Advantage |
$18,049.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,653.36
|
| Rate for Payer: Priority Health Medicare |
$18,049.27
|
| Rate for Payer: Priority Health Tiered Network |
$26,922.68
|
| Rate for Payer: Railroad Medicare Medicare |
$18,049.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,024.62
|
| Rate for Payer: UHC Core |
$28,465.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,049.27
|
| Rate for Payer: UHC Exchange |
$23,247.37
|
| Rate for Payer: VA VA |
$18,049.27
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$24,651.00
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$12,034.47 |
| Max. Negotiated Rate |
$24,651.00 |
| Rate for Payer: Aetna Medicare |
$13,174.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,834.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,834.83
|
| Rate for Payer: BCBS MAPPO |
$12,667.86
|
| Rate for Payer: BCBS Trust/PPO |
$24,651.00
|
| Rate for Payer: BCN Commercial |
$24,651.00
|
| Rate for Payer: BCN Medicare Advantage |
$12,667.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,667.86
|
| Rate for Payer: Mclaren Medicare |
$12,667.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,301.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,568.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,934.65
|
| Rate for Payer: Nomi Health Commercial |
$18,626.31
|
| Rate for Payer: PACE Medicare |
$12,034.47
|
| Rate for Payer: PACE SWMI |
$12,667.86
|
| Rate for Payer: PHP Medicare Advantage |
$12,667.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,278.76
|
| Rate for Payer: Priority Health Medicare |
$12,667.86
|
| Rate for Payer: Priority Health Tiered Network |
$18,623.00
|
| Rate for Payer: Railroad Medicare Medicare |
$12,667.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,535.57
|
| Rate for Payer: UHC Core |
$19,690.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,667.86
|
| Rate for Payer: UHC Exchange |
$16,080.71
|
| Rate for Payer: VA VA |
$12,667.86
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$25,784.72
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$10,956.39 |
| Max. Negotiated Rate |
$25,784.72 |
| Rate for Payer: Aetna Medicare |
$11,994.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,416.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,416.30
|
| Rate for Payer: BCBS MAPPO |
$11,533.04
|
| Rate for Payer: BCBS Trust/PPO |
$25,784.72
|
| Rate for Payer: BCN Commercial |
$25,784.72
|
| Rate for Payer: BCN Medicare Advantage |
$11,533.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,533.04
|
| Rate for Payer: Mclaren Medicare |
$11,533.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,109.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,263.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,686.34
|
| Rate for Payer: Nomi Health Commercial |
$16,875.78
|
| Rate for Payer: PACE Medicare |
$10,956.39
|
| Rate for Payer: PACE SWMI |
$11,533.04
|
| Rate for Payer: PHP Medicare Advantage |
$11,533.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,090.98
|
| Rate for Payer: Priority Health Medicare |
$11,533.04
|
| Rate for Payer: Priority Health Tiered Network |
$16,872.78
|
| Rate for Payer: Railroad Medicare Medicare |
$11,533.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,323.66
|
| Rate for Payer: UHC Core |
$17,839.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,533.04
|
| Rate for Payer: UHC Exchange |
$14,569.42
|
| Rate for Payer: VA VA |
$11,533.04
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$48,511.41
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$21,159.59 |
| Max. Negotiated Rate |
$48,511.41 |
| Rate for Payer: Aetna Medicare |
$23,164.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,841.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,841.56
|
| Rate for Payer: BCBS MAPPO |
$22,273.25
|
| Rate for Payer: BCBS Trust/PPO |
$48,511.41
|
| Rate for Payer: BCN Commercial |
$48,511.41
|
| Rate for Payer: BCN Medicare Advantage |
$22,273.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,273.25
|
| Rate for Payer: Mclaren Medicare |
$22,273.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,386.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,614.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,500.58
|
| Rate for Payer: Nomi Health Commercial |
$33,443.25
|
| Rate for Payer: PACE Medicare |
$21,159.59
|
| Rate for Payer: PACE SWMI |
$22,273.25
|
| Rate for Payer: PHP Medicare Advantage |
$22,273.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,796.65
|
| Rate for Payer: Priority Health Medicare |
$22,273.25
|
| Rate for Payer: Priority Health Tiered Network |
$33,437.31
|
| Rate for Payer: Railroad Medicare Medicare |
$22,273.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,257.75
|
| Rate for Payer: UHC Core |
$35,353.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,273.25
|
| Rate for Payer: UHC Exchange |
$28,872.67
|
| Rate for Payer: VA VA |
$22,273.25
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,749.42
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$7,311.43 |
| Max. Negotiated Rate |
$14,749.42 |
| Rate for Payer: Aetna Medicare |
$8,004.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,620.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,620.30
|
| Rate for Payer: BCBS MAPPO |
$7,696.24
|
| Rate for Payer: BCBS Trust/PPO |
$14,749.42
|
| Rate for Payer: BCN Commercial |
$14,749.42
|
| Rate for Payer: BCN Medicare Advantage |
$7,696.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,696.24
|
| Rate for Payer: Mclaren Medicare |
$7,696.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,081.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,850.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,465.86
|
| Rate for Payer: Nomi Health Commercial |
$10,957.26
|
| Rate for Payer: PACE Medicare |
$7,311.43
|
| Rate for Payer: PACE SWMI |
$7,696.24
|
| Rate for Payer: PHP Medicare Advantage |
$7,696.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,694.15
|
| Rate for Payer: Priority Health Medicare |
$7,696.24
|
| Rate for Payer: Priority Health Tiered Network |
$10,955.31
|
| Rate for Payer: Railroad Medicare Medicare |
$7,696.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,845.22
|
| Rate for Payer: UHC Core |
$11,583.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,696.24
|
| Rate for Payer: UHC Exchange |
$9,459.77
|
| Rate for Payer: VA VA |
$7,696.24
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
OP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.71 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna American Axle |
$99.62
|
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna Medicare |
$76.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: BCBS Complete |
$61.30
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Advantage |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.94
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health SBD |
$96.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.62
|
| Rate for Payer: UHC Core |
$79.85
|
| Rate for Payer: UHC Exchange |
$60.23
|
| Rate for Payer: UMR Bronson Commercial |
$56.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.94
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
IP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna American Axle |
$99.62
|
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Advantage |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.94
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health SBD |
$96.55
|
| Rate for Payer: UMR Bronson Commercial |
$67.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.94
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$4,504.22
|
|
|
Service Code
|
APR-DRG 2031
|
| Min. Negotiated Rate |
$4,289.74 |
| Max. Negotiated Rate |
$4,504.22 |
| Rate for Payer: BCBS Complete |
$4,504.22
|
| Rate for Payer: Mclaren Medicaid |
$4,289.74
|
| Rate for Payer: Meridian Medicaid |
$4,504.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,289.74
|
| Rate for Payer: UHC Medicaid |
$4,289.74
|
| Rate for Payer: UHCCP Medicaid |
$4,289.74
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$16,163.15
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$6,283.41 |
| Max. Negotiated Rate |
$16,163.15 |
| Rate for Payer: Aetna Medicare |
$6,878.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,267.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,267.65
|
| Rate for Payer: BCBS MAPPO |
$6,614.12
|
| Rate for Payer: BCBS Trust/PPO |
$16,163.15
|
| Rate for Payer: BCN Commercial |
$16,163.15
|
| Rate for Payer: BCN Medicare Advantage |
$6,614.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,614.12
|
| Rate for Payer: Mclaren Medicare |
$6,614.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,944.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,606.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,275.53
|
| Rate for Payer: Nomi Health Commercial |
$9,288.00
|
| Rate for Payer: PACE Medicare |
$6,283.41
|
| Rate for Payer: PACE SWMI |
$6,614.12
|
| Rate for Payer: PHP Medicare Advantage |
$6,614.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,607.94
|
| Rate for Payer: Priority Health Medicare |
$6,614.12
|
| Rate for Payer: Priority Health Tiered Network |
$9,286.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,614.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,736.00
|
| Rate for Payer: UHC Core |
$9,818.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,614.12
|
| Rate for Payer: UHC Exchange |
$8,018.64
|
| Rate for Payer: VA VA |
$6,614.12
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$5,674.32
|
|
|
Service Code
|
APR-DRG 2033
|
| Min. Negotiated Rate |
$5,404.11 |
| Max. Negotiated Rate |
$5,674.32 |
| Rate for Payer: BCBS Complete |
$5,674.32
|
| Rate for Payer: Mclaren Medicaid |
$5,404.11
|
| Rate for Payer: Meridian Medicaid |
$5,674.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,404.11
|
| Rate for Payer: UHC Medicaid |
$5,404.11
|
| Rate for Payer: UHCCP Medicaid |
$5,404.11
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$9,333.51
|
|
|
Service Code
|
APR-DRG 2034
|
| Min. Negotiated Rate |
$8,889.05 |
| Max. Negotiated Rate |
$9,333.51 |
| Rate for Payer: BCBS Complete |
$9,333.51
|
| Rate for Payer: Mclaren Medicaid |
$8,889.05
|
| Rate for Payer: Meridian Medicaid |
$9,333.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,889.05
|
| Rate for Payer: UHC Medicaid |
$8,889.05
|
| Rate for Payer: UHCCP Medicaid |
$8,889.05
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$5,058.10
|
|
|
Service Code
|
APR-DRG 2032
|
| Min. Negotiated Rate |
$4,817.23 |
| Max. Negotiated Rate |
$5,058.10 |
| Rate for Payer: BCBS Complete |
$5,058.10
|
| Rate for Payer: Mclaren Medicaid |
$4,817.23
|
| Rate for Payer: Meridian Medicaid |
$5,058.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,817.23
|
| Rate for Payer: UHC Medicaid |
$4,817.23
|
| Rate for Payer: UHCCP Medicaid |
$4,817.23
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$457.04 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$612.43
|
| Rate for Payer: Aetna Commercial |
$612.43
|
| Rate for Payer: Aetna Medicare |
$475.32
|
| Rate for Payer: Aetna Medicare |
$475.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.43
|
| Rate for Payer: BCBS MAPPO |
$457.04
|
| Rate for Payer: BCBS MAPPO |
$457.04
|
| Rate for Payer: BCN Commercial |
$707.55
|
| Rate for Payer: BCN Commercial |
$707.55
|
| Rate for Payer: BCN Medicare Advantage |
$457.04
|
| Rate for Payer: BCN Medicare Advantage |
$457.04
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cofinity Commercial |
$658.14
|
| Rate for Payer: Cofinity Commercial |
$658.14
|
| Rate for Payer: Cofinity Commercial |
$612.43
|
| Rate for Payer: Cofinity Commercial |
$612.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$479.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$479.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$502.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$502.74
|
| Rate for Payer: Nomi Health Commercial |
$548.45
|
| Rate for Payer: Nomi Health Commercial |
$548.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,060.50
|
| Rate for Payer: PACE SWMI |
$457.04
|
| Rate for Payer: PACE SWMI |
$457.04
|
| Rate for Payer: PHP Commercial |
$639.86
|
| Rate for Payer: PHP Commercial |
$639.86
|
| Rate for Payer: PHP Medicare Advantage |
$457.04
|
| Rate for Payer: PHP Medicare Advantage |
$457.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$732.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$732.03
|
| Rate for Payer: Priority Health Medicare |
$457.04
|
| Rate for Payer: Priority Health Medicare |
$457.04
|
| Rate for Payer: Priority Health SBD |
$732.03
|
| Rate for Payer: Priority Health SBD |
$732.03
|
| Rate for Payer: Priority Health Tiered Network |
$732.03
|
| Rate for Payer: Priority Health Tiered Network |
$732.03
|
| Rate for Payer: Railroad Medicare Medicare |
$457.04
|
| Rate for Payer: Railroad Medicare Medicare |
$457.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.09
|
| Rate for Payer: UHC Core |
$699.09
|
| Rate for Payer: UHC Core |
$699.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$457.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$457.04
|
| Rate for Payer: UHC Exchange |
$699.09
|
| Rate for Payer: UHC Exchange |
$699.09
|
| Rate for Payer: UMR Bronson Commercial |
$650.44
|
| Rate for Payer: UMR Bronson Commercial |
$828.00
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$64.86 |
| Max. Negotiated Rate |
$119.40 |
| Rate for Payer: Aetna Commercial |
$100.11
|
| Rate for Payer: Aetna Medicare |
$77.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: BCBS MAPPO |
$74.71
|
| Rate for Payer: BCN Commercial |
$118.52
|
| Rate for Payer: BCN Medicare Advantage |
$74.71
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$107.58
|
| Rate for Payer: Cofinity Commercial |
$100.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.18
|
| Rate for Payer: Nomi Health Commercial |
$89.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PACE SWMI |
$74.71
|
| Rate for Payer: PHP Commercial |
$104.59
|
| Rate for Payer: PHP Medicare Advantage |
$74.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$119.40
|
| Rate for Payer: Priority Health Medicare |
$74.71
|
| Rate for Payer: Priority Health SBD |
$119.40
|
| Rate for Payer: Priority Health Tiered Network |
$119.40
|
| Rate for Payer: Railroad Medicare Medicare |
$74.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.69
|
| Rate for Payer: UHC Core |
$103.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.71
|
| Rate for Payer: UHC Exchange |
$103.69
|
| Rate for Payer: UMR Bronson Commercial |
$64.86
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna Medicare |
$24.86
|
| Rate for Payer: Aetna Medicare |
$24.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.03
|
| Rate for Payer: BCBS MAPPO |
$23.90
|
| Rate for Payer: BCBS MAPPO |
$23.90
|
| Rate for Payer: BCN Commercial |
$38.34
|
| Rate for Payer: BCN Commercial |
$38.34
|
| Rate for Payer: BCN Medicare Advantage |
$23.90
|
| Rate for Payer: BCN Medicare Advantage |
$23.90
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Cofinity Commercial |
$34.42
|
| Rate for Payer: Cofinity Commercial |
$34.42
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.29
|
| Rate for Payer: Nomi Health Commercial |
$28.68
|
| Rate for Payer: Nomi Health Commercial |
$28.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: PACE SWMI |
$23.90
|
| Rate for Payer: PACE SWMI |
$23.90
|
| Rate for Payer: PHP Commercial |
$33.46
|
| Rate for Payer: PHP Commercial |
$33.46
|
| Rate for Payer: PHP Medicare Advantage |
$23.90
|
| Rate for Payer: PHP Medicare Advantage |
$23.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.64
|
| Rate for Payer: Priority Health Medicare |
$23.90
|
| Rate for Payer: Priority Health Medicare |
$23.90
|
| Rate for Payer: Priority Health SBD |
$38.64
|
| Rate for Payer: Priority Health SBD |
$38.64
|
| Rate for Payer: Priority Health Tiered Network |
$38.64
|
| Rate for Payer: Priority Health Tiered Network |
$38.64
|
| Rate for Payer: Railroad Medicare Medicare |
$23.90
|
| Rate for Payer: Railroad Medicare Medicare |
$23.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.97
|
| Rate for Payer: UHC Core |
$32.97
|
| Rate for Payer: UHC Core |
$32.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.90
|
| Rate for Payer: UHC Exchange |
$32.97
|
| Rate for Payer: UHC Exchange |
$32.97
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$282.57 |
| Max. Negotiated Rate |
$530.25 |
| Rate for Payer: Aetna Commercial |
$378.64
|
| Rate for Payer: Aetna Medicare |
$293.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.90
|
| Rate for Payer: BCBS MAPPO |
$282.57
|
| Rate for Payer: BCN Commercial |
$466.61
|
| Rate for Payer: BCN Medicare Advantage |
$282.57
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$378.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$310.83
|
| Rate for Payer: Nomi Health Commercial |
$339.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.25
|
| Rate for Payer: PACE SWMI |
$282.57
|
| Rate for Payer: PHP Commercial |
$395.60
|
| Rate for Payer: PHP Medicare Advantage |
$282.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$470.13
|
| Rate for Payer: Priority Health Medicare |
$282.57
|
| Rate for Payer: Priority Health SBD |
$470.13
|
| Rate for Payer: Priority Health Tiered Network |
$470.13
|
| Rate for Payer: Railroad Medicare Medicare |
$282.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.20
|
| Rate for Payer: UHC Core |
$495.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$282.57
|
| Rate for Payer: UHC Exchange |
$495.20
|
| Rate for Payer: UMR Bronson Commercial |
$325.22
|
|
