|
REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT, SKULL; WITH PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 69717
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$12,516.24
|
| Rate for Payer: BCN Commercial |
$12,516.24
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
REPLACEMENT OF GASTRO-JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDING CONTRAST INJECTION(S), IMAGE DOCUMENTATION AND REPORT
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 49452
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.57
|
| Rate for Payer: BCN Commercial |
$1,118.57
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
REPLACEMENT OF GASTROSTOMY OR CECOSTOMY (OR OTHER COLONIC) TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDING CONTRAST INJECTION(S), IMAGE DOCUMENTATION AND REPORT
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 49450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,224.45
|
| Rate for Payer: BCN Commercial |
$1,224.45
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE; NOT REQUIRING REVISION OF GASTROSTOMY TRACT
|
Facility
|
OP
|
$805.08
|
|
|
Service Code
|
CPT 43762
|
|
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 |
$525.86
|
| Rate for Payer: BCN Commercial |
$525.86
|
| 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
|
|
|
REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE; NOT REQUIRING REVISION OF GASTROSTOMY TRACT
|
Facility
|
OP
|
$805.08
|
|
|
Service Code
|
CPT 43762
|
|
Hospital Revenue Code
|
361
|
| 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 |
$525.86
|
| Rate for Payer: BCN Commercial |
$525.86
|
| 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
|
|
|
REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT IMPLANT
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 11970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$7,484.83
|
| Rate for Payer: BCN Commercial |
$7,484.83
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
REPLACEMENT OR REVISION OF CEREBROSPINAL FLUID SHUNT, OBSTRUCTED VALVE, OR DISTAL CATHETER IN SHUNT SYSTEM
|
Facility
|
OP
|
$28,278.25
|
|
|
Service Code
|
CPT 62230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,141.73 |
| Max. Negotiated Rate |
$28,278.25 |
| Rate for Payer: Aetna Medicare |
$9,094.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,930.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,930.36
|
| Rate for Payer: BCBS Complete |
$4,802.36
|
| Rate for Payer: BCBS MAPPO |
$8,744.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,141.73
|
| Rate for Payer: BCN Commercial |
$4,141.73
|
| Rate for Payer: BCN Medicare Advantage |
$8,744.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,744.29
|
| Rate for Payer: Mclaren Medicaid |
$8,744.29
|
| Rate for Payer: Mclaren Medicare |
$8,744.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,181.50
|
| Rate for Payer: Meridian Medicaid |
$9,181.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,055.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,618.72
|
| Rate for Payer: Nomi Health Commercial |
$26,232.87
|
| Rate for Payer: PACE Medicare |
$8,307.08
|
| Rate for Payer: PACE SWMI |
$8,744.29
|
| Rate for Payer: PHP Medicare Advantage |
$8,744.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,573.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,278.25
|
| Rate for Payer: Priority Health Medicare |
$8,744.29
|
| Rate for Payer: Priority Health Tiered Network |
$22,622.60
|
| Rate for Payer: Railroad Medicare Medicare |
$8,744.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,744.29
|
| Rate for Payer: UHC Medicaid |
$4,573.26
|
| Rate for Payer: UHCCP Medicaid |
$4,573.26
|
| Rate for Payer: VA VA |
$8,744.29
|
|
|
RESLIZUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,635.20
|
|
|
Service Code
|
HCPCS J2786
|
| Hospital Charge Code |
178451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$3,271.68 |
| Rate for Payer: Aetna American Axle |
$2,362.88
|
| Rate for Payer: Aetna Commercial |
$3,089.92
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,362.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$36.09
|
| Rate for Payer: BCN Commercial |
$36.09
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$2,908.16
|
| Rate for Payer: Cash Price |
$2,908.16
|
| Rate for Payer: Cofinity Advantage |
$2,544.64
|
| Rate for Payer: Cofinity Commercial |
$3,126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,908.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$3,271.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,544.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,726.40
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,089.92
|
| Rate for Payer: Nomi Health Commercial |
$34.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,726.40
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$3,089.92
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.54
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$2,290.18
|
| Rate for Payer: Priority Health Tiered Network |
$27.63
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.36
|
| Rate for Payer: UHC Core |
$18.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$18.36
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,345.02
|
| Rate for Payer: VA VA |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,726.40
|
|
|
RESLIZUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,635.20
|
|
|
Service Code
|
HCPCS J2786
|
| Hospital Charge Code |
178451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,599.49 |
| Max. Negotiated Rate |
$3,271.68 |
| Rate for Payer: Aetna American Axle |
$2,362.88
|
| Rate for Payer: Aetna Commercial |
$3,089.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,362.88
|
| Rate for Payer: Cash Price |
$2,908.16
|
| Rate for Payer: Cofinity Advantage |
$2,544.64
|
| Rate for Payer: Cofinity Commercial |
$3,126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,908.16
|
| Rate for Payer: Healthscope Commercial |
$3,271.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,544.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,726.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,089.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,726.40
|
| Rate for Payer: PHP Commercial |
$3,089.92
|
| Rate for Payer: Priority Health SBD |
$2,290.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,599.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,726.40
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 43900035980
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna American Axle |
$2.58
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.58
|
| Rate for Payer: UHC Core |
$2.07
|
| Rate for Payer: UHC Exchange |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.98
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 43900035980
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna American Axle |
$2.58
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
| Rate for Payer: UMR Bronson Commercial |
$1.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.98
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$5,322.02
|
|
|
Service Code
|
APR-DRG 1332
|
| Min. Negotiated Rate |
$5,068.59 |
| Max. Negotiated Rate |
$5,322.02 |
| Rate for Payer: BCBS Complete |
$5,322.02
|
| Rate for Payer: Mclaren Medicaid |
$5,068.59
|
| Rate for Payer: Meridian Medicaid |
$5,322.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,068.59
|
| Rate for Payer: UHC Medicaid |
$5,068.59
|
| Rate for Payer: UHCCP Medicaid |
$5,068.59
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$8,193.68
|
|
|
Service Code
|
APR-DRG 1333
|
| Min. Negotiated Rate |
$7,803.50 |
| Max. Negotiated Rate |
$8,193.68 |
| Rate for Payer: BCBS Complete |
$8,193.68
|
| Rate for Payer: Mclaren Medicaid |
$7,803.50
|
| Rate for Payer: Meridian Medicaid |
$8,193.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,803.50
|
| Rate for Payer: UHC Medicaid |
$7,803.50
|
| Rate for Payer: UHCCP Medicaid |
$7,803.50
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$13,128.29
|
|
|
Service Code
|
APR-DRG 1334
|
| Min. Negotiated Rate |
$12,503.13 |
| Max. Negotiated Rate |
$13,128.29 |
| Rate for Payer: BCBS Complete |
$13,128.29
|
| Rate for Payer: Mclaren Medicaid |
$12,503.13
|
| Rate for Payer: Meridian Medicaid |
$13,128.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,503.13
|
| Rate for Payer: UHC Medicaid |
$12,503.13
|
| Rate for Payer: UHCCP Medicaid |
$12,503.13
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$3,879.53
|
|
|
Service Code
|
APR-DRG 1331
|
| Min. Negotiated Rate |
$3,694.79 |
| Max. Negotiated Rate |
$3,879.53 |
| Rate for Payer: BCBS Complete |
$3,879.53
|
| Rate for Payer: Mclaren Medicaid |
$3,694.79
|
| Rate for Payer: Meridian Medicaid |
$3,879.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,694.79
|
| Rate for Payer: UHC Medicaid |
$3,694.79
|
| Rate for Payer: UHCCP Medicaid |
$3,694.79
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
|
IP
|
$20,824.33
|
|
|
Service Code
|
MSDRG 178
|
| Min. Negotiated Rate |
$8,317.21 |
| Max. Negotiated Rate |
$20,824.33 |
| Rate for Payer: Aetna Medicare |
$9,105.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,943.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,943.70
|
| Rate for Payer: BCBS MAPPO |
$8,754.96
|
| Rate for Payer: BCBS Trust/PPO |
$20,824.33
|
| Rate for Payer: BCN Commercial |
$20,824.33
|
| Rate for Payer: BCN Medicare Advantage |
$8,754.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,754.96
|
| Rate for Payer: Mclaren Medicare |
$8,754.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,192.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,068.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,630.46
|
| Rate for Payer: Nomi Health Commercial |
$12,590.40
|
| Rate for Payer: PACE Medicare |
$8,317.21
|
| Rate for Payer: PACE SWMI |
$8,754.96
|
| Rate for Payer: PHP Medicare Advantage |
$8,754.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,735.21
|
| Rate for Payer: Priority Health Medicare |
$8,754.96
|
| Rate for Payer: Priority Health Tiered Network |
$12,588.16
|
| Rate for Payer: Railroad Medicare Medicare |
$8,754.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,908.80
|
| Rate for Payer: UHC Core |
$13,309.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,754.96
|
| Rate for Payer: UHC Exchange |
$10,869.71
|
| Rate for Payer: VA VA |
$8,754.96
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC
|
Facility
|
IP
|
$27,327.47
|
|
|
Service Code
|
MSDRG 177
|
| Min. Negotiated Rate |
$12,978.28 |
| Max. Negotiated Rate |
$27,327.47 |
| Rate for Payer: Aetna Medicare |
$14,207.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,076.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,076.69
|
| Rate for Payer: BCBS MAPPO |
$13,661.35
|
| Rate for Payer: BCBS Trust/PPO |
$27,327.47
|
| Rate for Payer: BCN Commercial |
$27,327.47
|
| Rate for Payer: BCN Medicare Advantage |
$13,661.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,661.35
|
| Rate for Payer: Mclaren Medicare |
$13,661.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,344.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,710.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,027.49
|
| Rate for Payer: Nomi Health Commercial |
$20,158.83
|
| Rate for Payer: PACE Medicare |
$12,978.28
|
| Rate for Payer: PACE SWMI |
$13,661.35
|
| Rate for Payer: PHP Medicare Advantage |
$13,661.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,194.07
|
| Rate for Payer: Priority Health Medicare |
$13,661.35
|
| Rate for Payer: Priority Health Tiered Network |
$20,155.25
|
| Rate for Payer: Railroad Medicare Medicare |
$13,661.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,472.01
|
| Rate for Payer: UHC Core |
$21,310.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,661.35
|
| Rate for Payer: UHC Exchange |
$17,403.79
|
| Rate for Payer: VA VA |
$13,661.35
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,234.52
|
|
|
Service Code
|
MSDRG 179
|
| Min. Negotiated Rate |
$6,561.46 |
| Max. Negotiated Rate |
$16,234.52 |
| Rate for Payer: Aetna Medicare |
$7,183.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,633.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,633.50
|
| Rate for Payer: BCBS MAPPO |
$6,906.80
|
| Rate for Payer: BCBS Trust/PPO |
$16,234.52
|
| Rate for Payer: BCN Commercial |
$16,234.52
|
| Rate for Payer: BCN Medicare Advantage |
$6,906.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,906.80
|
| Rate for Payer: Mclaren Medicare |
$6,906.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,252.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,942.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,597.48
|
| Rate for Payer: Nomi Health Commercial |
$9,739.50
|
| Rate for Payer: PACE Medicare |
$6,561.46
|
| Rate for Payer: PACE SWMI |
$6,906.80
|
| Rate for Payer: PHP Medicare Advantage |
$6,906.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,172.22
|
| Rate for Payer: Priority Health Medicare |
$6,906.80
|
| Rate for Payer: Priority Health Tiered Network |
$9,737.77
|
| Rate for Payer: Railroad Medicare Medicare |
$6,906.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,306.50
|
| Rate for Payer: UHC Core |
$10,295.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,906.80
|
| Rate for Payer: UHC Exchange |
$8,408.43
|
| Rate for Payer: VA VA |
$6,906.80
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
|
IP
|
$6,454.58
|
|
|
Service Code
|
APR-DRG 1361
|
| Min. Negotiated Rate |
$6,147.22 |
| Max. Negotiated Rate |
$6,454.58 |
| Rate for Payer: BCBS Complete |
$6,454.58
|
| Rate for Payer: Mclaren Medicaid |
$6,147.22
|
| Rate for Payer: Meridian Medicaid |
$6,454.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,147.22
|
| Rate for Payer: UHC Medicaid |
$6,147.22
|
| Rate for Payer: UHCCP Medicaid |
$6,147.22
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
|
IP
|
$13,272.96
|
|
|
Service Code
|
APR-DRG 1364
|
| Min. Negotiated Rate |
$12,640.92 |
| Max. Negotiated Rate |
$13,272.96 |
| Rate for Payer: BCBS Complete |
$13,272.96
|
| Rate for Payer: Mclaren Medicaid |
$12,640.92
|
| Rate for Payer: Meridian Medicaid |
$13,272.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,640.92
|
| Rate for Payer: UHC Medicaid |
$12,640.92
|
| Rate for Payer: UHCCP Medicaid |
$12,640.92
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
|
IP
|
$8,677.33
|
|
|
Service Code
|
APR-DRG 1363
|
| Min. Negotiated Rate |
$8,264.13 |
| Max. Negotiated Rate |
$8,677.33 |
| Rate for Payer: BCBS Complete |
$8,677.33
|
| Rate for Payer: Mclaren Medicaid |
$8,264.13
|
| Rate for Payer: Meridian Medicaid |
$8,677.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,264.13
|
| Rate for Payer: UHC Medicaid |
$8,264.13
|
| Rate for Payer: UHCCP Medicaid |
$8,264.13
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
|
IP
|
$7,025.40
|
|
|
Service Code
|
APR-DRG 1362
|
| Min. Negotiated Rate |
$6,690.86 |
| Max. Negotiated Rate |
$7,025.40 |
| Rate for Payer: BCBS Complete |
$7,025.40
|
| Rate for Payer: Mclaren Medicaid |
$6,690.86
|
| Rate for Payer: Meridian Medicaid |
$7,025.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.86
|
| Rate for Payer: UHC Medicaid |
$6,690.86
|
| Rate for Payer: UHCCP Medicaid |
$6,690.86
|
|
|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$22,361.58
|
|
|
Service Code
|
MSDRG 181
|
| Min. Negotiated Rate |
$9,071.95 |
| Max. Negotiated Rate |
$22,361.58 |
| Rate for Payer: Aetna Medicare |
$9,931.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,936.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,936.77
|
| Rate for Payer: BCBS MAPPO |
$9,549.42
|
| Rate for Payer: BCBS Trust/PPO |
$22,361.58
|
| Rate for Payer: BCN Commercial |
$22,361.58
|
| Rate for Payer: BCN Medicare Advantage |
$9,549.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,549.42
|
| Rate for Payer: Mclaren Medicare |
$9,549.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,026.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,981.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,504.36
|
| Rate for Payer: Nomi Health Commercial |
$13,815.90
|
| Rate for Payer: PACE Medicare |
$9,071.95
|
| Rate for Payer: PACE SWMI |
$9,549.42
|
| Rate for Payer: PHP Medicare Advantage |
$9,549.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,266.81
|
| Rate for Payer: Priority Health Medicare |
$9,549.42
|
| Rate for Payer: Priority Health Tiered Network |
$13,813.45
|
| Rate for Payer: Railroad Medicare Medicare |
$9,549.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,457.30
|
| Rate for Payer: UHC Core |
$14,605.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,549.42
|
| Rate for Payer: UHC Exchange |
$11,927.73
|
| Rate for Payer: VA VA |
$9,549.42
|
|
|
RESPIRATORY NEOPLASMS WITH MCC
|
Facility
|
IP
|
$35,938.85
|
|
|
Service Code
|
MSDRG 180
|
| Min. Negotiated Rate |
$14,593.42 |
| Max. Negotiated Rate |
$35,938.85 |
| Rate for Payer: Aetna Medicare |
$15,975.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,201.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,201.86
|
| Rate for Payer: BCBS MAPPO |
$15,361.49
|
| Rate for Payer: BCBS Trust/PPO |
$35,938.85
|
| Rate for Payer: BCN Commercial |
$35,938.85
|
| Rate for Payer: BCN Medicare Advantage |
$15,361.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,361.49
|
| Rate for Payer: Mclaren Medicare |
$15,361.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,129.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,665.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,897.64
|
| Rate for Payer: Nomi Health Commercial |
$22,781.40
|
| Rate for Payer: PACE Medicare |
$14,593.42
|
| Rate for Payer: PACE SWMI |
$15,361.49
|
| Rate for Payer: PHP Medicare Advantage |
$15,361.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,471.70
|
| Rate for Payer: Priority Health Medicare |
$15,361.49
|
| Rate for Payer: Priority Health Tiered Network |
$22,777.36
|
| Rate for Payer: Railroad Medicare Medicare |
$15,361.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,785.80
|
| Rate for Payer: UHC Core |
$24,082.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,361.49
|
| Rate for Payer: UHC Exchange |
$19,667.94
|
| Rate for Payer: VA VA |
$15,361.49
|
|
|
RESPIRATORY NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,152.87
|
|
|
Service Code
|
MSDRG 182
|
| Min. Negotiated Rate |
$6,551.93 |
| Max. Negotiated Rate |
$12,152.87 |
| Rate for Payer: Aetna Medicare |
$7,172.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,620.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,620.96
|
| Rate for Payer: BCBS MAPPO |
$6,896.77
|
| Rate for Payer: BCBS Trust/PPO |
$11,005.11
|
| Rate for Payer: BCN Commercial |
$11,005.11
|
| Rate for Payer: BCN Medicare Advantage |
$6,896.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,896.77
|
| Rate for Payer: Mclaren Medicare |
$6,896.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,241.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,931.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,586.45
|
| Rate for Payer: Nomi Health Commercial |
$9,597.60
|
| Rate for Payer: PACE Medicare |
$6,551.93
|
| Rate for Payer: PACE SWMI |
$6,896.77
|
| Rate for Payer: PHP Medicare Advantage |
$6,896.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,152.87
|
| Rate for Payer: Priority Health Medicare |
$6,896.77
|
| Rate for Payer: Priority Health Tiered Network |
$9,722.29
|
| Rate for Payer: Railroad Medicare Medicare |
$6,896.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,127.20
|
| Rate for Payer: UHC Core |
$10,145.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,896.77
|
| Rate for Payer: UHC Exchange |
$8,285.93
|
| Rate for Payer: VA VA |
$6,896.77
|
|
