|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
|
IP
|
$161,716.59
|
|
|
Service Code
|
MSDRG 019
|
| Min. Negotiated Rate |
$57,244.57 |
| Max. Negotiated Rate |
$161,716.59 |
| Rate for Payer: Aetna Medicare |
$62,667.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75,321.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75,321.80
|
| Rate for Payer: BCBS MAPPO |
$60,257.44
|
| Rate for Payer: BCBS Trust/PPO |
$161,716.59
|
| Rate for Payer: BCN Commercial |
$161,716.59
|
| Rate for Payer: BCN Medicare Advantage |
$60,257.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60,257.44
|
| Rate for Payer: Mclaren Medicare |
$60,257.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63,270.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69,296.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$66,283.18
|
| Rate for Payer: Nomi Health Commercial |
$85,490.88
|
| Rate for Payer: PACE Medicare |
$57,244.57
|
| Rate for Payer: PACE SWMI |
$60,257.44
|
| Rate for Payer: PHP Medicare Advantage |
$60,257.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115,025.02
|
| Rate for Payer: Priority Health Medicare |
$60,257.44
|
| Rate for Payer: Priority Health Tiered Network |
$92,020.00
|
| Rate for Payer: Railroad Medicare Medicare |
$60,257.44
|
| Rate for Payer: VA VA |
$60,257.44
|
|
|
SIMVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$230.54
|
|
|
Service Code
|
NDC 68180047802
|
| Hospital Charge Code |
11364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.30 |
| Max. Negotiated Rate |
$207.49 |
| Rate for Payer: Aetna American Axle |
$149.85
|
| Rate for Payer: Aetna Commercial |
$195.96
|
| Rate for Payer: Aetna Medicare |
$115.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.85
|
| Rate for Payer: BCBS Complete |
$92.22
|
| Rate for Payer: Cash Price |
$184.43
|
| Rate for Payer: Cofinity Advantage |
$161.38
|
| Rate for Payer: Cofinity Commercial |
$198.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.43
|
| Rate for Payer: Healthscope Commercial |
$207.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.91
|
| Rate for Payer: PHP Commercial |
$195.96
|
| Rate for Payer: Priority Health SBD |
$145.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.85
|
| Rate for Payer: UHC Core |
$120.11
|
| Rate for Payer: UHC Exchange |
$90.60
|
| Rate for Payer: UMR Bronson Commercial |
$85.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.91
|
|
|
SIMVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$230.54
|
|
|
Service Code
|
NDC 68180047802
|
| Hospital Charge Code |
11364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$207.49 |
| Rate for Payer: Aetna American Axle |
$149.85
|
| Rate for Payer: Aetna Commercial |
$195.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.85
|
| Rate for Payer: Cash Price |
$184.43
|
| Rate for Payer: Cofinity Advantage |
$161.38
|
| Rate for Payer: Cofinity Commercial |
$198.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.43
|
| Rate for Payer: Healthscope Commercial |
$207.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.91
|
| Rate for Payer: PHP Commercial |
$195.96
|
| Rate for Payer: Priority Health SBD |
$145.24
|
| Rate for Payer: UMR Bronson Commercial |
$101.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.91
|
|
|
SIMVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 51079045620
|
| Hospital Charge Code |
11366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Advantage |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.10
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
SIMVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 51079045601
|
| Hospital Charge Code |
11366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.30
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.55
|
|
|
SIMVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 51079045601
|
| Hospital Charge Code |
11366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.35
|
| Rate for Payer: UHC Core |
$1.08
|
| Rate for Payer: UHC Exchange |
$0.81
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.55
|
|
|
SIMVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 51079045620
|
| Hospital Charge Code |
11366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna Medicare |
$103.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Advantage |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.10
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.42
|
| Rate for Payer: UHC Core |
$107.74
|
| Rate for Payer: UHC Exchange |
$81.27
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
SIMVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 63739057310
|
| Hospital Charge Code |
11366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.43 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna American Axle |
$193.99
|
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna Medicare |
$149.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.99
|
| Rate for Payer: BCBS Complete |
$119.38
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Advantage |
$208.91
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health SBD |
$188.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.99
|
| Rate for Payer: UHC Core |
$155.49
|
| Rate for Payer: UHC Exchange |
$117.29
|
| Rate for Payer: UMR Bronson Commercial |
$110.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
SIMVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 63739057310
|
| Hospital Charge Code |
11366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna American Axle |
$193.99
|
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.99
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Advantage |
$208.91
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health SBD |
$188.02
|
| Rate for Payer: UMR Bronson Commercial |
$131.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$267.79
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
11368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.08 |
| Max. Negotiated Rate |
$357.09 |
| Rate for Payer: Aetna American Axle |
$174.06
|
| Rate for Payer: Aetna American Axle |
$294.14
|
| Rate for Payer: Aetna Commercial |
$227.62
|
| Rate for Payer: Aetna Commercial |
$384.64
|
| Rate for Payer: Aetna Medicare |
$133.90
|
| Rate for Payer: Aetna Medicare |
$226.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.14
|
| Rate for Payer: BCBS Complete |
$181.01
|
| Rate for Payer: BCBS Complete |
$107.12
|
| Rate for Payer: BCBS Trust/PPO |
$357.09
|
| Rate for Payer: BCBS Trust/PPO |
$357.09
|
| Rate for Payer: BCN Commercial |
$357.09
|
| Rate for Payer: BCN Commercial |
$357.09
|
| Rate for Payer: Cash Price |
$214.23
|
| Rate for Payer: Cash Price |
$362.02
|
| Rate for Payer: Cash Price |
$214.23
|
| Rate for Payer: Cash Price |
$362.02
|
| Rate for Payer: Cofinity Advantage |
$187.45
|
| Rate for Payer: Cofinity Advantage |
$316.76
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$389.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.02
|
| Rate for Payer: Healthscope Commercial |
$241.01
|
| Rate for Payer: Healthscope Commercial |
$407.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.84
|
| Rate for Payer: PHP Commercial |
$227.62
|
| Rate for Payer: PHP Commercial |
$384.64
|
| Rate for Payer: Priority Health SBD |
$168.71
|
| Rate for Payer: Priority Health SBD |
$285.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.71
|
| Rate for Payer: UHC Core |
$181.71
|
| Rate for Payer: UHC Core |
$181.71
|
| Rate for Payer: UHC Exchange |
$181.71
|
| Rate for Payer: UHC Exchange |
$181.71
|
| Rate for Payer: UMR Bronson Commercial |
$99.08
|
| Rate for Payer: UMR Bronson Commercial |
$167.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.39
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$267.79
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
11368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.83 |
| Max. Negotiated Rate |
$241.01 |
| Rate for Payer: Aetna American Axle |
$174.06
|
| Rate for Payer: Aetna American Axle |
$294.14
|
| Rate for Payer: Aetna Commercial |
$227.62
|
| Rate for Payer: Aetna Commercial |
$384.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.14
|
| Rate for Payer: Cash Price |
$214.23
|
| Rate for Payer: Cash Price |
$362.02
|
| Rate for Payer: Cofinity Advantage |
$316.76
|
| Rate for Payer: Cofinity Advantage |
$187.45
|
| Rate for Payer: Cofinity Commercial |
$389.17
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.02
|
| Rate for Payer: Healthscope Commercial |
$241.01
|
| Rate for Payer: Healthscope Commercial |
$407.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.39
|
| Rate for Payer: PHP Commercial |
$227.62
|
| Rate for Payer: PHP Commercial |
$384.64
|
| Rate for Payer: Priority Health SBD |
$285.09
|
| Rate for Payer: Priority Health SBD |
$168.71
|
| Rate for Payer: UMR Bronson Commercial |
$117.83
|
| Rate for Payer: UMR Bronson Commercial |
$199.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.39
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$22,035.04
|
|
|
Service Code
|
APR-DRG 3003
|
| Min. Negotiated Rate |
$20,985.75 |
| Max. Negotiated Rate |
$22,035.04 |
| Rate for Payer: BCBS Complete |
$22,035.04
|
| Rate for Payer: Mclaren Medicaid |
$20,985.75
|
| Rate for Payer: Meridian Medicaid |
$22,035.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,985.75
|
| Rate for Payer: UHC Medicaid |
$20,985.75
|
| Rate for Payer: UHCCP Medicaid |
$20,985.75
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$16,628.28
|
|
|
Service Code
|
APR-DRG 3002
|
| Min. Negotiated Rate |
$15,836.45 |
| Max. Negotiated Rate |
$16,628.28 |
| Rate for Payer: BCBS Complete |
$16,628.28
|
| Rate for Payer: Mclaren Medicaid |
$15,836.45
|
| Rate for Payer: Meridian Medicaid |
$16,628.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,836.45
|
| Rate for Payer: UHC Medicaid |
$15,836.45
|
| Rate for Payer: UHCCP Medicaid |
$15,836.45
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$28,889.74
|
|
|
Service Code
|
APR-DRG 3004
|
| Min. Negotiated Rate |
$27,514.04 |
| Max. Negotiated Rate |
$28,889.74 |
| Rate for Payer: BCBS Complete |
$28,889.74
|
| Rate for Payer: Mclaren Medicaid |
$27,514.04
|
| Rate for Payer: Meridian Medicaid |
$28,889.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,514.04
|
| Rate for Payer: UHC Medicaid |
$27,514.04
|
| Rate for Payer: UHCCP Medicaid |
$27,514.04
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$67,768.28
|
|
|
Service Code
|
MSDRG 402
|
| Min. Negotiated Rate |
$32,504.40 |
| Max. Negotiated Rate |
$67,768.28 |
| Rate for Payer: Aetna Medicare |
$35,583.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,768.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,768.95
|
| Rate for Payer: BCBS MAPPO |
$34,215.16
|
| Rate for Payer: BCBS Trust/PPO |
$67,768.28
|
| Rate for Payer: BCN Commercial |
$67,768.28
|
| Rate for Payer: BCN Medicare Advantage |
$34,215.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,215.16
|
| Rate for Payer: Mclaren Medicare |
$34,215.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35,925.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,347.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$37,636.68
|
| Rate for Payer: Nomi Health Commercial |
$51,864.45
|
| Rate for Payer: PACE Medicare |
$32,504.40
|
| Rate for Payer: PACE SWMI |
$34,215.16
|
| Rate for Payer: PHP Medicare Advantage |
$34,215.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$64,819.06
|
| Rate for Payer: Priority Health Medicare |
$34,215.16
|
| Rate for Payer: Priority Health Tiered Network |
$51,855.24
|
| Rate for Payer: Railroad Medicare Medicare |
$34,215.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65,534.15
|
| Rate for Payer: UHC Core |
$54,827.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34,215.16
|
| Rate for Payer: UHC Exchange |
$44,776.31
|
| Rate for Payer: VA VA |
$34,215.16
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$14,543.54
|
|
|
Service Code
|
APR-DRG 3001
|
| Min. Negotiated Rate |
$13,850.99 |
| Max. Negotiated Rate |
$14,543.54 |
| Rate for Payer: BCBS Complete |
$14,543.54
|
| Rate for Payer: Mclaren Medicaid |
$13,850.99
|
| Rate for Payer: Meridian Medicaid |
$14,543.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,850.99
|
| Rate for Payer: UHC Medicaid |
$13,850.99
|
| Rate for Payer: UHCCP Medicaid |
$13,850.99
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$93,846.73
|
|
|
Service Code
|
MSDRG 450
|
| Min. Negotiated Rate |
$42,904.62 |
| Max. Negotiated Rate |
$93,846.73 |
| Rate for Payer: Aetna Medicare |
$46,969.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,453.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,453.45
|
| Rate for Payer: BCBS MAPPO |
$45,162.76
|
| Rate for Payer: BCBS Trust/PPO |
$93,846.73
|
| Rate for Payer: BCN Commercial |
$93,846.73
|
| Rate for Payer: BCN Medicare Advantage |
$45,162.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,162.76
|
| Rate for Payer: Mclaren Medicare |
$45,162.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47,420.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,937.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$49,679.04
|
| Rate for Payer: Nomi Health Commercial |
$68,751.84
|
| Rate for Payer: PACE Medicare |
$42,904.62
|
| Rate for Payer: PACE SWMI |
$45,162.76
|
| Rate for Payer: PHP Medicare Advantage |
$45,162.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$85,924.56
|
| Rate for Payer: Priority Health Medicare |
$45,162.76
|
| Rate for Payer: Priority Health Tiered Network |
$68,739.64
|
| Rate for Payer: Railroad Medicare Medicare |
$45,162.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86,872.48
|
| Rate for Payer: UHC Core |
$72,679.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$45,162.76
|
| Rate for Payer: UHC Exchange |
$59,355.76
|
| Rate for Payer: VA VA |
$45,162.76
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$61,836.12
|
|
|
Service Code
|
MSDRG 451
|
| Min. Negotiated Rate |
$26,227.41 |
| Max. Negotiated Rate |
$61,836.12 |
| Rate for Payer: Aetna Medicare |
$28,712.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,509.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,509.75
|
| Rate for Payer: BCBS MAPPO |
$27,607.80
|
| Rate for Payer: BCBS Trust/PPO |
$61,836.12
|
| Rate for Payer: BCN Commercial |
$61,836.12
|
| Rate for Payer: BCN Medicare Advantage |
$27,607.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,607.80
|
| Rate for Payer: Mclaren Medicare |
$27,607.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,988.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,748.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,368.58
|
| Rate for Payer: Nomi Health Commercial |
$41,672.16
|
| Rate for Payer: PACE Medicare |
$26,227.41
|
| Rate for Payer: PACE SWMI |
$27,607.80
|
| Rate for Payer: PHP Medicare Advantage |
$27,607.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$52,080.96
|
| Rate for Payer: Priority Health Medicare |
$27,607.80
|
| Rate for Payer: Priority Health Tiered Network |
$41,664.76
|
| Rate for Payer: Railroad Medicare Medicare |
$27,607.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,655.52
|
| Rate for Payer: UHC Core |
$44,052.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,607.80
|
| Rate for Payer: UHC Exchange |
$35,976.96
|
| Rate for Payer: VA VA |
$27,607.80
|
|
|
SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$38,557.67
|
|
|
Service Code
|
MSDRG 135
|
| Min. Negotiated Rate |
$17,803.02 |
| Max. Negotiated Rate |
$38,557.67 |
| Rate for Payer: Aetna Medicare |
$19,489.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,425.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,425.03
|
| Rate for Payer: BCBS MAPPO |
$18,740.02
|
| Rate for Payer: BCBS Trust/PPO |
$38,557.67
|
| Rate for Payer: BCN Commercial |
$38,557.67
|
| Rate for Payer: BCN Medicare Advantage |
$18,740.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,740.02
|
| Rate for Payer: Mclaren Medicare |
$18,740.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,677.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,551.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,614.02
|
| Rate for Payer: Nomi Health Commercial |
$27,286.08
|
| Rate for Payer: PACE Medicare |
$17,803.02
|
| Rate for Payer: PACE SWMI |
$18,740.02
|
| Rate for Payer: PHP Medicare Advantage |
$18,740.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,985.04
|
| Rate for Payer: Priority Health Medicare |
$18,740.02
|
| Rate for Payer: Priority Health Tiered Network |
$27,988.03
|
| Rate for Payer: Railroad Medicare Medicare |
$18,740.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,477.76
|
| Rate for Payer: UHC Core |
$28,844.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,740.02
|
| Rate for Payer: UHC Exchange |
$23,556.98
|
| Rate for Payer: VA VA |
$18,740.02
|
|
|
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,861.19
|
|
|
Service Code
|
MSDRG 136
|
| Min. Negotiated Rate |
$8,629.43 |
| Max. Negotiated Rate |
$22,861.19 |
| Rate for Payer: Aetna Medicare |
$9,446.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,354.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,354.51
|
| Rate for Payer: BCBS MAPPO |
$9,083.61
|
| Rate for Payer: BCBS Trust/PPO |
$22,861.19
|
| Rate for Payer: BCN Commercial |
$22,861.19
|
| Rate for Payer: BCN Medicare Advantage |
$9,083.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,083.61
|
| Rate for Payer: Mclaren Medicare |
$9,083.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,537.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,446.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,991.97
|
| Rate for Payer: Nomi Health Commercial |
$13,097.37
|
| Rate for Payer: PACE Medicare |
$8,629.43
|
| Rate for Payer: PACE SWMI |
$9,083.61
|
| Rate for Payer: PHP Medicare Advantage |
$9,083.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,368.81
|
| Rate for Payer: Priority Health Medicare |
$9,083.61
|
| Rate for Payer: Priority Health Tiered Network |
$13,095.04
|
| Rate for Payer: Railroad Medicare Medicare |
$9,083.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,549.39
|
| Rate for Payer: UHC Core |
$13,845.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,083.61
|
| Rate for Payer: UHC Exchange |
$11,307.40
|
| Rate for Payer: VA VA |
$9,083.61
|
|
|
SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION
|
Facility
|
OP
|
$344,544.64
|
|
|
Service Code
|
HCPCS Q2043
|
| Hospital Charge Code |
104852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29,428.79 |
| Max. Negotiated Rate |
$310,090.18 |
| Rate for Payer: Aetna American Axle |
$223,954.02
|
| Rate for Payer: Aetna Commercial |
$292,862.94
|
| Rate for Payer: Aetna Medicare |
$58,519.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223,954.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70,336.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70,336.49
|
| Rate for Payer: BCBS Complete |
$30,903.04
|
| Rate for Payer: BCBS MAPPO |
$56,269.19
|
| Rate for Payer: BCBS Trust/PPO |
$206,391.61
|
| Rate for Payer: BCN Commercial |
$206,391.61
|
| Rate for Payer: BCN Medicare Advantage |
$56,269.19
|
| Rate for Payer: Cash Price |
$275,635.71
|
| Rate for Payer: Cash Price |
$275,635.71
|
| Rate for Payer: Cofinity Advantage |
$241,181.25
|
| Rate for Payer: Cofinity Commercial |
$296,308.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275,635.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,269.19
|
| Rate for Payer: Healthscope Commercial |
$310,090.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241,181.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258,408.48
|
| Rate for Payer: Mclaren Medicaid |
$56,269.19
|
| Rate for Payer: Mclaren Medicare |
$56,269.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59,082.65
|
| Rate for Payer: Meridian Medicaid |
$59,082.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64,709.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$61,896.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292,862.94
|
| Rate for Payer: Nomi Health Commercial |
$168,807.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258,408.48
|
| Rate for Payer: PACE Medicare |
$53,455.73
|
| Rate for Payer: PACE SWMI |
$56,269.19
|
| Rate for Payer: PHP Commercial |
$292,862.94
|
| Rate for Payer: PHP Medicare Advantage |
$56,269.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,428.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$174,327.15
|
| Rate for Payer: Priority Health Medicare |
$56,269.19
|
| Rate for Payer: Priority Health SBD |
$217,063.12
|
| Rate for Payer: Priority Health Tiered Network |
$139,461.72
|
| Rate for Payer: Railroad Medicare Medicare |
$56,269.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89,766.78
|
| Rate for Payer: UHC Core |
$89,766.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56,269.19
|
| Rate for Payer: UHC Exchange |
$89,766.78
|
| Rate for Payer: UHC Medicaid |
$29,428.79
|
| Rate for Payer: UHCCP Medicaid |
$29,428.79
|
| Rate for Payer: UMR Bronson Commercial |
$127,481.52
|
| Rate for Payer: VA VA |
$56,269.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258,408.48
|
|
|
SIROLIMUS 0.5 MG TABLET
|
Facility
|
OP
|
$1,498.50
|
|
|
Service Code
|
NDC 59762100101
|
| Hospital Charge Code |
104764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$554.45 |
| Max. Negotiated Rate |
$1,348.65 |
| Rate for Payer: Aetna American Axle |
$974.02
|
| Rate for Payer: Aetna Commercial |
$1,273.72
|
| Rate for Payer: Aetna Medicare |
$749.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.02
|
| Rate for Payer: BCBS Complete |
$599.40
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cofinity Advantage |
$1,048.95
|
| Rate for Payer: Cofinity Commercial |
$1,288.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.80
|
| Rate for Payer: Healthscope Commercial |
$1,348.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,048.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,123.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,198.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,123.88
|
| Rate for Payer: PHP Commercial |
$1,273.72
|
| Rate for Payer: Priority Health SBD |
$944.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.02
|
| Rate for Payer: UHC Core |
$780.72
|
| Rate for Payer: UHC Exchange |
$588.91
|
| Rate for Payer: UMR Bronson Commercial |
$554.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,123.88
|
|
|
SIROLIMUS 0.5 MG TABLET
|
Facility
|
IP
|
$1,498.50
|
|
|
Service Code
|
NDC 59762100101
|
| Hospital Charge Code |
104764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$659.34 |
| Max. Negotiated Rate |
$1,348.65 |
| Rate for Payer: Aetna American Axle |
$974.02
|
| Rate for Payer: Aetna Commercial |
$1,273.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.02
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cofinity Advantage |
$1,048.95
|
| Rate for Payer: Cofinity Commercial |
$1,288.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.80
|
| Rate for Payer: Healthscope Commercial |
$1,348.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,048.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,123.88
|
| Rate for Payer: PHP Commercial |
$1,273.72
|
| Rate for Payer: Priority Health SBD |
$944.05
|
| Rate for Payer: UMR Bronson Commercial |
$659.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,123.88
|
|
|
SKIN CARE CONSULT
|
Professional
|
Both
|
$27.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
SKIN DEBRIDEMENT WITH CC
|
Facility
|
IP
|
$33,026.30
|
|
|
Service Code
|
MSDRG 571
|
| Min. Negotiated Rate |
$13,985.65 |
| Max. Negotiated Rate |
$33,026.30 |
| Rate for Payer: Aetna Medicare |
$15,310.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,402.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,402.17
|
| Rate for Payer: BCBS MAPPO |
$14,721.74
|
| Rate for Payer: BCBS Trust/PPO |
$33,026.30
|
| Rate for Payer: BCN Commercial |
$33,026.30
|
| Rate for Payer: BCN Medicare Advantage |
$14,721.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,721.74
|
| Rate for Payer: Mclaren Medicare |
$14,721.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,457.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,930.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,193.91
|
| Rate for Payer: Nomi Health Commercial |
$21,794.55
|
| Rate for Payer: PACE Medicare |
$13,985.65
|
| Rate for Payer: PACE SWMI |
$14,721.74
|
| Rate for Payer: PHP Medicare Advantage |
$14,721.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,238.36
|
| Rate for Payer: Priority Health Medicare |
$14,721.74
|
| Rate for Payer: Priority Health Tiered Network |
$21,790.68
|
| Rate for Payer: Railroad Medicare Medicare |
$14,721.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,538.85
|
| Rate for Payer: UHC Core |
$23,039.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,721.74
|
| Rate for Payer: UHC Exchange |
$18,815.96
|
| Rate for Payer: VA VA |
$14,721.74
|
|
