|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC
|
Facility
|
IP
|
$33,383.16
|
|
|
Service Code
|
MSDRG 537
|
| Min. Negotiated Rate |
$8,144.82 |
| Max. Negotiated Rate |
$33,383.16 |
| Rate for Payer: Aetna Medicare |
$8,916.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,716.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,716.86
|
| Rate for Payer: BCBS MAPPO |
$8,573.49
|
| Rate for Payer: BCBS Trust/PPO |
$33,383.16
|
| Rate for Payer: BCN Commercial |
$33,383.16
|
| Rate for Payer: BCN Medicare Advantage |
$8,573.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,573.49
|
| Rate for Payer: Mclaren Medicare |
$8,573.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,002.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,859.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,430.84
|
| Rate for Payer: Nomi Health Commercial |
$12,310.47
|
| Rate for Payer: PACE Medicare |
$8,144.82
|
| Rate for Payer: PACE SWMI |
$8,573.49
|
| Rate for Payer: PHP Medicare Advantage |
$8,573.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,385.36
|
| Rate for Payer: Priority Health Medicare |
$8,573.49
|
| Rate for Payer: Priority Health Tiered Network |
$12,308.28
|
| Rate for Payer: Railroad Medicare Medicare |
$8,573.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,555.09
|
| Rate for Payer: UHC Core |
$13,013.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,573.49
|
| Rate for Payer: UHC Exchange |
$10,628.04
|
| Rate for Payer: VA VA |
$8,573.49
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC
|
Facility
|
IP
|
$16,835.70
|
|
|
Service Code
|
MSDRG 538
|
| Min. Negotiated Rate |
$6,285.81 |
| Max. Negotiated Rate |
$16,835.70 |
| Rate for Payer: Aetna Medicare |
$6,881.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,270.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,270.80
|
| Rate for Payer: BCBS MAPPO |
$6,616.64
|
| Rate for Payer: BCBS Trust/PPO |
$16,835.70
|
| Rate for Payer: BCN Commercial |
$16,835.70
|
| Rate for Payer: BCN Medicare Advantage |
$6,616.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,616.64
|
| Rate for Payer: Mclaren Medicare |
$6,616.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,947.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,609.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,278.30
|
| Rate for Payer: Nomi Health Commercial |
$9,291.87
|
| Rate for Payer: PACE Medicare |
$6,285.81
|
| Rate for Payer: PACE SWMI |
$6,616.64
|
| Rate for Payer: PHP Medicare Advantage |
$6,616.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,612.78
|
| Rate for Payer: Priority Health Medicare |
$6,616.64
|
| Rate for Payer: Priority Health Tiered Network |
$9,290.22
|
| Rate for Payer: Railroad Medicare Medicare |
$6,616.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,740.89
|
| Rate for Payer: UHC Core |
$9,822.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,616.64
|
| Rate for Payer: UHC Exchange |
$8,021.98
|
| Rate for Payer: VA VA |
$6,616.64
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 37765
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$4,036.50
|
| Rate for Payer: BCN Commercial |
$4,036.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 37766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$605.22 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$605.22
|
| Rate for Payer: BCN Commercial |
$605.22
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT USE OF FOREIGN MATERIAL;
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 69660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$7,284.99
|
| Rate for Payer: BCN Commercial |
$7,284.99
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
STAVUDINE 30 MG CAPSULE
|
Facility
|
IP
|
$458.50
|
|
|
Service Code
|
NDC 65862004660
|
| Hospital Charge Code |
13310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.74 |
| Max. Negotiated Rate |
$412.65 |
| Rate for Payer: Aetna American Axle |
$298.02
|
| Rate for Payer: Aetna Commercial |
$389.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.02
|
| Rate for Payer: Cash Price |
$366.80
|
| Rate for Payer: Cofinity Advantage |
$320.95
|
| Rate for Payer: Cofinity Commercial |
$394.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.80
|
| Rate for Payer: Healthscope Commercial |
$412.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.88
|
| Rate for Payer: PHP Commercial |
$389.73
|
| Rate for Payer: Priority Health SBD |
$288.86
|
| Rate for Payer: UMR Bronson Commercial |
$201.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.88
|
|
|
STAVUDINE 30 MG CAPSULE
|
Facility
|
OP
|
$458.50
|
|
|
Service Code
|
NDC 65862004660
|
| Hospital Charge Code |
13310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.65 |
| Max. Negotiated Rate |
$412.65 |
| Rate for Payer: Aetna American Axle |
$298.02
|
| Rate for Payer: Aetna Commercial |
$389.73
|
| Rate for Payer: Aetna Medicare |
$229.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.02
|
| Rate for Payer: BCBS Complete |
$183.40
|
| Rate for Payer: Cash Price |
$366.80
|
| Rate for Payer: Cofinity Advantage |
$320.95
|
| Rate for Payer: Cofinity Commercial |
$394.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.80
|
| Rate for Payer: Healthscope Commercial |
$412.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.88
|
| Rate for Payer: PHP Commercial |
$389.73
|
| Rate for Payer: Priority Health SBD |
$288.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.02
|
| Rate for Payer: UHC Core |
$238.88
|
| Rate for Payer: UHC Exchange |
$180.19
|
| Rate for Payer: UMR Bronson Commercial |
$169.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.88
|
|
|
STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, EXTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$773.91
|
|
|
Service Code
|
CPT 61782
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$773.91 |
| Max. Negotiated Rate |
$773.91 |
| Rate for Payer: BCBS Trust/PPO |
$773.91
|
| Rate for Payer: BCN Commercial |
$773.91
|
|
|
STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; SPINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,042.54
|
|
|
Service Code
|
CPT 61783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,042.54 |
| Max. Negotiated Rate |
$1,042.54 |
| Rate for Payer: BCBS Trust/PPO |
$1,042.54
|
| Rate for Payer: BCN Commercial |
$1,042.54
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
OP
|
$443.75
|
|
|
Service Code
|
NDC 62327033343
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.19 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna Medicare |
$221.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: BCBS Complete |
$177.50
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Advantage |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.81
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.44
|
| Rate for Payer: UHC Core |
$231.19
|
| Rate for Payer: UHC Exchange |
$174.39
|
| Rate for Payer: UMR Bronson Commercial |
$164.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
IP
|
$443.75
|
|
|
Service Code
|
NDC 62327033303
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Advantage |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.81
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UMR Bronson Commercial |
$195.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
IP
|
$443.75
|
|
|
Service Code
|
NDC 62327033343
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Advantage |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.81
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UMR Bronson Commercial |
$195.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
OP
|
$443.75
|
|
|
Service Code
|
NDC 62327033303
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.19 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna Medicare |
$221.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: BCBS Complete |
$177.50
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Advantage |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.81
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.44
|
| Rate for Payer: UHC Core |
$231.19
|
| Rate for Payer: UHC Exchange |
$174.39
|
| Rate for Payer: UMR Bronson Commercial |
$164.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
|
IP
|
$53,013.37
|
|
|
Service Code
|
MSDRG 327
|
| Min. Negotiated Rate |
$19,981.40 |
| Max. Negotiated Rate |
$53,013.37 |
| Rate for Payer: Aetna Medicare |
$21,874.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,291.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,291.31
|
| Rate for Payer: BCBS MAPPO |
$21,033.05
|
| Rate for Payer: BCBS Trust/PPO |
$53,013.37
|
| Rate for Payer: BCN Commercial |
$53,013.37
|
| Rate for Payer: BCN Medicare Advantage |
$21,033.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,033.05
|
| Rate for Payer: Mclaren Medicare |
$21,033.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,084.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,188.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,136.35
|
| Rate for Payer: Nomi Health Commercial |
$31,530.18
|
| Rate for Payer: PACE Medicare |
$19,981.40
|
| Rate for Payer: PACE SWMI |
$21,033.05
|
| Rate for Payer: PHP Medicare Advantage |
$21,033.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39,405.73
|
| Rate for Payer: Priority Health Medicare |
$21,033.05
|
| Rate for Payer: Priority Health Tiered Network |
$31,524.58
|
| Rate for Payer: Railroad Medicare Medicare |
$21,033.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,840.46
|
| Rate for Payer: UHC Core |
$33,331.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,033.05
|
| Rate for Payer: UHC Exchange |
$27,221.06
|
| Rate for Payer: VA VA |
$21,033.05
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$99,361.64
|
|
|
Service Code
|
MSDRG 326
|
| Min. Negotiated Rate |
$40,186.03 |
| Max. Negotiated Rate |
$99,361.64 |
| Rate for Payer: Aetna Medicare |
$43,993.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,876.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,876.35
|
| Rate for Payer: BCBS MAPPO |
$42,301.08
|
| Rate for Payer: BCBS Trust/PPO |
$99,361.64
|
| Rate for Payer: BCN Commercial |
$99,361.64
|
| Rate for Payer: BCN Medicare Advantage |
$42,301.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,301.08
|
| Rate for Payer: Mclaren Medicare |
$42,301.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44,416.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,646.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$46,531.19
|
| Rate for Payer: Nomi Health Commercial |
$64,337.46
|
| Rate for Payer: PACE Medicare |
$40,186.03
|
| Rate for Payer: PACE SWMI |
$42,301.08
|
| Rate for Payer: PHP Medicare Advantage |
$42,301.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$80,407.56
|
| Rate for Payer: Priority Health Medicare |
$42,301.08
|
| Rate for Payer: Priority Health Tiered Network |
$64,326.04
|
| Rate for Payer: Railroad Medicare Medicare |
$42,301.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81,294.62
|
| Rate for Payer: UHC Core |
$68,013.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42,301.08
|
| Rate for Payer: UHC Exchange |
$55,544.67
|
| Rate for Payer: VA VA |
$42,301.08
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,975.32
|
|
|
Service Code
|
MSDRG 328
|
| Min. Negotiated Rate |
$13,292.89 |
| Max. Negotiated Rate |
$34,975.32 |
| Rate for Payer: Aetna Medicare |
$14,552.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,490.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,490.65
|
| Rate for Payer: BCBS MAPPO |
$13,992.52
|
| Rate for Payer: BCBS Trust/PPO |
$34,975.32
|
| Rate for Payer: BCN Commercial |
$34,975.32
|
| Rate for Payer: BCN Medicare Advantage |
$13,992.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,992.52
|
| Rate for Payer: Mclaren Medicare |
$13,992.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,692.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,091.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,391.77
|
| Rate for Payer: Nomi Health Commercial |
$20,669.67
|
| Rate for Payer: PACE Medicare |
$13,292.89
|
| Rate for Payer: PACE SWMI |
$13,992.52
|
| Rate for Payer: PHP Medicare Advantage |
$13,992.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,832.50
|
| Rate for Payer: Priority Health Medicare |
$13,992.52
|
| Rate for Payer: Priority Health Tiered Network |
$20,666.00
|
| Rate for Payer: Railroad Medicare Medicare |
$13,992.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,117.49
|
| Rate for Payer: UHC Core |
$21,850.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,992.52
|
| Rate for Payer: UHC Exchange |
$17,844.82
|
| Rate for Payer: VA VA |
$13,992.52
|
|
|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$185.01
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
7508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$166.51 |
| Rate for Payer: Aetna American Axle |
$120.26
|
| Rate for Payer: Aetna Commercial |
$157.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.26
|
| Rate for Payer: Cash Price |
$148.01
|
| Rate for Payer: Cofinity Advantage |
$129.51
|
| Rate for Payer: Cofinity Commercial |
$159.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.01
|
| Rate for Payer: Healthscope Commercial |
$166.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.76
|
| Rate for Payer: PHP Commercial |
$157.26
|
| Rate for Payer: Priority Health SBD |
$116.56
|
| Rate for Payer: UMR Bronson Commercial |
$81.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.76
|
|
|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$185.01
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
7508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$166.51 |
| Rate for Payer: Aetna American Axle |
$120.26
|
| Rate for Payer: Aetna Commercial |
$157.26
|
| Rate for Payer: Aetna Medicare |
$92.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.26
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS Trust/PPO |
$109.83
|
| Rate for Payer: BCN Commercial |
$109.83
|
| Rate for Payer: Cash Price |
$148.01
|
| Rate for Payer: Cash Price |
$148.01
|
| Rate for Payer: Cofinity Advantage |
$129.51
|
| Rate for Payer: Cofinity Commercial |
$159.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.01
|
| Rate for Payer: Healthscope Commercial |
$166.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.76
|
| Rate for Payer: PHP Commercial |
$157.26
|
| Rate for Payer: Priority Health SBD |
$116.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.90
|
| Rate for Payer: UHC Core |
$55.90
|
| Rate for Payer: UHC Exchange |
$55.90
|
| Rate for Payer: UMR Bronson Commercial |
$68.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.76
|
|
|
STREPTOZOCIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,536.49
|
|
|
Service Code
|
HCPCS J9320
|
| Hospital Charge Code |
11436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$289.33 |
| Max. Negotiated Rate |
$4,073.66 |
| Rate for Payer: Aetna American Axle |
$998.72
|
| Rate for Payer: Aetna Commercial |
$1,306.02
|
| Rate for Payer: Aetna Medicare |
$768.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.72
|
| Rate for Payer: BCBS Complete |
$614.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,073.66
|
| Rate for Payer: BCN Commercial |
$4,073.66
|
| Rate for Payer: Cash Price |
$1,229.19
|
| Rate for Payer: Cash Price |
$1,229.19
|
| Rate for Payer: Cofinity Advantage |
$1,075.54
|
| Rate for Payer: Cofinity Commercial |
$1,321.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.19
|
| Rate for Payer: Healthscope Commercial |
$1,382.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,075.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,229.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,152.37
|
| Rate for Payer: PHP Commercial |
$1,306.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,378.00
|
| Rate for Payer: Priority Health SBD |
$967.99
|
| Rate for Payer: Priority Health Tiered Network |
$1,102.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.33
|
| Rate for Payer: UHC Core |
$289.33
|
| Rate for Payer: UHC Exchange |
$289.33
|
| Rate for Payer: UMR Bronson Commercial |
$568.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.37
|
|
|
STREPTOZOCIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,536.49
|
|
|
Service Code
|
HCPCS J9320
|
| Hospital Charge Code |
11436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$676.06 |
| Max. Negotiated Rate |
$1,382.84 |
| Rate for Payer: Aetna American Axle |
$998.72
|
| Rate for Payer: Aetna Commercial |
$1,306.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.72
|
| Rate for Payer: Cash Price |
$1,229.19
|
| Rate for Payer: Cofinity Advantage |
$1,075.54
|
| Rate for Payer: Cofinity Commercial |
$1,321.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.19
|
| Rate for Payer: Healthscope Commercial |
$1,382.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,075.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,152.37
|
| Rate for Payer: PHP Commercial |
$1,306.02
|
| Rate for Payer: Priority Health SBD |
$967.99
|
| Rate for Payer: UMR Bronson Commercial |
$676.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.37
|
|
|
SUBCONJUNCTIVAL INJECTION
|
Facility
|
OP
|
$1,439.47
|
|
|
Service Code
|
CPT 68200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$1,439.47 |
| Rate for Payer: Aetna Medicare |
$462.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.40
|
| Rate for Payer: BCBS Complete |
$244.46
|
| Rate for Payer: BCBS MAPPO |
$445.12
|
| Rate for Payer: BCBS Trust/PPO |
$297.46
|
| Rate for Payer: BCN Commercial |
$297.46
|
| Rate for Payer: BCN Medicare Advantage |
$445.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.12
|
| Rate for Payer: Mclaren Medicaid |
$445.12
|
| Rate for Payer: Mclaren Medicare |
$445.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.38
|
| Rate for Payer: Meridian Medicaid |
$467.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.63
|
| Rate for Payer: Nomi Health Commercial |
$1,335.36
|
| Rate for Payer: PACE Medicare |
$422.86
|
| Rate for Payer: PACE SWMI |
$445.12
|
| Rate for Payer: PHP Medicare Advantage |
$445.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,439.47
|
| Rate for Payer: Priority Health Medicare |
$445.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,151.58
|
| Rate for Payer: Railroad Medicare Medicare |
$445.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$445.12
|
| Rate for Payer: UHC Medicaid |
$232.80
|
| Rate for Payer: UHCCP Medicaid |
$232.80
|
| Rate for Payer: VA VA |
$445.12
|
|
|
SUBMUCOSAL INJECTABLE COMPOSITION (ELEVIEW)
|
Facility
|
OP
|
$287.55
|
|
|
Service Code
|
NDC 05391530190
|
| Hospital Charge Code |
200133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.39 |
| Max. Negotiated Rate |
$258.80 |
| Rate for Payer: Aetna American Axle |
$186.91
|
| Rate for Payer: Aetna Commercial |
$244.42
|
| Rate for Payer: Aetna Medicare |
$143.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.91
|
| Rate for Payer: BCBS Complete |
$115.02
|
| Rate for Payer: Cash Price |
$230.04
|
| Rate for Payer: Cofinity Advantage |
$201.28
|
| Rate for Payer: Cofinity Commercial |
$247.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$258.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.66
|
| Rate for Payer: PHP Commercial |
$244.42
|
| Rate for Payer: Priority Health SBD |
$181.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.91
|
| Rate for Payer: UHC Core |
$149.81
|
| Rate for Payer: UHC Exchange |
$113.01
|
| Rate for Payer: UMR Bronson Commercial |
$106.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.66
|
|
|
SUBMUCOSAL INJECTABLE COMPOSITION (ELEVIEW)
|
Facility
|
IP
|
$287.55
|
|
|
Service Code
|
NDC 05391530190
|
| Hospital Charge Code |
200133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$258.80 |
| Rate for Payer: Aetna American Axle |
$186.91
|
| Rate for Payer: Aetna Commercial |
$244.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.91
|
| Rate for Payer: Cash Price |
$230.04
|
| Rate for Payer: Cofinity Advantage |
$201.28
|
| Rate for Payer: Cofinity Commercial |
$247.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$258.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.66
|
| Rate for Payer: PHP Commercial |
$244.42
|
| Rate for Payer: Priority Health SBD |
$181.16
|
| Rate for Payer: UMR Bronson Commercial |
$126.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.66
|
|
|
SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 30140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.42
|
| Rate for Payer: BCN Commercial |
$2,064.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
SUCCIMER 100 MG CAPSULE
|
Facility
|
IP
|
$8,152.95
|
|
|
Service Code
|
NDC 55292020111
|
| Hospital Charge Code |
11438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,587.30 |
| Max. Negotiated Rate |
$7,337.65 |
| Rate for Payer: Aetna American Axle |
$5,299.42
|
| Rate for Payer: Aetna Commercial |
$6,930.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,299.42
|
| Rate for Payer: Cash Price |
$6,522.36
|
| Rate for Payer: Cofinity Advantage |
$5,707.06
|
| Rate for Payer: Cofinity Commercial |
$7,011.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,522.36
|
| Rate for Payer: Healthscope Commercial |
$7,337.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,707.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,114.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,930.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,114.71
|
| Rate for Payer: PHP Commercial |
$6,930.01
|
| Rate for Payer: Priority Health SBD |
$5,136.36
|
| Rate for Payer: UMR Bronson Commercial |
$3,587.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,114.71
|
|
