|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$18,798.37
|
|
|
Service Code
|
APR-DRG 4824
|
| Min. Negotiated Rate |
$17,903.21 |
| Max. Negotiated Rate |
$18,798.37 |
| Rate for Payer: BCBS Complete |
$18,798.37
|
| Rate for Payer: Mclaren Medicaid |
$17,903.21
|
| Rate for Payer: Meridian Medicaid |
$18,798.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,903.21
|
| Rate for Payer: UHC Medicaid |
$17,903.21
|
| Rate for Payer: UHCCP Medicaid |
$17,903.21
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$5,503.61
|
|
|
Service Code
|
APR-DRG 4821
|
| Min. Negotiated Rate |
$5,241.54 |
| Max. Negotiated Rate |
$5,503.61 |
| Rate for Payer: BCBS Complete |
$5,503.61
|
| Rate for Payer: Mclaren Medicaid |
$5,241.54
|
| Rate for Payer: Meridian Medicaid |
$5,503.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,241.54
|
| Rate for Payer: UHC Medicaid |
$5,241.54
|
| Rate for Payer: UHCCP Medicaid |
$5,241.54
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$29,356.10
|
|
|
Service Code
|
MSDRG 713
|
| Min. Negotiated Rate |
$12,507.17 |
| Max. Negotiated Rate |
$29,356.10 |
| Rate for Payer: Aetna Medicare |
$13,692.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,456.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,456.80
|
| Rate for Payer: BCBS MAPPO |
$13,165.44
|
| Rate for Payer: BCBS Trust/PPO |
$29,356.10
|
| Rate for Payer: BCN Commercial |
$29,356.10
|
| Rate for Payer: BCN Medicare Advantage |
$13,165.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,165.44
|
| Rate for Payer: Mclaren Medicare |
$13,165.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,823.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,140.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,481.98
|
| Rate for Payer: Nomi Health Commercial |
$19,393.86
|
| Rate for Payer: PACE Medicare |
$12,507.17
|
| Rate for Payer: PACE SWMI |
$13,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$13,165.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,238.03
|
| Rate for Payer: Priority Health Medicare |
$13,165.44
|
| Rate for Payer: Priority Health Tiered Network |
$19,390.42
|
| Rate for Payer: Railroad Medicare Medicare |
$13,165.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,505.42
|
| Rate for Payer: UHC Core |
$20,501.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,165.44
|
| Rate for Payer: UHC Exchange |
$16,743.37
|
| Rate for Payer: VA VA |
$13,165.44
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$24,947.47
|
|
|
Service Code
|
MSDRG 714
|
| Min. Negotiated Rate |
$8,963.90 |
| Max. Negotiated Rate |
$24,947.47 |
| Rate for Payer: Aetna Medicare |
$9,813.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,794.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,794.60
|
| Rate for Payer: BCBS MAPPO |
$9,435.68
|
| Rate for Payer: BCBS Trust/PPO |
$24,947.47
|
| Rate for Payer: BCN Commercial |
$24,947.47
|
| Rate for Payer: BCN Medicare Advantage |
$9,435.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,435.68
|
| Rate for Payer: Mclaren Medicare |
$9,435.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,907.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,851.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,379.25
|
| Rate for Payer: Nomi Health Commercial |
$13,640.46
|
| Rate for Payer: PACE Medicare |
$8,963.90
|
| Rate for Payer: PACE SWMI |
$9,435.68
|
| Rate for Payer: PHP Medicare Advantage |
$9,435.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,047.55
|
| Rate for Payer: Priority Health Medicare |
$9,435.68
|
| Rate for Payer: Priority Health Tiered Network |
$13,638.04
|
| Rate for Payer: Railroad Medicare Medicare |
$9,435.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,235.62
|
| Rate for Payer: UHC Core |
$14,419.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,435.68
|
| Rate for Payer: UHC Exchange |
$11,776.26
|
| Rate for Payer: VA VA |
$9,435.68
|
|
|
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,592.29
|
| Rate for Payer: BCN Commercial |
$2,592.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 52640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,221.94
|
| Rate for Payer: BCN Commercial |
$2,221.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$17,277.20
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,006.91
|
| Rate for Payer: BCN Commercial |
$3,006.91
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY INJECTIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
|
Facility
|
OP
|
$1,760.51
|
|
|
Service Code
|
CPT 64488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,760.51 |
| Max. Negotiated Rate |
$1,760.51 |
| Rate for Payer: BCBS Trust/PPO |
$1,760.51
|
| Rate for Payer: BCN Commercial |
$1,760.51
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,997.31
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
183257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$6,297.58 |
| Rate for Payer: Aetna American Axle |
$4,548.25
|
| Rate for Payer: Aetna Commercial |
$5,947.71
|
| Rate for Payer: Aetna Medicare |
$76.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,548.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.79
|
| Rate for Payer: BCBS Complete |
$40.33
|
| Rate for Payer: BCBS MAPPO |
$73.43
|
| Rate for Payer: BCBS Trust/PPO |
$238.25
|
| Rate for Payer: BCN Commercial |
$238.25
|
| Rate for Payer: BCN Medicare Advantage |
$73.43
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cofinity Advantage |
$4,898.12
|
| Rate for Payer: Cofinity Commercial |
$6,017.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,597.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.43
|
| Rate for Payer: Healthscope Commercial |
$6,297.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,898.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,247.98
|
| Rate for Payer: Mclaren Medicaid |
$73.43
|
| Rate for Payer: Mclaren Medicare |
$73.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.10
|
| Rate for Payer: Meridian Medicaid |
$77.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,947.71
|
| Rate for Payer: Nomi Health Commercial |
$220.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,247.98
|
| Rate for Payer: PACE Medicare |
$69.76
|
| Rate for Payer: PACE SWMI |
$73.43
|
| Rate for Payer: PHP Commercial |
$5,947.71
|
| Rate for Payer: PHP Medicare Advantage |
$73.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$236.62
|
| Rate for Payer: Priority Health Medicare |
$73.43
|
| Rate for Payer: Priority Health SBD |
$4,408.31
|
| Rate for Payer: Priority Health Tiered Network |
$189.30
|
| Rate for Payer: Railroad Medicare Medicare |
$73.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.24
|
| Rate for Payer: UHC Core |
$121.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.43
|
| Rate for Payer: UHC Exchange |
$121.24
|
| Rate for Payer: UHC Medicaid |
$38.40
|
| Rate for Payer: UHCCP Medicaid |
$38.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,589.00
|
| Rate for Payer: VA VA |
$73.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,247.98
|
|
|
TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION
|
Facility
|
OP
|
$20,991.83
|
|
|
Service Code
|
HCPCS J9356
|
| Hospital Charge Code |
190129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.33 |
| Max. Negotiated Rate |
$18,892.65 |
| Rate for Payer: Aetna American Axle |
$13,644.69
|
| Rate for Payer: Aetna Commercial |
$17,843.06
|
| Rate for Payer: Aetna Medicare |
$62.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,644.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.89
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: BCBS MAPPO |
$59.91
|
| Rate for Payer: BCBS Trust/PPO |
$198.02
|
| Rate for Payer: BCN Commercial |
$198.02
|
| Rate for Payer: BCN Medicare Advantage |
$59.91
|
| Rate for Payer: Cash Price |
$16,793.46
|
| Rate for Payer: Cash Price |
$16,793.46
|
| Rate for Payer: Cofinity Advantage |
$14,694.28
|
| Rate for Payer: Cofinity Commercial |
$18,052.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,793.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.91
|
| Rate for Payer: Healthscope Commercial |
$18,892.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,694.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,743.87
|
| Rate for Payer: Mclaren Medicaid |
$59.91
|
| Rate for Payer: Mclaren Medicare |
$59.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.91
|
| Rate for Payer: Meridian Medicaid |
$62.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,843.06
|
| Rate for Payer: Nomi Health Commercial |
$179.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,743.87
|
| Rate for Payer: PACE Medicare |
$56.91
|
| Rate for Payer: PACE SWMI |
$59.91
|
| Rate for Payer: PHP Commercial |
$17,843.06
|
| Rate for Payer: PHP Medicare Advantage |
$59.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$193.78
|
| Rate for Payer: Priority Health Medicare |
$59.91
|
| Rate for Payer: Priority Health SBD |
$13,224.85
|
| Rate for Payer: Priority Health Tiered Network |
$155.02
|
| Rate for Payer: Railroad Medicare Medicare |
$59.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.77
|
| Rate for Payer: UHC Core |
$100.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.91
|
| Rate for Payer: UHC Exchange |
$100.77
|
| Rate for Payer: UHC Medicaid |
$31.33
|
| Rate for Payer: UHCCP Medicaid |
$31.33
|
| Rate for Payer: UMR Bronson Commercial |
$7,766.98
|
| Rate for Payer: VA VA |
$59.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,743.87
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,671.29
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
190713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$15,004.16 |
| Rate for Payer: Aetna American Axle |
$10,836.34
|
| Rate for Payer: Aetna American Axle |
$10,619.61
|
| Rate for Payer: Aetna Commercial |
$13,887.18
|
| Rate for Payer: Aetna Commercial |
$14,170.60
|
| Rate for Payer: Aetna Medicare |
$58.64
|
| Rate for Payer: Aetna Medicare |
$58.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,619.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,836.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.47
|
| Rate for Payer: BCBS Complete |
$30.96
|
| Rate for Payer: BCBS Complete |
$30.96
|
| Rate for Payer: BCBS MAPPO |
$56.38
|
| Rate for Payer: BCBS MAPPO |
$56.38
|
| Rate for Payer: BCBS Trust/PPO |
$157.73
|
| Rate for Payer: BCBS Trust/PPO |
$157.73
|
| Rate for Payer: BCN Commercial |
$157.73
|
| Rate for Payer: BCN Commercial |
$157.73
|
| Rate for Payer: BCN Medicare Advantage |
$56.38
|
| Rate for Payer: BCN Medicare Advantage |
$56.38
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cash Price |
$13,337.03
|
| Rate for Payer: Cash Price |
$13,337.03
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cofinity Advantage |
$11,669.90
|
| Rate for Payer: Cofinity Advantage |
$11,436.50
|
| Rate for Payer: Cofinity Commercial |
$14,050.56
|
| Rate for Payer: Cofinity Commercial |
$14,337.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,070.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,337.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.38
|
| Rate for Payer: Healthscope Commercial |
$14,704.07
|
| Rate for Payer: Healthscope Commercial |
$15,004.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,669.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,436.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,253.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,503.47
|
| Rate for Payer: Mclaren Medicaid |
$56.38
|
| Rate for Payer: Mclaren Medicaid |
$56.38
|
| Rate for Payer: Mclaren Medicare |
$56.38
|
| Rate for Payer: Mclaren Medicare |
$56.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.20
|
| Rate for Payer: Meridian Medicaid |
$59.20
|
| Rate for Payer: Meridian Medicaid |
$59.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,887.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,170.60
|
| Rate for Payer: Nomi Health Commercial |
$169.14
|
| Rate for Payer: Nomi Health Commercial |
$169.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,503.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,253.40
|
| Rate for Payer: PACE Medicare |
$53.56
|
| Rate for Payer: PACE Medicare |
$53.56
|
| Rate for Payer: PACE SWMI |
$56.38
|
| Rate for Payer: PACE SWMI |
$56.38
|
| Rate for Payer: PHP Commercial |
$13,887.18
|
| Rate for Payer: PHP Commercial |
$14,170.60
|
| Rate for Payer: PHP Medicare Advantage |
$56.38
|
| Rate for Payer: PHP Medicare Advantage |
$56.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$149.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$149.96
|
| Rate for Payer: Priority Health Medicare |
$56.38
|
| Rate for Payer: Priority Health Medicare |
$56.38
|
| Rate for Payer: Priority Health SBD |
$10,292.85
|
| Rate for Payer: Priority Health SBD |
$10,502.91
|
| Rate for Payer: Priority Health Tiered Network |
$119.97
|
| Rate for Payer: Priority Health Tiered Network |
$119.97
|
| Rate for Payer: Railroad Medicare Medicare |
$56.38
|
| Rate for Payer: Railroad Medicare Medicare |
$56.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.88
|
| Rate for Payer: UHC Core |
$84.88
|
| Rate for Payer: UHC Core |
$84.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.38
|
| Rate for Payer: UHC Exchange |
$84.88
|
| Rate for Payer: UHC Exchange |
$84.88
|
| Rate for Payer: UHC Medicaid |
$29.49
|
| Rate for Payer: UHC Medicaid |
$29.49
|
| Rate for Payer: UHCCP Medicaid |
$29.49
|
| Rate for Payer: UHCCP Medicaid |
$29.49
|
| Rate for Payer: UMR Bronson Commercial |
$6,045.01
|
| Rate for Payer: UMR Bronson Commercial |
$6,168.38
|
| Rate for Payer: VA VA |
$56.38
|
| Rate for Payer: VA VA |
$56.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,503.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,253.40
|
|
|
TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10,572.29
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
192041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,651.81 |
| Max. Negotiated Rate |
$9,515.06 |
| Rate for Payer: Aetna American Axle |
$6,871.99
|
| Rate for Payer: Aetna Commercial |
$8,986.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,871.99
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cofinity Advantage |
$7,400.60
|
| Rate for Payer: Cofinity Commercial |
$9,092.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,457.83
|
| Rate for Payer: Healthscope Commercial |
$9,515.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,400.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,929.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,986.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,929.22
|
| Rate for Payer: PHP Commercial |
$8,986.45
|
| Rate for Payer: Priority Health SBD |
$6,660.54
|
| Rate for Payer: UMR Bronson Commercial |
$4,651.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,929.22
|
|
|
TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,572.29
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
192041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$9,515.06 |
| Rate for Payer: Aetna American Axle |
$6,871.99
|
| Rate for Payer: Aetna Commercial |
$8,986.45
|
| Rate for Payer: Aetna Medicare |
$37.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,871.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.73
|
| Rate for Payer: BCBS Complete |
$19.65
|
| Rate for Payer: BCBS MAPPO |
$35.78
|
| Rate for Payer: BCBS Trust/PPO |
$110.53
|
| Rate for Payer: BCN Commercial |
$110.53
|
| Rate for Payer: BCN Medicare Advantage |
$35.78
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cofinity Advantage |
$7,400.60
|
| Rate for Payer: Cofinity Commercial |
$9,092.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,457.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.78
|
| Rate for Payer: Healthscope Commercial |
$9,515.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,400.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,929.22
|
| Rate for Payer: Mclaren Medicaid |
$35.78
|
| Rate for Payer: Mclaren Medicare |
$35.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.57
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,986.45
|
| Rate for Payer: Nomi Health Commercial |
$107.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,929.22
|
| Rate for Payer: PACE Medicare |
$33.99
|
| Rate for Payer: PACE SWMI |
$35.78
|
| Rate for Payer: PHP Commercial |
$8,986.45
|
| Rate for Payer: PHP Medicare Advantage |
$35.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$127.09
|
| Rate for Payer: Priority Health Medicare |
$35.78
|
| Rate for Payer: Priority Health SBD |
$6,660.54
|
| Rate for Payer: Priority Health Tiered Network |
$101.67
|
| Rate for Payer: Railroad Medicare Medicare |
$35.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.22
|
| Rate for Payer: UHC Core |
$62.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.78
|
| Rate for Payer: UHC Exchange |
$62.22
|
| Rate for Payer: UHC Medicaid |
$18.71
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: UMR Bronson Commercial |
$3,911.75
|
| Rate for Payer: VA VA |
$35.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,929.22
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,359.05
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$8,423.15 |
| Rate for Payer: Aetna American Axle |
$6,083.38
|
| Rate for Payer: Aetna Commercial |
$7,955.19
|
| Rate for Payer: Aetna Medicare |
$58.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,083.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.03
|
| Rate for Payer: BCBS Complete |
$30.77
|
| Rate for Payer: BCBS MAPPO |
$56.02
|
| Rate for Payer: BCBS Trust/PPO |
$171.45
|
| Rate for Payer: BCN Commercial |
$171.45
|
| Rate for Payer: BCN Medicare Advantage |
$56.02
|
| Rate for Payer: Cash Price |
$7,487.24
|
| Rate for Payer: Cash Price |
$7,487.24
|
| Rate for Payer: Cofinity Advantage |
$6,551.34
|
| Rate for Payer: Cofinity Commercial |
$8,048.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,487.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.02
|
| Rate for Payer: Healthscope Commercial |
$8,423.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,551.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,019.29
|
| Rate for Payer: Mclaren Medicaid |
$56.02
|
| Rate for Payer: Mclaren Medicare |
$56.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.82
|
| Rate for Payer: Meridian Medicaid |
$58.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,955.19
|
| Rate for Payer: Nomi Health Commercial |
$168.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,019.29
|
| Rate for Payer: PACE Medicare |
$53.22
|
| Rate for Payer: PACE SWMI |
$56.02
|
| Rate for Payer: PHP Commercial |
$7,955.19
|
| Rate for Payer: PHP Medicare Advantage |
$56.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$218.78
|
| Rate for Payer: Priority Health Medicare |
$56.02
|
| Rate for Payer: Priority Health SBD |
$5,896.20
|
| Rate for Payer: Priority Health Tiered Network |
$175.02
|
| Rate for Payer: Railroad Medicare Medicare |
$56.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.46
|
| Rate for Payer: UHC Core |
$91.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.02
|
| Rate for Payer: UHC Exchange |
$91.46
|
| Rate for Payer: UHC Medicaid |
$29.30
|
| Rate for Payer: UHCCP Medicaid |
$29.30
|
| Rate for Payer: UMR Bronson Commercial |
$3,462.85
|
| Rate for Payer: VA VA |
$56.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,019.29
|
|
|
TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,985.55
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
192875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$9,887.00 |
| Rate for Payer: Aetna American Axle |
$7,140.61
|
| Rate for Payer: Aetna Commercial |
$9,337.72
|
| Rate for Payer: Aetna Medicare |
$10.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.04
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS MAPPO |
$10.43
|
| Rate for Payer: BCBS Trust/PPO |
$125.65
|
| Rate for Payer: BCN Commercial |
$125.65
|
| Rate for Payer: BCN Medicare Advantage |
$10.43
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Advantage |
$7,689.89
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,788.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.43
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,689.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,239.16
|
| Rate for Payer: Mclaren Medicaid |
$10.43
|
| Rate for Payer: Mclaren Medicare |
$10.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.95
|
| Rate for Payer: Meridian Medicaid |
$10.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,337.72
|
| Rate for Payer: Nomi Health Commercial |
$31.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,239.16
|
| Rate for Payer: PACE Medicare |
$9.91
|
| Rate for Payer: PACE SWMI |
$10.43
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: PHP Medicare Advantage |
$10.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.28
|
| Rate for Payer: Priority Health Medicare |
$10.43
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
| Rate for Payer: Priority Health Tiered Network |
$70.62
|
| Rate for Payer: Railroad Medicare Medicare |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.55
|
| Rate for Payer: UHC Core |
$13.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.43
|
| Rate for Payer: UHC Exchange |
$13.55
|
| Rate for Payer: UHC Medicaid |
$5.45
|
| Rate for Payer: UHCCP Medicaid |
$5.45
|
| Rate for Payer: UMR Bronson Commercial |
$4,064.65
|
| Rate for Payer: VA VA |
$10.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,239.16
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$26,643.98
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$13,549.50 |
| Max. Negotiated Rate |
$26,643.98 |
| Rate for Payer: Aetna Medicare |
$14,833.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,828.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,828.29
|
| Rate for Payer: BCBS MAPPO |
$14,262.63
|
| Rate for Payer: BCBS Trust/PPO |
$24,354.53
|
| Rate for Payer: BCN Commercial |
$24,354.53
|
| Rate for Payer: BCN Medicare Advantage |
$14,262.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,262.63
|
| Rate for Payer: Mclaren Medicare |
$14,262.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,975.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,402.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,688.89
|
| Rate for Payer: Nomi Health Commercial |
$21,086.34
|
| Rate for Payer: PACE Medicare |
$13,549.50
|
| Rate for Payer: PACE SWMI |
$14,262.63
|
| Rate for Payer: PHP Medicare Advantage |
$14,262.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,353.25
|
| Rate for Payer: Priority Health Medicare |
$14,262.63
|
| Rate for Payer: Priority Health Tiered Network |
$21,082.60
|
| Rate for Payer: Railroad Medicare Medicare |
$14,262.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,643.98
|
| Rate for Payer: UHC Core |
$22,291.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,262.63
|
| Rate for Payer: UHC Exchange |
$18,204.54
|
| Rate for Payer: VA VA |
$14,262.63
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$19,418.84
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$7,598.22 |
| Max. Negotiated Rate |
$19,418.84 |
| Rate for Payer: Aetna Medicare |
$8,318.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,997.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,997.66
|
| Rate for Payer: BCBS MAPPO |
$7,998.13
|
| Rate for Payer: BCBS Trust/PPO |
$19,418.84
|
| Rate for Payer: BCN Commercial |
$19,418.84
|
| Rate for Payer: BCN Medicare Advantage |
$7,998.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,998.13
|
| Rate for Payer: Mclaren Medicare |
$7,998.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,398.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,197.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,797.94
|
| Rate for Payer: Nomi Health Commercial |
$11,422.95
|
| Rate for Payer: PACE Medicare |
$7,598.22
|
| Rate for Payer: PACE SWMI |
$7,998.13
|
| Rate for Payer: PHP Medicare Advantage |
$7,998.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,276.15
|
| Rate for Payer: Priority Health Medicare |
$7,998.13
|
| Rate for Payer: Priority Health Tiered Network |
$11,420.92
|
| Rate for Payer: Railroad Medicare Medicare |
$7,998.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,433.65
|
| Rate for Payer: UHC Core |
$12,075.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,998.13
|
| Rate for Payer: UHC Exchange |
$9,861.81
|
| Rate for Payer: VA VA |
$7,998.13
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$24,071.78
|
|
|
Service Code
|
MSDRG 086
|
| Min. Negotiated Rate |
$10,912.69 |
| Max. Negotiated Rate |
$24,071.78 |
| Rate for Payer: Aetna Medicare |
$11,946.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,358.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,358.80
|
| Rate for Payer: BCBS MAPPO |
$11,487.04
|
| Rate for Payer: BCBS Trust/PPO |
$24,071.78
|
| Rate for Payer: BCN Commercial |
$24,071.78
|
| Rate for Payer: BCN Medicare Advantage |
$11,487.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,487.04
|
| Rate for Payer: Mclaren Medicare |
$11,487.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,061.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,210.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,635.74
|
| Rate for Payer: Nomi Health Commercial |
$16,804.83
|
| Rate for Payer: PACE Medicare |
$10,912.69
|
| Rate for Payer: PACE SWMI |
$11,487.04
|
| Rate for Payer: PHP Medicare Advantage |
$11,487.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,002.31
|
| Rate for Payer: Priority Health Medicare |
$11,487.04
|
| Rate for Payer: Priority Health Tiered Network |
$16,801.85
|
| Rate for Payer: Railroad Medicare Medicare |
$11,487.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,234.01
|
| Rate for Payer: UHC Core |
$17,764.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,487.04
|
| Rate for Payer: UHC Exchange |
$14,508.17
|
| Rate for Payer: VA VA |
$11,487.04
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$29,712.96
|
|
|
Service Code
|
MSDRG 083
|
| Min. Negotiated Rate |
$11,652.34 |
| Max. Negotiated Rate |
$29,712.96 |
| Rate for Payer: Aetna Medicare |
$12,756.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,332.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,332.02
|
| Rate for Payer: BCBS MAPPO |
$12,265.62
|
| Rate for Payer: BCBS Trust/PPO |
$29,712.96
|
| Rate for Payer: BCN Commercial |
$29,712.96
|
| Rate for Payer: BCN Medicare Advantage |
$12,265.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,265.62
|
| Rate for Payer: Mclaren Medicare |
$12,265.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,878.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,105.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,492.18
|
| Rate for Payer: Nomi Health Commercial |
$18,005.82
|
| Rate for Payer: PACE Medicare |
$11,652.34
|
| Rate for Payer: PACE SWMI |
$12,265.62
|
| Rate for Payer: PHP Medicare Advantage |
$12,265.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,503.28
|
| Rate for Payer: Priority Health Medicare |
$12,265.62
|
| Rate for Payer: Priority Health Tiered Network |
$18,002.62
|
| Rate for Payer: Railroad Medicare Medicare |
$12,265.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,751.54
|
| Rate for Payer: UHC Core |
$19,034.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,265.62
|
| Rate for Payer: UHC Exchange |
$15,545.02
|
| Rate for Payer: VA VA |
$12,265.62
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$45,675.72
|
|
|
Service Code
|
MSDRG 085
|
| Min. Negotiated Rate |
$18,612.57 |
| Max. Negotiated Rate |
$45,675.72 |
| Rate for Payer: Aetna Medicare |
$20,375.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,490.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,490.22
|
| Rate for Payer: BCBS MAPPO |
$19,592.18
|
| Rate for Payer: BCBS Trust/PPO |
$45,675.72
|
| Rate for Payer: BCN Commercial |
$45,675.72
|
| Rate for Payer: BCN Medicare Advantage |
$19,592.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,592.18
|
| Rate for Payer: Mclaren Medicare |
$19,592.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,571.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,531.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,551.40
|
| Rate for Payer: Nomi Health Commercial |
$29,307.51
|
| Rate for Payer: PACE Medicare |
$18,612.57
|
| Rate for Payer: PACE SWMI |
$19,592.18
|
| Rate for Payer: PHP Medicare Advantage |
$19,592.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,627.89
|
| Rate for Payer: Priority Health Medicare |
$19,592.18
|
| Rate for Payer: Priority Health Tiered Network |
$29,302.31
|
| Rate for Payer: Railroad Medicare Medicare |
$19,592.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,031.97
|
| Rate for Payer: UHC Core |
$30,981.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,592.18
|
| Rate for Payer: UHC Exchange |
$25,302.15
|
| Rate for Payer: VA VA |
$19,592.18
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$55,440.04
|
|
|
Service Code
|
MSDRG 082
|
| Min. Negotiated Rate |
$18,721.41 |
| Max. Negotiated Rate |
$55,440.04 |
| Rate for Payer: Aetna Medicare |
$20,495.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,633.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,633.44
|
| Rate for Payer: BCBS MAPPO |
$19,706.75
|
| Rate for Payer: BCBS Trust/PPO |
$55,440.04
|
| Rate for Payer: BCN Commercial |
$55,440.04
|
| Rate for Payer: BCN Medicare Advantage |
$19,706.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,706.75
|
| Rate for Payer: Mclaren Medicare |
$19,706.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,692.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,662.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,677.42
|
| Rate for Payer: Nomi Health Commercial |
$29,484.24
|
| Rate for Payer: PACE Medicare |
$18,721.41
|
| Rate for Payer: PACE SWMI |
$19,706.75
|
| Rate for Payer: PHP Medicare Advantage |
$19,706.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,848.76
|
| Rate for Payer: Priority Health Medicare |
$19,706.75
|
| Rate for Payer: Priority Health Tiered Network |
$29,479.01
|
| Rate for Payer: Railroad Medicare Medicare |
$19,706.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,255.28
|
| Rate for Payer: UHC Core |
$31,168.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,706.75
|
| Rate for Payer: UHC Exchange |
$25,454.73
|
| Rate for Payer: VA VA |
$19,706.75
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$16,747.86
|
|
|
Service Code
|
MSDRG 087
|
| Min. Negotiated Rate |
$7,830.21 |
| Max. Negotiated Rate |
$16,747.86 |
| Rate for Payer: Aetna Medicare |
$8,572.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,302.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,302.91
|
| Rate for Payer: BCBS MAPPO |
$8,242.33
|
| Rate for Payer: BCBS Trust/PPO |
$16,747.86
|
| Rate for Payer: BCN Commercial |
$16,747.86
|
| Rate for Payer: BCN Medicare Advantage |
$8,242.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,242.33
|
| Rate for Payer: Mclaren Medicare |
$8,242.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,654.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,478.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,066.56
|
| Rate for Payer: Nomi Health Commercial |
$11,799.63
|
| Rate for Payer: PACE Medicare |
$7,830.21
|
| Rate for Payer: PACE SWMI |
$8,242.33
|
| Rate for Payer: PHP Medicare Advantage |
$8,242.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,746.92
|
| Rate for Payer: Priority Health Medicare |
$8,242.33
|
| Rate for Payer: Priority Health Tiered Network |
$11,797.54
|
| Rate for Payer: Railroad Medicare Medicare |
$8,242.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,909.61
|
| Rate for Payer: UHC Core |
$12,473.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,242.33
|
| Rate for Payer: UHC Exchange |
$10,187.01
|
| Rate for Payer: VA VA |
$8,242.33
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$19,053.74
|
|
|
Service Code
|
MSDRG 084
|
| Min. Negotiated Rate |
$8,156.73 |
| Max. Negotiated Rate |
$19,053.74 |
| Rate for Payer: Aetna Medicare |
$8,929.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,732.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,732.54
|
| Rate for Payer: BCBS MAPPO |
$8,586.03
|
| Rate for Payer: BCBS Trust/PPO |
$19,053.74
|
| Rate for Payer: BCN Commercial |
$19,053.74
|
| Rate for Payer: BCN Medicare Advantage |
$8,586.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,586.03
|
| Rate for Payer: Mclaren Medicare |
$8,586.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,015.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,873.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,444.63
|
| Rate for Payer: Nomi Health Commercial |
$12,329.82
|
| Rate for Payer: PACE Medicare |
$8,156.73
|
| Rate for Payer: PACE SWMI |
$8,586.03
|
| Rate for Payer: PHP Medicare Advantage |
$8,586.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,409.54
|
| Rate for Payer: Priority Health Medicare |
$8,586.03
|
| Rate for Payer: Priority Health Tiered Network |
$12,327.63
|
| Rate for Payer: Railroad Medicare Medicare |
$8,586.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,579.54
|
| Rate for Payer: UHC Core |
$13,034.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,586.03
|
| Rate for Payer: UHC Exchange |
$10,644.74
|
| Rate for Payer: VA VA |
$8,586.03
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$23,995.23
|
|
|
Service Code
|
MSDRG 604
|
| Min. Negotiated Rate |
$12,258.50 |
| Max. Negotiated Rate |
$23,995.23 |
| Rate for Payer: Aetna Medicare |
$13,419.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,129.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,129.60
|
| Rate for Payer: BCBS MAPPO |
$12,903.68
|
| Rate for Payer: BCBS Trust/PPO |
$18,068.25
|
| Rate for Payer: BCN Commercial |
$18,068.25
|
| Rate for Payer: BCN Medicare Advantage |
$12,903.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,903.68
|
| Rate for Payer: Mclaren Medicare |
$12,903.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,548.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,839.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,194.05
|
| Rate for Payer: Nomi Health Commercial |
$18,990.09
|
| Rate for Payer: PACE Medicare |
$12,258.50
|
| Rate for Payer: PACE SWMI |
$12,903.68
|
| Rate for Payer: PHP Medicare Advantage |
$12,903.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,733.40
|
| Rate for Payer: Priority Health Medicare |
$12,903.68
|
| Rate for Payer: Priority Health Tiered Network |
$18,986.72
|
| Rate for Payer: Railroad Medicare Medicare |
$12,903.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,995.23
|
| Rate for Payer: UHC Core |
$20,075.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,903.68
|
| Rate for Payer: UHC Exchange |
$16,394.78
|
| Rate for Payer: VA VA |
$12,903.68
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$15,561.97
|
|
|
Service Code
|
MSDRG 605
|
| Min. Negotiated Rate |
$7,840.54 |
| Max. Negotiated Rate |
$15,561.97 |
| Rate for Payer: Aetna Medicare |
$8,583.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,316.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,316.50
|
| Rate for Payer: BCBS MAPPO |
$8,253.20
|
| Rate for Payer: BCBS Trust/PPO |
$15,561.97
|
| Rate for Payer: BCN Commercial |
$15,561.97
|
| Rate for Payer: BCN Medicare Advantage |
$8,253.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,253.20
|
| Rate for Payer: Mclaren Medicare |
$8,253.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,665.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,491.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,078.52
|
| Rate for Payer: Nomi Health Commercial |
$11,816.40
|
| Rate for Payer: PACE Medicare |
$7,840.54
|
| Rate for Payer: PACE SWMI |
$8,253.20
|
| Rate for Payer: PHP Medicare Advantage |
$8,253.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,767.88
|
| Rate for Payer: Priority Health Medicare |
$8,253.20
|
| Rate for Payer: Priority Health Tiered Network |
$11,814.30
|
| Rate for Payer: Railroad Medicare Medicare |
$8,253.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,930.80
|
| Rate for Payer: UHC Core |
$12,491.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,253.20
|
| Rate for Payer: UHC Exchange |
$10,201.49
|
| Rate for Payer: VA VA |
$8,253.20
|
|
