|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
OP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$969.39 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna American Axle |
$1,702.98
|
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna Medicare |
$1,309.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.98
|
| Rate for Payer: BCBS Complete |
$1,047.99
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Advantage |
$1,833.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,833.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,095.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health SBD |
$1,650.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,702.98
|
| Rate for Payer: UHC Core |
$1,365.00
|
| Rate for Payer: UHC Exchange |
$1,029.65
|
| Rate for Payer: UMR Bronson Commercial |
$969.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
IP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,152.79 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna American Axle |
$1,702.98
|
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.98
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Advantage |
$1,833.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,833.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health SBD |
$1,650.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,152.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONJUGATED ESTROGENS 1.25 MG TABLET
|
Facility
|
IP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110481
|
| Hospital Charge Code |
2938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,152.79 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna American Axle |
$1,702.98
|
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.98
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Advantage |
$1,833.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,833.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health SBD |
$1,650.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,152.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONJUGATED ESTROGENS 1.25 MG TABLET
|
Facility
|
OP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110481
|
| Hospital Charge Code |
2938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$969.39 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna American Axle |
$1,702.98
|
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna Medicare |
$1,309.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.98
|
| Rate for Payer: BCBS Complete |
$1,047.99
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Advantage |
$1,833.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,833.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,964.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,095.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health SBD |
$1,650.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,702.98
|
| Rate for Payer: UHC Core |
$1,365.00
|
| Rate for Payer: UHC Exchange |
$1,029.65
|
| Rate for Payer: UMR Bronson Commercial |
$969.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,964.98
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,207.62
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$531.35 |
| Max. Negotiated Rate |
$1,086.86 |
| Rate for Payer: Aetna American Axle |
$784.95
|
| Rate for Payer: Aetna Commercial |
$1,026.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$784.95
|
| Rate for Payer: Cash Price |
$966.10
|
| Rate for Payer: Cofinity Advantage |
$845.33
|
| Rate for Payer: Cofinity Commercial |
$1,038.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.10
|
| Rate for Payer: Healthscope Commercial |
$1,086.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$845.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$905.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.72
|
| Rate for Payer: PHP Commercial |
$1,026.48
|
| Rate for Payer: Priority Health SBD |
$760.80
|
| Rate for Payer: UMR Bronson Commercial |
$531.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$905.72
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$1,207.62
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.87 |
| Max. Negotiated Rate |
$1,270.33 |
| Rate for Payer: Aetna American Axle |
$784.95
|
| Rate for Payer: Aetna Commercial |
$1,026.48
|
| Rate for Payer: Aetna Medicare |
$407.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$784.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.65
|
| Rate for Payer: BCBS Complete |
$215.13
|
| Rate for Payer: BCBS MAPPO |
$391.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,270.33
|
| Rate for Payer: BCN Commercial |
$1,270.33
|
| Rate for Payer: BCN Medicare Advantage |
$391.72
|
| Rate for Payer: Cash Price |
$966.10
|
| Rate for Payer: Cash Price |
$966.10
|
| Rate for Payer: Cofinity Advantage |
$845.33
|
| Rate for Payer: Cofinity Commercial |
$1,038.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.72
|
| Rate for Payer: Healthscope Commercial |
$1,086.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$845.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$905.72
|
| Rate for Payer: Mclaren Medicaid |
$391.72
|
| Rate for Payer: Mclaren Medicare |
$391.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.31
|
| Rate for Payer: Meridian Medicaid |
$411.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$430.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.48
|
| Rate for Payer: Nomi Health Commercial |
$1,175.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.72
|
| Rate for Payer: PACE Medicare |
$372.13
|
| Rate for Payer: PACE SWMI |
$391.72
|
| Rate for Payer: PHP Commercial |
$1,026.48
|
| Rate for Payer: PHP Medicare Advantage |
$391.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,236.55
|
| Rate for Payer: Priority Health Medicare |
$391.72
|
| Rate for Payer: Priority Health SBD |
$760.80
|
| Rate for Payer: Priority Health Tiered Network |
$989.24
|
| Rate for Payer: Railroad Medicare Medicare |
$391.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.40
|
| Rate for Payer: UHC Core |
$646.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$391.72
|
| Rate for Payer: UHC Exchange |
$646.40
|
| Rate for Payer: UHC Medicaid |
$204.87
|
| Rate for Payer: UHCCP Medicaid |
$204.87
|
| Rate for Payer: UMR Bronson Commercial |
$446.82
|
| Rate for Payer: VA VA |
$391.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$905.72
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$5,538.72
|
|
|
Service Code
|
APR-DRG 3461
|
| Min. Negotiated Rate |
$5,274.98 |
| Max. Negotiated Rate |
$5,538.72 |
| Rate for Payer: BCBS Complete |
$5,538.72
|
| Rate for Payer: Mclaren Medicaid |
$5,274.98
|
| Rate for Payer: Meridian Medicaid |
$5,538.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,274.98
|
| Rate for Payer: UHC Medicaid |
$5,274.98
|
| Rate for Payer: UHCCP Medicaid |
$5,274.98
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$6,614.99
|
|
|
Service Code
|
APR-DRG 3462
|
| Min. Negotiated Rate |
$6,299.99 |
| Max. Negotiated Rate |
$6,614.99 |
| Rate for Payer: BCBS Complete |
$6,614.99
|
| Rate for Payer: Mclaren Medicaid |
$6,299.99
|
| Rate for Payer: Meridian Medicaid |
$6,614.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,299.99
|
| Rate for Payer: UHC Medicaid |
$6,299.99
|
| Rate for Payer: UHCCP Medicaid |
$6,299.99
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$16,952.13
|
|
|
Service Code
|
APR-DRG 3464
|
| Min. Negotiated Rate |
$16,144.88 |
| Max. Negotiated Rate |
$16,952.13 |
| Rate for Payer: BCBS Complete |
$16,952.13
|
| Rate for Payer: Mclaren Medicaid |
$16,144.88
|
| Rate for Payer: Meridian Medicaid |
$16,952.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,144.88
|
| Rate for Payer: UHC Medicaid |
$16,144.88
|
| Rate for Payer: UHCCP Medicaid |
$16,144.88
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$9,137.99
|
|
|
Service Code
|
APR-DRG 3463
|
| Min. Negotiated Rate |
$8,702.84 |
| Max. Negotiated Rate |
$9,137.99 |
| Rate for Payer: BCBS Complete |
$9,137.99
|
| Rate for Payer: Mclaren Medicaid |
$8,702.84
|
| Rate for Payer: Meridian Medicaid |
$9,137.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,702.84
|
| Rate for Payer: UHC Medicaid |
$8,702.84
|
| Rate for Payer: UHCCP Medicaid |
$8,702.84
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$28,200.41
|
|
|
Service Code
|
MSDRG 546
|
| Min. Negotiated Rate |
$9,726.57 |
| Max. Negotiated Rate |
$28,200.41 |
| Rate for Payer: Aetna Medicare |
$10,648.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,798.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,798.11
|
| Rate for Payer: BCBS MAPPO |
$10,238.49
|
| Rate for Payer: BCBS Trust/PPO |
$28,200.41
|
| Rate for Payer: BCN Commercial |
$28,200.41
|
| Rate for Payer: BCN Medicare Advantage |
$10,238.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,238.49
|
| Rate for Payer: Mclaren Medicare |
$10,238.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,750.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,774.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,262.34
|
| Rate for Payer: Nomi Health Commercial |
$14,878.86
|
| Rate for Payer: PACE Medicare |
$9,726.57
|
| Rate for Payer: PACE SWMI |
$10,238.49
|
| Rate for Payer: PHP Medicare Advantage |
$10,238.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,595.28
|
| Rate for Payer: Priority Health Medicare |
$10,238.49
|
| Rate for Payer: Priority Health Tiered Network |
$14,876.22
|
| Rate for Payer: Railroad Medicare Medicare |
$10,238.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,800.42
|
| Rate for Payer: UHC Core |
$15,728.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,238.49
|
| Rate for Payer: UHC Exchange |
$12,845.42
|
| Rate for Payer: VA VA |
$10,238.49
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$57,644.35
|
|
|
Service Code
|
MSDRG 545
|
| Min. Negotiated Rate |
$20,279.35 |
| Max. Negotiated Rate |
$57,644.35 |
| Rate for Payer: Aetna Medicare |
$22,200.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,683.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,683.35
|
| Rate for Payer: BCBS MAPPO |
$21,346.68
|
| Rate for Payer: BCBS Trust/PPO |
$57,644.35
|
| Rate for Payer: BCN Commercial |
$57,644.35
|
| Rate for Payer: BCN Medicare Advantage |
$21,346.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,346.68
|
| Rate for Payer: Mclaren Medicare |
$21,346.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,414.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,548.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,481.35
|
| Rate for Payer: Nomi Health Commercial |
$32,013.93
|
| Rate for Payer: PACE Medicare |
$20,279.35
|
| Rate for Payer: PACE SWMI |
$21,346.68
|
| Rate for Payer: PHP Medicare Advantage |
$21,346.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40,010.31
|
| Rate for Payer: Priority Health Medicare |
$21,346.68
|
| Rate for Payer: Priority Health Tiered Network |
$32,008.25
|
| Rate for Payer: Railroad Medicare Medicare |
$21,346.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,451.71
|
| Rate for Payer: UHC Core |
$33,842.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,346.68
|
| Rate for Payer: UHC Exchange |
$27,638.69
|
| Rate for Payer: VA VA |
$21,346.68
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,921.58
|
|
|
Service Code
|
MSDRG 547
|
| Min. Negotiated Rate |
$7,206.57 |
| Max. Negotiated Rate |
$22,921.58 |
| Rate for Payer: Aetna Medicare |
$7,889.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,482.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,482.33
|
| Rate for Payer: BCBS MAPPO |
$7,585.86
|
| Rate for Payer: BCBS Trust/PPO |
$22,921.58
|
| Rate for Payer: BCN Commercial |
$22,921.58
|
| Rate for Payer: BCN Medicare Advantage |
$7,585.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,585.86
|
| Rate for Payer: Mclaren Medicare |
$7,585.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,965.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,723.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,344.45
|
| Rate for Payer: Nomi Health Commercial |
$10,786.98
|
| Rate for Payer: PACE Medicare |
$7,206.57
|
| Rate for Payer: PACE SWMI |
$7,585.86
|
| Rate for Payer: PHP Medicare Advantage |
$7,585.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,481.33
|
| Rate for Payer: Priority Health Medicare |
$7,585.86
|
| Rate for Payer: Priority Health Tiered Network |
$10,785.07
|
| Rate for Payer: Railroad Medicare Medicare |
$7,585.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,630.06
|
| Rate for Payer: UHC Core |
$11,403.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,585.86
|
| Rate for Payer: UHC Exchange |
$9,312.76
|
| Rate for Payer: VA VA |
$7,585.86
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$428.73
|
|
|
Service Code
|
CPT 30903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$282.34
|
| Rate for Payer: BCN Commercial |
$282.34
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$428.73
|
|
|
Service Code
|
CPT 30901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$216.94
|
| Rate for Payer: BCN Commercial |
$216.94
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
OP
|
$428.73
|
|
|
Service Code
|
CPT 30905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$301.27
|
| Rate for Payer: BCN Commercial |
$301.27
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); SIMPLE
|
Facility
|
OP
|
$1,737.88
|
|
|
Service Code
|
CPT 42960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.05 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$618.99
|
| Rate for Payer: BCN Commercial |
$618.99
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Mclaren Medicaid |
$537.39
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); WITH SECONDARY SURGICAL INTERVENTION
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42962
|
|
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 |
$4,494.74
|
| Rate for Payer: BCN Commercial |
$4,494.74
|
| 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
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$8,674.91
|
|
|
Service Code
|
APR-DRG 3843
|
| Min. Negotiated Rate |
$8,261.82 |
| Max. Negotiated Rate |
$8,674.91 |
| Rate for Payer: BCBS Complete |
$8,674.91
|
| Rate for Payer: Mclaren Medicaid |
$8,261.82
|
| Rate for Payer: Meridian Medicaid |
$8,674.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,261.82
|
| Rate for Payer: UHC Medicaid |
$8,261.82
|
| Rate for Payer: UHCCP Medicaid |
$8,261.82
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$5,394.66
|
|
|
Service Code
|
APR-DRG 3842
|
| Min. Negotiated Rate |
$5,137.77 |
| Max. Negotiated Rate |
$5,394.66 |
| Rate for Payer: BCBS Complete |
$5,394.66
|
| Rate for Payer: Mclaren Medicaid |
$5,137.77
|
| Rate for Payer: Meridian Medicaid |
$5,394.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,137.77
|
| Rate for Payer: UHC Medicaid |
$5,137.77
|
| Rate for Payer: UHCCP Medicaid |
$5,137.77
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$15,648.26
|
|
|
Service Code
|
APR-DRG 3844
|
| Min. Negotiated Rate |
$14,903.10 |
| Max. Negotiated Rate |
$15,648.26 |
| Rate for Payer: BCBS Complete |
$15,648.26
|
| Rate for Payer: Mclaren Medicaid |
$14,903.10
|
| Rate for Payer: Meridian Medicaid |
$15,648.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,903.10
|
| Rate for Payer: UHC Medicaid |
$14,903.10
|
| Rate for Payer: UHCCP Medicaid |
$14,903.10
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$4,292.36
|
|
|
Service Code
|
APR-DRG 3841
|
| Min. Negotiated Rate |
$4,087.96 |
| Max. Negotiated Rate |
$4,292.36 |
| Rate for Payer: BCBS Complete |
$4,292.36
|
| Rate for Payer: Mclaren Medicaid |
$4,087.96
|
| Rate for Payer: Meridian Medicaid |
$4,292.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,087.96
|
| Rate for Payer: UHC Medicaid |
$4,087.96
|
| Rate for Payer: UHCCP Medicaid |
$4,087.96
|
|
|
CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 27132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$13,761.04
|
| Rate for Payer: BCN Commercial |
$13,761.04
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23,588.67
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
184552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$21,229.80 |
| Rate for Payer: Aetna American Axle |
$15,332.64
|
| Rate for Payer: Aetna Commercial |
$20,050.37
|
| Rate for Payer: Aetna Medicare |
$11,794.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,332.64
|
| Rate for Payer: BCBS Complete |
$9,435.47
|
| Rate for Payer: BCBS Trust/PPO |
$275.36
|
| Rate for Payer: BCN Commercial |
$275.36
|
| Rate for Payer: Cash Price |
$18,870.94
|
| Rate for Payer: Cash Price |
$18,870.94
|
| Rate for Payer: Cofinity Advantage |
$16,512.07
|
| Rate for Payer: Cofinity Commercial |
$20,286.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,870.94
|
| Rate for Payer: Healthscope Commercial |
$21,229.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,512.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,691.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,870.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,050.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,691.50
|
| Rate for Payer: PHP Commercial |
$20,050.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.81
|
| Rate for Payer: Priority Health SBD |
$14,860.86
|
| Rate for Payer: Priority Health Tiered Network |
$74.25
|
| Rate for Payer: UMR Bronson Commercial |
$8,727.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,691.50
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23,588.67
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
184552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,379.01 |
| Max. Negotiated Rate |
$21,229.80 |
| Rate for Payer: Aetna American Axle |
$15,332.64
|
| Rate for Payer: Aetna Commercial |
$20,050.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,332.64
|
| Rate for Payer: Cash Price |
$18,870.94
|
| Rate for Payer: Cofinity Advantage |
$16,512.07
|
| Rate for Payer: Cofinity Commercial |
$20,286.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,870.94
|
| Rate for Payer: Healthscope Commercial |
$21,229.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,512.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,691.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,050.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,691.50
|
| Rate for Payer: PHP Commercial |
$20,050.37
|
| Rate for Payer: Priority Health SBD |
$14,860.86
|
| Rate for Payer: UMR Bronson Commercial |
$10,379.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,691.50
|
|
