|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$131.82
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna American Axle |
$85.68
|
| Rate for Payer: Aetna American Axle |
$53.80
|
| Rate for Payer: Aetna American Axle |
$177.20
|
| Rate for Payer: Aetna Commercial |
$231.73
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.20
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Advantage |
$57.94
|
| Rate for Payer: Cofinity Advantage |
$92.27
|
| Rate for Payer: Cofinity Advantage |
$190.83
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$234.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$245.36
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: PHP Commercial |
$231.73
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: Priority Health SBD |
$83.05
|
| Rate for Payer: Priority Health SBD |
$171.75
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: UMR Bronson Commercial |
$58.00
|
| Rate for Payer: UMR Bronson Commercial |
$36.42
|
| Rate for Payer: UMR Bronson Commercial |
$119.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Aetna American Axle |
$53.80
|
| Rate for Payer: Aetna American Axle |
$85.68
|
| Rate for Payer: Aetna American Axle |
$177.20
|
| Rate for Payer: Aetna American Axle |
$189.21
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Commercial |
$247.43
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$231.73
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: Aetna Medicare |
$136.31
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna Medicare |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.21
|
| Rate for Payer: BCBS Complete |
$52.73
|
| Rate for Payer: BCBS Complete |
$109.05
|
| Rate for Payer: BCBS Complete |
$116.44
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS Trust/PPO |
$66.96
|
| Rate for Payer: BCBS Trust/PPO |
$66.96
|
| Rate for Payer: BCBS Trust/PPO |
$66.96
|
| Rate for Payer: BCBS Trust/PPO |
$66.96
|
| Rate for Payer: BCN Commercial |
$66.96
|
| Rate for Payer: BCN Commercial |
$66.96
|
| Rate for Payer: BCN Commercial |
$66.96
|
| Rate for Payer: BCN Commercial |
$66.96
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cofinity Advantage |
$57.94
|
| Rate for Payer: Cofinity Advantage |
$203.76
|
| Rate for Payer: Cofinity Advantage |
$190.83
|
| Rate for Payer: Cofinity Advantage |
$92.27
|
| Rate for Payer: Cofinity Commercial |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$250.34
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Healthscope Commercial |
$261.98
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Healthscope Commercial |
$245.36
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: PHP Commercial |
$247.43
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$231.73
|
| Rate for Payer: Priority Health SBD |
$183.39
|
| Rate for Payer: Priority Health SBD |
$83.05
|
| Rate for Payer: Priority Health SBD |
$171.75
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Exchange |
$34.07
|
| Rate for Payer: UHC Exchange |
$34.07
|
| Rate for Payer: UHC Exchange |
$34.07
|
| Rate for Payer: UHC Exchange |
$34.07
|
| Rate for Payer: UMR Bronson Commercial |
$30.62
|
| Rate for Payer: UMR Bronson Commercial |
$48.77
|
| Rate for Payer: UMR Bronson Commercial |
$100.87
|
| Rate for Payer: UMR Bronson Commercial |
$107.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
COVID VAC 2025-26 (6MO-11YR)(MODERNA) (PF) 25 MCG/0.25 ML IM SYRINGE
|
Facility
|
IP
|
$409.25
|
|
|
Service Code
|
HCPCS 91321
|
| Hospital Charge Code |
213092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.07 |
| Max. Negotiated Rate |
$368.32 |
| Rate for Payer: Aetna American Axle |
$266.01
|
| Rate for Payer: Aetna Commercial |
$347.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.01
|
| Rate for Payer: Cash Price |
$327.40
|
| Rate for Payer: Cofinity Advantage |
$286.48
|
| Rate for Payer: Cofinity Commercial |
$351.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.40
|
| Rate for Payer: Healthscope Commercial |
$368.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.94
|
| Rate for Payer: PHP Commercial |
$347.86
|
| Rate for Payer: Priority Health SBD |
$257.83
|
| Rate for Payer: UMR Bronson Commercial |
$180.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.94
|
|
|
COVID VAC 2025-26 (6MO-11YR)(MODERNA) (PF) 25 MCG/0.25 ML IM SYRINGE
|
Facility
|
OP
|
$409.25
|
|
|
Service Code
|
HCPCS 91321
|
| Hospital Charge Code |
213092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$410.56 |
| Rate for Payer: Aetna American Axle |
$266.01
|
| Rate for Payer: Aetna Commercial |
$347.86
|
| Rate for Payer: Aetna Medicare |
$204.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.01
|
| Rate for Payer: BCBS Complete |
$163.70
|
| Rate for Payer: BCBS Trust/PPO |
$410.56
|
| Rate for Payer: BCN Commercial |
$410.56
|
| Rate for Payer: Cash Price |
$327.40
|
| Rate for Payer: Cash Price |
$327.40
|
| Rate for Payer: Cofinity Advantage |
$286.48
|
| Rate for Payer: Cofinity Commercial |
$351.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.40
|
| Rate for Payer: Healthscope Commercial |
$368.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.94
|
| Rate for Payer: PHP Commercial |
$347.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$147.06
|
| Rate for Payer: Priority Health SBD |
$257.83
|
| Rate for Payer: Priority Health Tiered Network |
$117.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.65
|
| Rate for Payer: UHC Core |
$242.65
|
| Rate for Payer: UHC Exchange |
$242.65
|
| Rate for Payer: UMR Bronson Commercial |
$151.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.94
|
|
|
COVID VACC 2025-2026 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE
|
Facility
|
OP
|
$329.84
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
213085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$537.67 |
| Rate for Payer: Aetna American Axle |
$214.40
|
| Rate for Payer: Aetna Commercial |
$280.36
|
| Rate for Payer: Aetna Medicare |
$164.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.40
|
| Rate for Payer: BCBS Complete |
$131.94
|
| Rate for Payer: BCBS Trust/PPO |
$537.67
|
| Rate for Payer: BCN Commercial |
$537.67
|
| Rate for Payer: Cash Price |
$263.87
|
| Rate for Payer: Cash Price |
$263.87
|
| Rate for Payer: Cofinity Advantage |
$230.89
|
| Rate for Payer: Cofinity Commercial |
$283.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.87
|
| Rate for Payer: Healthscope Commercial |
$296.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.38
|
| Rate for Payer: PHP Commercial |
$280.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$168.37
|
| Rate for Payer: Priority Health SBD |
$207.80
|
| Rate for Payer: Priority Health Tiered Network |
$134.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.81
|
| Rate for Payer: UHC Core |
$277.81
|
| Rate for Payer: UHC Exchange |
$277.81
|
| Rate for Payer: UMR Bronson Commercial |
$122.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.38
|
|
|
COVID VACC 2025-2026 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE
|
Facility
|
IP
|
$329.84
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
213085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.13 |
| Max. Negotiated Rate |
$296.86 |
| Rate for Payer: Aetna American Axle |
$214.40
|
| Rate for Payer: Aetna Commercial |
$280.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.40
|
| Rate for Payer: Cash Price |
$263.87
|
| Rate for Payer: Cofinity Advantage |
$230.89
|
| Rate for Payer: Cofinity Commercial |
$283.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.87
|
| Rate for Payer: Healthscope Commercial |
$296.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.38
|
| Rate for Payer: PHP Commercial |
$280.36
|
| Rate for Payer: Priority Health SBD |
$207.80
|
| Rate for Payer: UMR Bronson Commercial |
$145.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.38
|
|
|
CPT 0255T
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$351.75 |
| Rate for Payer: Aetna Medicare |
$234.50
|
| Rate for Payer: BCBS Complete |
$187.60
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.75
|
| Rate for Payer: UMR Bronson Commercial |
$215.74
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$31,225.51
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$13,308.78 |
| Max. Negotiated Rate |
$31,225.51 |
| Rate for Payer: Aetna Medicare |
$14,569.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,511.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,511.55
|
| Rate for Payer: BCBS MAPPO |
$14,009.24
|
| Rate for Payer: BCBS Trust/PPO |
$31,225.51
|
| Rate for Payer: BCN Commercial |
$31,225.51
|
| Rate for Payer: BCN Medicare Advantage |
$14,009.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,009.24
|
| Rate for Payer: Mclaren Medicare |
$14,009.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,709.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,110.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,410.16
|
| Rate for Payer: Nomi Health Commercial |
$20,695.47
|
| Rate for Payer: PACE Medicare |
$13,308.78
|
| Rate for Payer: PACE SWMI |
$14,009.24
|
| Rate for Payer: PHP Medicare Advantage |
$14,009.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,864.75
|
| Rate for Payer: Priority Health Medicare |
$14,009.24
|
| Rate for Payer: Priority Health Tiered Network |
$20,691.80
|
| Rate for Payer: Railroad Medicare Medicare |
$14,009.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,150.09
|
| Rate for Payer: UHC Core |
$21,877.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,009.24
|
| Rate for Payer: UHC Exchange |
$17,867.09
|
| Rate for Payer: VA VA |
$14,009.24
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$22,608.64
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$8,752.58 |
| Max. Negotiated Rate |
$22,608.64 |
| Rate for Payer: Aetna Medicare |
$9,581.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,516.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,516.55
|
| Rate for Payer: BCBS MAPPO |
$9,213.24
|
| Rate for Payer: BCBS Trust/PPO |
$22,608.64
|
| Rate for Payer: BCN Commercial |
$22,608.64
|
| Rate for Payer: BCN Medicare Advantage |
$9,213.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,213.24
|
| Rate for Payer: Mclaren Medicare |
$9,213.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,673.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,595.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,134.56
|
| Rate for Payer: Nomi Health Commercial |
$13,297.32
|
| Rate for Payer: PACE Medicare |
$8,752.58
|
| Rate for Payer: PACE SWMI |
$9,213.24
|
| Rate for Payer: PHP Medicare Advantage |
$9,213.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,618.70
|
| Rate for Payer: Priority Health Medicare |
$9,213.24
|
| Rate for Payer: Priority Health Tiered Network |
$13,294.96
|
| Rate for Payer: Railroad Medicare Medicare |
$9,213.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,802.04
|
| Rate for Payer: UHC Core |
$14,057.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,213.24
|
| Rate for Payer: UHC Exchange |
$11,480.02
|
| Rate for Payer: VA VA |
$9,213.24
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$79,127.51
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$25,264.54 |
| Max. Negotiated Rate |
$79,127.51 |
| Rate for Payer: Aetna Medicare |
$27,658.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,242.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,242.81
|
| Rate for Payer: BCBS MAPPO |
$26,594.25
|
| Rate for Payer: BCBS Trust/PPO |
$79,127.51
|
| Rate for Payer: BCN Commercial |
$79,127.51
|
| Rate for Payer: BCN Medicare Advantage |
$26,594.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,594.25
|
| Rate for Payer: Mclaren Medicare |
$26,594.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27,923.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,583.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,253.67
|
| Rate for Payer: Nomi Health Commercial |
$40,108.68
|
| Rate for Payer: PACE Medicare |
$25,264.54
|
| Rate for Payer: PACE SWMI |
$26,594.25
|
| Rate for Payer: PHP Medicare Advantage |
$26,594.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50,126.96
|
| Rate for Payer: Priority Health Medicare |
$26,594.25
|
| Rate for Payer: Priority Health Tiered Network |
$40,101.56
|
| Rate for Payer: Railroad Medicare Medicare |
$26,594.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50,679.96
|
| Rate for Payer: UHC Core |
$42,400.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26,594.25
|
| Rate for Payer: UHC Exchange |
$34,627.16
|
| Rate for Payer: VA VA |
$26,594.25
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$106,210.66
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$36,684.85 |
| Max. Negotiated Rate |
$106,210.66 |
| Rate for Payer: Aetna Medicare |
$40,160.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,269.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,269.54
|
| Rate for Payer: BCBS MAPPO |
$38,615.63
|
| Rate for Payer: BCBS Trust/PPO |
$106,210.66
|
| Rate for Payer: BCN Commercial |
$106,210.66
|
| Rate for Payer: BCN Medicare Advantage |
$38,615.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,615.63
|
| Rate for Payer: Mclaren Medicare |
$38,615.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40,546.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,407.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$42,477.19
|
| Rate for Payer: Nomi Health Commercial |
$58,652.43
|
| Rate for Payer: PACE Medicare |
$36,684.85
|
| Rate for Payer: PACE SWMI |
$38,615.63
|
| Rate for Payer: PHP Medicare Advantage |
$38,615.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73,302.53
|
| Rate for Payer: Priority Health Medicare |
$38,615.63
|
| Rate for Payer: Priority Health Tiered Network |
$58,642.02
|
| Rate for Payer: Railroad Medicare Medicare |
$38,615.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74,111.21
|
| Rate for Payer: UHC Core |
$62,003.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38,615.63
|
| Rate for Payer: UHC Exchange |
$50,636.60
|
| Rate for Payer: VA VA |
$38,615.63
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$71,526.33
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$20,606.65 |
| Max. Negotiated Rate |
$71,526.33 |
| Rate for Payer: Aetna Medicare |
$22,558.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,114.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,114.01
|
| Rate for Payer: BCBS MAPPO |
$21,691.21
|
| Rate for Payer: BCBS Trust/PPO |
$71,526.33
|
| Rate for Payer: BCN Commercial |
$71,526.33
|
| Rate for Payer: BCN Medicare Advantage |
$21,691.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,691.21
|
| Rate for Payer: Mclaren Medicare |
$21,691.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,775.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,944.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,860.33
|
| Rate for Payer: Nomi Health Commercial |
$32,545.41
|
| Rate for Payer: PACE Medicare |
$20,606.65
|
| Rate for Payer: PACE SWMI |
$21,691.21
|
| Rate for Payer: PHP Medicare Advantage |
$21,691.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40,674.55
|
| Rate for Payer: Priority Health Medicare |
$21,691.21
|
| Rate for Payer: Priority Health Tiered Network |
$32,539.63
|
| Rate for Payer: Railroad Medicare Medicare |
$21,691.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,123.27
|
| Rate for Payer: UHC Core |
$34,404.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,691.21
|
| Rate for Payer: UHC Exchange |
$28,097.54
|
| Rate for Payer: VA VA |
$21,691.21
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$30,457.53
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$29,007.17 |
| Max. Negotiated Rate |
$30,457.53 |
| Rate for Payer: BCBS Complete |
$30,457.53
|
| Rate for Payer: Mclaren Medicaid |
$29,007.17
|
| Rate for Payer: Meridian Medicaid |
$30,457.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,007.17
|
| Rate for Payer: UHC Medicaid |
$29,007.17
|
| Rate for Payer: UHCCP Medicaid |
$29,007.17
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$207,334.66
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$54,038.94 |
| Max. Negotiated Rate |
$207,334.66 |
| Rate for Payer: Aetna Medicare |
$59,158.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71,103.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71,103.86
|
| Rate for Payer: BCBS MAPPO |
$56,883.09
|
| Rate for Payer: BCBS Trust/PPO |
$207,334.66
|
| Rate for Payer: BCN Commercial |
$207,334.66
|
| Rate for Payer: BCN Medicare Advantage |
$56,883.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,883.09
|
| Rate for Payer: Mclaren Medicare |
$56,883.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59,727.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65,415.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$62,571.40
|
| Rate for Payer: Nomi Health Commercial |
$86,831.19
|
| Rate for Payer: PACE Medicare |
$54,038.94
|
| Rate for Payer: PACE SWMI |
$56,883.09
|
| Rate for Payer: PHP Medicare Advantage |
$56,883.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$108,519.74
|
| Rate for Payer: Priority Health Medicare |
$56,883.09
|
| Rate for Payer: Priority Health Tiered Network |
$86,815.78
|
| Rate for Payer: Railroad Medicare Medicare |
$56,883.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109,716.93
|
| Rate for Payer: UHC Core |
$91,792.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56,883.09
|
| Rate for Payer: UHC Exchange |
$74,964.26
|
| Rate for Payer: VA VA |
$56,883.09
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$20,884.32
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$19,889.83 |
| Max. Negotiated Rate |
$20,884.32 |
| Rate for Payer: BCBS Complete |
$20,884.32
|
| Rate for Payer: Mclaren Medicaid |
$19,889.83
|
| Rate for Payer: Meridian Medicaid |
$20,884.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,889.83
|
| Rate for Payer: UHC Medicaid |
$19,889.83
|
| Rate for Payer: UHCCP Medicaid |
$19,889.83
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$16,613.14
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$15,822.04 |
| Max. Negotiated Rate |
$16,613.14 |
| Rate for Payer: BCBS Complete |
$16,613.14
|
| Rate for Payer: Mclaren Medicaid |
$15,822.04
|
| Rate for Payer: Meridian Medicaid |
$16,613.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,822.04
|
| Rate for Payer: UHC Medicaid |
$15,822.04
|
| Rate for Payer: UHCCP Medicaid |
$15,822.04
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$35,885.48
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$34,176.65 |
| Max. Negotiated Rate |
$35,885.48 |
| Rate for Payer: BCBS Complete |
$35,885.48
|
| Rate for Payer: Mclaren Medicaid |
$34,176.65
|
| Rate for Payer: Meridian Medicaid |
$35,885.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$34,176.65
|
| Rate for Payer: UHC Medicaid |
$34,176.65
|
| Rate for Payer: UHCCP Medicaid |
$34,176.65
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$123,669.50
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$46,088.02 |
| Max. Negotiated Rate |
$123,669.50 |
| Rate for Payer: Aetna Medicare |
$50,454.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60,642.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60,642.14
|
| Rate for Payer: BCBS MAPPO |
$48,513.71
|
| Rate for Payer: BCBS Trust/PPO |
$123,669.50
|
| Rate for Payer: BCN Commercial |
$123,669.50
|
| Rate for Payer: BCN Medicare Advantage |
$48,513.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48,513.71
|
| Rate for Payer: Mclaren Medicare |
$48,513.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50,939.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55,790.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$53,365.08
|
| Rate for Payer: Nomi Health Commercial |
$73,920.87
|
| Rate for Payer: PACE Medicare |
$46,088.02
|
| Rate for Payer: PACE SWMI |
$48,513.71
|
| Rate for Payer: PHP Medicare Advantage |
$48,513.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92,384.70
|
| Rate for Payer: Priority Health Medicare |
$48,513.71
|
| Rate for Payer: Priority Health Tiered Network |
$73,907.75
|
| Rate for Payer: Railroad Medicare Medicare |
$48,513.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93,403.89
|
| Rate for Payer: UHC Core |
$78,144.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48,513.71
|
| Rate for Payer: UHC Exchange |
$63,818.35
|
| Rate for Payer: VA VA |
$48,513.71
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$96,064.77
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$31,641.65 |
| Max. Negotiated Rate |
$96,064.77 |
| Rate for Payer: Aetna Medicare |
$34,639.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,633.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,633.75
|
| Rate for Payer: BCBS MAPPO |
$33,307.00
|
| Rate for Payer: BCBS Trust/PPO |
$96,064.77
|
| Rate for Payer: BCN Commercial |
$96,064.77
|
| Rate for Payer: BCN Medicare Advantage |
$33,307.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,307.00
|
| Rate for Payer: Mclaren Medicare |
$33,307.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,972.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,303.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$36,637.70
|
| Rate for Payer: Nomi Health Commercial |
$50,463.51
|
| Rate for Payer: PACE Medicare |
$31,641.65
|
| Rate for Payer: PACE SWMI |
$33,307.00
|
| Rate for Payer: PHP Medicare Advantage |
$33,307.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$63,068.20
|
| Rate for Payer: Priority Health Medicare |
$33,307.00
|
| Rate for Payer: Priority Health Tiered Network |
$50,454.55
|
| Rate for Payer: Railroad Medicare Medicare |
$33,307.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63,763.97
|
| Rate for Payer: UHC Core |
$53,346.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33,307.00
|
| Rate for Payer: UHC Exchange |
$43,566.83
|
| Rate for Payer: VA VA |
$33,307.00
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)
|
Facility
|
OP
|
$17,930.33
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$8,168.05
|
| Rate for Payer: BCN Commercial |
$8,168.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,377.65
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
192134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$5,739.89 |
| Rate for Payer: Aetna American Axle |
$4,145.47
|
| Rate for Payer: Aetna Commercial |
$5,421.00
|
| Rate for Payer: Aetna Medicare |
$135.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,145.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.43
|
| Rate for Payer: BCBS Complete |
$71.36
|
| Rate for Payer: BCBS MAPPO |
$129.94
|
| Rate for Payer: BCBS Trust/PPO |
$420.20
|
| Rate for Payer: BCN Commercial |
$420.20
|
| Rate for Payer: BCN Medicare Advantage |
$129.94
|
| Rate for Payer: Cash Price |
$5,102.12
|
| Rate for Payer: Cash Price |
$5,102.12
|
| Rate for Payer: Cofinity Advantage |
$4,464.35
|
| Rate for Payer: Cofinity Commercial |
$5,484.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.94
|
| Rate for Payer: Healthscope Commercial |
$5,739.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,464.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,783.24
|
| Rate for Payer: Mclaren Medicaid |
$129.94
|
| Rate for Payer: Mclaren Medicare |
$129.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.44
|
| Rate for Payer: Meridian Medicaid |
$136.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$142.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,421.00
|
| Rate for Payer: Nomi Health Commercial |
$389.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,783.24
|
| Rate for Payer: PACE Medicare |
$123.44
|
| Rate for Payer: PACE SWMI |
$129.94
|
| Rate for Payer: PHP Commercial |
$5,421.00
|
| Rate for Payer: PHP Medicare Advantage |
$129.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$408.38
|
| Rate for Payer: Priority Health Medicare |
$129.94
|
| Rate for Payer: Priority Health SBD |
$4,017.92
|
| Rate for Payer: Priority Health Tiered Network |
$326.70
|
| Rate for Payer: Railroad Medicare Medicare |
$129.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.82
|
| Rate for Payer: UHC Core |
$213.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$129.94
|
| Rate for Payer: UHC Exchange |
$213.82
|
| Rate for Payer: UHC Medicaid |
$67.96
|
| Rate for Payer: UHCCP Medicaid |
$67.96
|
| Rate for Payer: UMR Bronson Commercial |
$2,359.73
|
| Rate for Payer: VA VA |
$129.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,783.24
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,377.65
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
192134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,806.17 |
| Max. Negotiated Rate |
$5,739.89 |
| Rate for Payer: Aetna American Axle |
$4,145.47
|
| Rate for Payer: Aetna Commercial |
$5,421.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,145.47
|
| Rate for Payer: Cash Price |
$5,102.12
|
| Rate for Payer: Cofinity Advantage |
$4,464.35
|
| Rate for Payer: Cofinity Commercial |
$5,484.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.12
|
| Rate for Payer: Healthscope Commercial |
$5,739.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,464.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,783.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,421.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,783.24
|
| Rate for Payer: PHP Commercial |
$5,421.00
|
| Rate for Payer: Priority Health SBD |
$4,017.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,806.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,783.24
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$213.86
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
108145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.13 |
| Max. Negotiated Rate |
$192.47 |
| Rate for Payer: Aetna American Axle |
$139.01
|
| Rate for Payer: Aetna American Axle |
$143.73
|
| Rate for Payer: Aetna American Axle |
$168.33
|
| Rate for Payer: Aetna Commercial |
$187.96
|
| Rate for Payer: Aetna Commercial |
$220.12
|
| Rate for Payer: Aetna Commercial |
$181.78
|
| Rate for Payer: Aetna Medicare |
$110.56
|
| Rate for Payer: Aetna Medicare |
$106.93
|
| Rate for Payer: Aetna Medicare |
$129.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.01
|
| Rate for Payer: BCBS Complete |
$85.54
|
| Rate for Payer: BCBS Complete |
$88.45
|
| Rate for Payer: BCBS Complete |
$103.59
|
| Rate for Payer: Cash Price |
$171.09
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cash Price |
$207.18
|
| Rate for Payer: Cofinity Advantage |
$181.28
|
| Rate for Payer: Cofinity Advantage |
$149.70
|
| Rate for Payer: Cofinity Advantage |
$154.79
|
| Rate for Payer: Cofinity Commercial |
$190.17
|
| Rate for Payer: Cofinity Commercial |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$222.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.90
|
| Rate for Payer: Healthscope Commercial |
$199.02
|
| Rate for Payer: Healthscope Commercial |
$192.47
|
| Rate for Payer: Healthscope Commercial |
$233.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.23
|
| Rate for Payer: PHP Commercial |
$220.12
|
| Rate for Payer: PHP Commercial |
$187.96
|
| Rate for Payer: PHP Commercial |
$181.78
|
| Rate for Payer: Priority Health SBD |
$139.31
|
| Rate for Payer: Priority Health SBD |
$134.73
|
| Rate for Payer: Priority Health SBD |
$163.15
|
| Rate for Payer: UMR Bronson Commercial |
$95.82
|
| Rate for Payer: UMR Bronson Commercial |
$79.13
|
| Rate for Payer: UMR Bronson Commercial |
$81.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.23
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$213.86
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
108145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.10 |
| Max. Negotiated Rate |
$192.47 |
| Rate for Payer: Aetna American Axle |
$139.01
|
| Rate for Payer: Aetna American Axle |
$168.33
|
| Rate for Payer: Aetna American Axle |
$143.73
|
| Rate for Payer: Aetna Commercial |
$187.96
|
| Rate for Payer: Aetna Commercial |
$181.78
|
| Rate for Payer: Aetna Commercial |
$220.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.73
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cash Price |
$171.09
|
| Rate for Payer: Cash Price |
$207.18
|
| Rate for Payer: Cofinity Advantage |
$181.28
|
| Rate for Payer: Cofinity Advantage |
$149.70
|
| Rate for Payer: Cofinity Advantage |
$154.79
|
| Rate for Payer: Cofinity Commercial |
$222.71
|
| Rate for Payer: Cofinity Commercial |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$190.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.18
|
| Rate for Payer: Healthscope Commercial |
$199.02
|
| Rate for Payer: Healthscope Commercial |
$233.07
|
| Rate for Payer: Healthscope Commercial |
$192.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.23
|
| Rate for Payer: PHP Commercial |
$187.96
|
| Rate for Payer: PHP Commercial |
$181.78
|
| Rate for Payer: PHP Commercial |
$220.12
|
| Rate for Payer: Priority Health SBD |
$134.73
|
| Rate for Payer: Priority Health SBD |
$139.31
|
| Rate for Payer: Priority Health SBD |
$163.15
|
| Rate for Payer: UMR Bronson Commercial |
$94.10
|
| Rate for Payer: UMR Bronson Commercial |
$113.95
|
| Rate for Payer: UMR Bronson Commercial |
$97.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.23
|
|
|
CURETTAGE, POSTPARTUM
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 59160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,491.12
|
| Rate for Payer: BCN Commercial |
$3,491.12
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
