|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
116307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10.72
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
9116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna American Axle |
$6.97
|
| Rate for Payer: Aetna American Axle |
$7.77
|
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Commercial |
$10.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.77
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cofinity Advantage |
$8.37
|
| Rate for Payer: Cofinity Advantage |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$10.29
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.57
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Healthscope Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.97
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: PHP Commercial |
$10.17
|
| Rate for Payer: Priority Health SBD |
$7.53
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.72
|
| Rate for Payer: UMR Bronson Commercial |
$5.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.97
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11.96
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
9116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna American Axle |
$7.77
|
| Rate for Payer: Aetna American Axle |
$6.97
|
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Commercial |
$10.17
|
| Rate for Payer: Aetna Medicare |
$4.26
|
| Rate for Payer: Aetna Medicare |
$4.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.12
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$4.10
|
| Rate for Payer: BCBS MAPPO |
$4.10
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCN Commercial |
$13.11
|
| Rate for Payer: BCN Commercial |
$13.11
|
| Rate for Payer: BCN Medicare Advantage |
$4.10
|
| Rate for Payer: BCN Medicare Advantage |
$4.10
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Advantage |
$8.37
|
| Rate for Payer: Cofinity Advantage |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Cofinity Commercial |
$10.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.10
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Healthscope Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.97
|
| Rate for Payer: Mclaren Medicaid |
$4.10
|
| Rate for Payer: Mclaren Medicaid |
$4.10
|
| Rate for Payer: Mclaren Medicare |
$4.10
|
| Rate for Payer: Mclaren Medicare |
$4.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.30
|
| Rate for Payer: Meridian Medicaid |
$4.30
|
| Rate for Payer: Meridian Medicaid |
$4.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.04
|
| Rate for Payer: PACE Medicare |
$3.90
|
| Rate for Payer: PACE Medicare |
$3.90
|
| Rate for Payer: PACE SWMI |
$4.10
|
| Rate for Payer: PACE SWMI |
$4.10
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: PHP Commercial |
$10.17
|
| Rate for Payer: PHP Medicare Advantage |
$4.10
|
| Rate for Payer: PHP Medicare Advantage |
$4.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.95
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: Priority Health SBD |
$7.53
|
| Rate for Payer: Priority Health Tiered Network |
$10.36
|
| Rate for Payer: Priority Health Tiered Network |
$10.36
|
| Rate for Payer: Railroad Medicare Medicare |
$4.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC Core |
$6.68
|
| Rate for Payer: UHC Core |
$6.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.10
|
| Rate for Payer: UHC Exchange |
$6.68
|
| Rate for Payer: UHC Exchange |
$6.68
|
| Rate for Payer: UHC Medicaid |
$2.14
|
| Rate for Payer: UHC Medicaid |
$2.14
|
| Rate for Payer: UHCCP Medicaid |
$2.14
|
| Rate for Payer: UHCCP Medicaid |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$3.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.43
|
| Rate for Payer: VA VA |
$4.10
|
| Rate for Payer: VA VA |
$4.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.04
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,245.61
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
24585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$535.09 |
| Max. Negotiated Rate |
$3,821.05 |
| Rate for Payer: Aetna American Axle |
$2,759.65
|
| Rate for Payer: Aetna Commercial |
$3,608.77
|
| Rate for Payer: Aetna Medicare |
$1,064.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,759.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,278.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,278.90
|
| Rate for Payer: BCBS Complete |
$561.90
|
| Rate for Payer: BCBS MAPPO |
$1,023.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,274.26
|
| Rate for Payer: BCN Commercial |
$3,274.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.12
|
| Rate for Payer: Cash Price |
$3,396.49
|
| Rate for Payer: Cash Price |
$3,396.49
|
| Rate for Payer: Cofinity Advantage |
$2,971.93
|
| Rate for Payer: Cofinity Commercial |
$3,651.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,396.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.12
|
| Rate for Payer: Healthscope Commercial |
$3,821.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,971.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,184.21
|
| Rate for Payer: Mclaren Medicaid |
$1,023.12
|
| Rate for Payer: Mclaren Medicare |
$1,023.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.28
|
| Rate for Payer: Meridian Medicaid |
$1,074.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,176.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,125.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,608.77
|
| Rate for Payer: Nomi Health Commercial |
$3,069.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,184.21
|
| Rate for Payer: PACE Medicare |
$971.96
|
| Rate for Payer: PACE SWMI |
$1,023.12
|
| Rate for Payer: PHP Commercial |
$3,608.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,151.97
|
| Rate for Payer: Priority Health Medicare |
$1,023.12
|
| Rate for Payer: Priority Health SBD |
$2,674.73
|
| Rate for Payer: Priority Health Tiered Network |
$2,521.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,023.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,666.09
|
| Rate for Payer: UHC Core |
$1,666.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,023.12
|
| Rate for Payer: UHC Exchange |
$1,666.09
|
| Rate for Payer: UHC Medicaid |
$535.09
|
| Rate for Payer: UHCCP Medicaid |
$535.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,570.88
|
| Rate for Payer: VA VA |
$1,023.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,184.21
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,245.61
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
24585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,868.07 |
| Max. Negotiated Rate |
$3,821.05 |
| Rate for Payer: Aetna American Axle |
$2,759.65
|
| Rate for Payer: Aetna Commercial |
$3,608.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,759.65
|
| Rate for Payer: Cash Price |
$3,396.49
|
| Rate for Payer: Cofinity Advantage |
$2,971.93
|
| Rate for Payer: Cofinity Commercial |
$3,651.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,396.49
|
| Rate for Payer: Healthscope Commercial |
$3,821.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,971.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,184.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,608.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,184.21
|
| Rate for Payer: PHP Commercial |
$3,608.77
|
| Rate for Payer: Priority Health SBD |
$2,674.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,868.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,184.21
|
|
|
ANTI-THYMO IMMUNE GLOBULIN (ATGAM) 5 MCG/0.1 ML TEST DOSE
|
Facility
|
IP
|
$22.54
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
169802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna American Axle |
$14.65
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cofinity Advantage |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.91
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.91
|
|
|
ANTI-THYMO IMMUNE GLOBULIN (ATGAM) 5 MCG/0.1 ML TEST DOSE
|
Facility
|
OP
|
$22.54
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
169802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$17,211.72 |
| Rate for Payer: Aetna American Axle |
$14.65
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Medicare |
$5,504.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,615.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,615.54
|
| Rate for Payer: BCBS Complete |
$2,906.60
|
| Rate for Payer: BCBS MAPPO |
$5,292.43
|
| Rate for Payer: BCBS Trust/PPO |
$17,211.72
|
| Rate for Payer: BCN Commercial |
$17,211.72
|
| Rate for Payer: BCN Medicare Advantage |
$5,292.43
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cofinity Advantage |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,292.43
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.91
|
| Rate for Payer: Mclaren Medicaid |
$5,292.43
|
| Rate for Payer: Mclaren Medicare |
$5,292.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,557.05
|
| Rate for Payer: Meridian Medicaid |
$5,557.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,086.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,821.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Nomi Health Commercial |
$15,877.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.91
|
| Rate for Payer: PACE Medicare |
$5,027.81
|
| Rate for Payer: PACE SWMI |
$5,292.43
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: PHP Medicare Advantage |
$5,292.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,767.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,195.91
|
| Rate for Payer: Priority Health Medicare |
$5,292.43
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health Tiered Network |
$12,956.73
|
| Rate for Payer: Railroad Medicare Medicare |
$5,292.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,758.08
|
| Rate for Payer: UHC Core |
$8,758.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,292.43
|
| Rate for Payer: UHC Exchange |
$8,758.08
|
| Rate for Payer: UHC Medicaid |
$2,767.94
|
| Rate for Payer: UHCCP Medicaid |
$2,767.94
|
| Rate for Payer: UMR Bronson Commercial |
$8.34
|
| Rate for Payer: VA VA |
$5,292.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.91
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION
|
Facility
|
IP
|
$3,775.65
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
188592
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,661.29 |
| Max. Negotiated Rate |
$3,398.09 |
| Rate for Payer: Aetna American Axle |
$2,454.17
|
| Rate for Payer: Aetna Commercial |
$3,209.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,454.17
|
| Rate for Payer: Cash Price |
$3,020.52
|
| Rate for Payer: Cofinity Advantage |
$2,642.95
|
| Rate for Payer: Cofinity Commercial |
$3,247.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,020.52
|
| Rate for Payer: Healthscope Commercial |
$3,398.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,642.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,831.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,209.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,831.74
|
| Rate for Payer: PHP Commercial |
$3,209.30
|
| Rate for Payer: Priority Health SBD |
$2,378.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,661.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,831.74
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION
|
Facility
|
OP
|
$3,775.65
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
188592
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,396.99 |
| Max. Negotiated Rate |
$8,126.51 |
| Rate for Payer: Aetna American Axle |
$2,454.17
|
| Rate for Payer: Aetna Commercial |
$3,209.30
|
| Rate for Payer: Aetna Medicare |
$1,887.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,454.17
|
| Rate for Payer: BCBS Complete |
$1,510.26
|
| Rate for Payer: BCBS Trust/PPO |
$3,389.21
|
| Rate for Payer: BCN Commercial |
$3,389.21
|
| Rate for Payer: Cash Price |
$3,020.52
|
| Rate for Payer: Cash Price |
$3,020.52
|
| Rate for Payer: Cofinity Advantage |
$2,642.95
|
| Rate for Payer: Cofinity Commercial |
$3,247.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,020.52
|
| Rate for Payer: Healthscope Commercial |
$3,398.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,642.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,831.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,020.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,209.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,831.74
|
| Rate for Payer: PHP Commercial |
$3,209.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,296.36
|
| Rate for Payer: Priority Health SBD |
$2,378.66
|
| Rate for Payer: Priority Health Tiered Network |
$2,637.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,126.51
|
| Rate for Payer: UHC Core |
$8,126.51
|
| Rate for Payer: UHC Exchange |
$8,126.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,396.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,831.74
|
|
|
ANTIVENIN LATRODECTUS MACTANS 6,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$123.31
|
|
|
Service Code
|
NDC 00006542402
|
| Hospital Charge Code |
24188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$110.98 |
| Rate for Payer: Aetna American Axle |
$80.15
|
| Rate for Payer: Aetna Commercial |
$104.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.15
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cofinity Advantage |
$86.32
|
| Rate for Payer: Cofinity Commercial |
$106.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.65
|
| Rate for Payer: Healthscope Commercial |
$110.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.48
|
| Rate for Payer: PHP Commercial |
$104.81
|
| Rate for Payer: Priority Health SBD |
$77.69
|
| Rate for Payer: UMR Bronson Commercial |
$54.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.48
|
|
|
ANTIVENIN LATRODECTUS MACTANS 6,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$123.31
|
|
|
Service Code
|
NDC 00006542402
|
| Hospital Charge Code |
24188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$110.98 |
| Rate for Payer: Aetna American Axle |
$80.15
|
| Rate for Payer: Aetna Commercial |
$104.81
|
| Rate for Payer: Aetna Medicare |
$61.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.15
|
| Rate for Payer: BCBS Complete |
$49.32
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cofinity Advantage |
$86.32
|
| Rate for Payer: Cofinity Commercial |
$106.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.65
|
| Rate for Payer: Healthscope Commercial |
$110.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.48
|
| Rate for Payer: PHP Commercial |
$104.81
|
| Rate for Payer: Priority Health SBD |
$77.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.15
|
| Rate for Payer: UHC Core |
$64.24
|
| Rate for Payer: UHC Exchange |
$48.46
|
| Rate for Payer: UMR Bronson Commercial |
$45.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.48
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$126,087.93
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$55,205.19 |
| Max. Negotiated Rate |
$126,087.93 |
| Rate for Payer: Aetna Medicare |
$60,435.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72,638.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72,638.41
|
| Rate for Payer: BCBS MAPPO |
$58,110.73
|
| Rate for Payer: BCBS Trust/PPO |
$126,087.93
|
| Rate for Payer: BCN Commercial |
$126,087.93
|
| Rate for Payer: BCN Medicare Advantage |
$58,110.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58,110.73
|
| Rate for Payer: Mclaren Medicare |
$58,110.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61,016.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66,827.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$63,921.80
|
| Rate for Payer: Nomi Health Commercial |
$88,724.91
|
| Rate for Payer: PACE Medicare |
$55,205.19
|
| Rate for Payer: PACE SWMI |
$58,110.73
|
| Rate for Payer: PHP Medicare Advantage |
$58,110.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$110,886.47
|
| Rate for Payer: Priority Health Medicare |
$58,110.73
|
| Rate for Payer: Priority Health Tiered Network |
$88,709.16
|
| Rate for Payer: Railroad Medicare Medicare |
$58,110.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112,109.77
|
| Rate for Payer: UHC Core |
$93,793.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58,110.73
|
| Rate for Payer: UHC Exchange |
$76,599.17
|
| Rate for Payer: VA VA |
$58,110.73
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$79,097.31
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$34,114.78 |
| Max. Negotiated Rate |
$79,097.31 |
| Rate for Payer: Aetna Medicare |
$37,346.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,887.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,887.86
|
| Rate for Payer: BCBS MAPPO |
$35,910.29
|
| Rate for Payer: BCBS Trust/PPO |
$79,097.31
|
| Rate for Payer: BCN Commercial |
$79,097.31
|
| Rate for Payer: BCN Medicare Advantage |
$35,910.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,910.29
|
| Rate for Payer: Mclaren Medicare |
$35,910.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,705.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,296.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,501.32
|
| Rate for Payer: Nomi Health Commercial |
$54,479.28
|
| Rate for Payer: PACE Medicare |
$34,114.78
|
| Rate for Payer: PACE SWMI |
$35,910.29
|
| Rate for Payer: PHP Medicare Advantage |
$35,910.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$68,087.02
|
| Rate for Payer: Priority Health Medicare |
$35,910.29
|
| Rate for Payer: Priority Health Tiered Network |
$54,469.61
|
| Rate for Payer: Railroad Medicare Medicare |
$35,910.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,838.16
|
| Rate for Payer: UHC Core |
$57,591.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,910.29
|
| Rate for Payer: UHC Exchange |
$47,033.78
|
| Rate for Payer: VA VA |
$35,910.29
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$421.35
|
|
|
Service Code
|
NDC 00003089321
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.90 |
| Max. Negotiated Rate |
$379.21 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.15
|
| Rate for Payer: Aetna Medicare |
$210.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: BCBS Complete |
$168.54
|
| Rate for Payer: Cash Price |
$337.08
|
| Rate for Payer: Cofinity Advantage |
$294.94
|
| Rate for Payer: Cofinity Commercial |
$362.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.08
|
| Rate for Payer: Healthscope Commercial |
$379.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.01
|
| Rate for Payer: PHP Commercial |
$358.15
|
| Rate for Payer: Priority Health SBD |
$265.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.88
|
| Rate for Payer: UHC Core |
$219.52
|
| Rate for Payer: UHC Exchange |
$165.59
|
| Rate for Payer: UMR Bronson Commercial |
$155.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.01
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.99 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UMR Bronson Commercial |
$308.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$421.35
|
|
|
Service Code
|
NDC 00003089321
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$379.21 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: Cash Price |
$337.08
|
| Rate for Payer: Cofinity Advantage |
$294.94
|
| Rate for Payer: Cofinity Commercial |
$362.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.08
|
| Rate for Payer: Healthscope Commercial |
$379.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.01
|
| Rate for Payer: PHP Commercial |
$358.15
|
| Rate for Payer: Priority Health SBD |
$265.45
|
| Rate for Payer: UMR Bronson Commercial |
$185.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.01
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.83 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.46
|
| Rate for Payer: UHC Core |
$365.87
|
| Rate for Payer: UHC Exchange |
$275.98
|
| Rate for Payer: UMR Bronson Commercial |
$259.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.99 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UMR Bronson Commercial |
$308.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.83 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.46
|
| Rate for Payer: UHC Core |
$365.87
|
| Rate for Payer: UHC Exchange |
$275.98
|
| Rate for Payer: UMR Bronson Commercial |
$259.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
IP
|
$421.35
|
|
|
Service Code
|
NDC 00003089421
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$379.21 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: Cash Price |
$337.08
|
| Rate for Payer: Cofinity Advantage |
$294.94
|
| Rate for Payer: Cofinity Commercial |
$362.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.08
|
| Rate for Payer: Healthscope Commercial |
$379.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.01
|
| Rate for Payer: PHP Commercial |
$358.15
|
| Rate for Payer: Priority Health SBD |
$265.45
|
| Rate for Payer: UMR Bronson Commercial |
$185.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.01
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
OP
|
$421.35
|
|
|
Service Code
|
NDC 00003089421
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.90 |
| Max. Negotiated Rate |
$379.21 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.15
|
| Rate for Payer: Aetna Medicare |
$210.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: BCBS Complete |
$168.54
|
| Rate for Payer: Cash Price |
$337.08
|
| Rate for Payer: Cofinity Advantage |
$294.94
|
| Rate for Payer: Cofinity Commercial |
$362.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.08
|
| Rate for Payer: Healthscope Commercial |
$379.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.01
|
| Rate for Payer: PHP Commercial |
$358.15
|
| Rate for Payer: Priority Health SBD |
$265.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.88
|
| Rate for Payer: UHC Core |
$219.52
|
| Rate for Payer: UHC Exchange |
$165.59
|
| Rate for Payer: UMR Bronson Commercial |
$155.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.01
|
|
|
APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (NOT AS SEPARATE PROCEDURE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$372.44
|
|
|
Service Code
|
CPT 44955
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.44 |
| Max. Negotiated Rate |
$372.44 |
| Rate for Payer: BCBS Trust/PPO |
$372.44
|
| Rate for Payer: BCN Commercial |
$372.44
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$21,450.30
|
|
|
Service Code
|
APR-DRG 2334
|
| Min. Negotiated Rate |
$20,428.85 |
| Max. Negotiated Rate |
$21,450.30 |
| Rate for Payer: BCBS Complete |
$21,450.30
|
| Rate for Payer: Mclaren Medicaid |
$20,428.85
|
| Rate for Payer: Meridian Medicaid |
$21,450.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,428.85
|
| Rate for Payer: UHC Medicaid |
$20,428.85
|
| Rate for Payer: UHCCP Medicaid |
$20,428.85
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$13,301.41
|
|
|
Service Code
|
APR-DRG 2333
|
| Min. Negotiated Rate |
$12,668.01 |
| Max. Negotiated Rate |
$13,301.41 |
| Rate for Payer: BCBS Complete |
$13,301.41
|
| Rate for Payer: Mclaren Medicaid |
$12,668.01
|
| Rate for Payer: Meridian Medicaid |
$13,301.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,668.01
|
| Rate for Payer: UHC Medicaid |
$12,668.01
|
| Rate for Payer: UHCCP Medicaid |
$12,668.01
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$8,637.99
|
|
|
Service Code
|
APR-DRG 2332
|
| Min. Negotiated Rate |
$8,226.66 |
| Max. Negotiated Rate |
$8,637.99 |
| Rate for Payer: BCBS Complete |
$8,637.99
|
| Rate for Payer: Mclaren Medicaid |
$8,226.66
|
| Rate for Payer: Meridian Medicaid |
$8,637.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,226.66
|
| Rate for Payer: UHC Medicaid |
$8,226.66
|
| Rate for Payer: UHCCP Medicaid |
$8,226.66
|
|
