|
ADENOSINE 6 MG/500 ML NS IV
|
Facility
IP
|
$236.64
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
151053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$212.98 |
| Rate for Payer: Aetna American Axle |
$153.82
|
| Rate for Payer: Aetna Commercial |
$201.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.82
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Commercial |
$165.65
|
| Rate for Payer: Cofinity Commercial |
$203.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Healthscope Commercial |
$212.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.14
|
| Rate for Payer: PHP Commercial |
$201.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.65
|
| Rate for Payer: Priority Health SBD |
$149.08
|
| Rate for Payer: UMR Bronson Commercial |
$104.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.48
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$1,000.71
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
15330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$440.31 |
| Max. Negotiated Rate |
$900.64 |
| Rate for Payer: Aetna American Axle |
$650.46
|
| Rate for Payer: Aetna American Axle |
$86.03
|
| Rate for Payer: Aetna American Axle |
$103.87
|
| Rate for Payer: Aetna American Axle |
$52.06
|
| Rate for Payer: Aetna American Axle |
$49.55
|
| Rate for Payer: Aetna American Axle |
$273.93
|
| Rate for Payer: Aetna American Axle |
$111.07
|
| Rate for Payer: Aetna American Axle |
$122.44
|
| Rate for Payer: Aetna American Axle |
$185.94
|
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Commercial |
$850.60
|
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Commercial |
$358.22
|
| Rate for Payer: Aetna Commercial |
$243.15
|
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna Commercial |
$160.11
|
| Rate for Payer: Aetna Commercial |
$68.08
|
| Rate for Payer: Aetna Commercial |
$145.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.55
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Cash Price |
$800.57
|
| Rate for Payer: Cash Price |
$228.85
|
| Rate for Payer: Cash Price |
$64.08
|
| Rate for Payer: Cash Price |
$136.70
|
| Rate for Payer: Cash Price |
$337.14
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cash Price |
$105.88
|
| Rate for Payer: Cofinity Commercial |
$362.43
|
| Rate for Payer: Cofinity Commercial |
$162.00
|
| Rate for Payer: Cofinity Commercial |
$131.86
|
| Rate for Payer: Cofinity Commercial |
$92.64
|
| Rate for Payer: Cofinity Commercial |
$113.82
|
| Rate for Payer: Cofinity Commercial |
$860.61
|
| Rate for Payer: Cofinity Commercial |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Cofinity Commercial |
$295.00
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$246.01
|
| Rate for Payer: Cofinity Commercial |
$200.24
|
| Rate for Payer: Cofinity Commercial |
$700.50
|
| Rate for Payer: Cofinity Commercial |
$119.62
|
| Rate for Payer: Cofinity Commercial |
$146.96
|
| Rate for Payer: Cofinity Commercial |
$53.36
|
| Rate for Payer: Cofinity Commercial |
$65.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.98
|
| Rate for Payer: Healthscope Commercial |
$68.61
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$379.29
|
| Rate for Payer: Healthscope Commercial |
$153.79
|
| Rate for Payer: Healthscope Commercial |
$169.53
|
| Rate for Payer: Healthscope Commercial |
$900.64
|
| Rate for Payer: Healthscope Commercial |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$119.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$700.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.25
|
| Rate for Payer: PHP Commercial |
$64.80
|
| Rate for Payer: PHP Commercial |
$850.60
|
| Rate for Payer: PHP Commercial |
$112.50
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: PHP Commercial |
$145.25
|
| Rate for Payer: PHP Commercial |
$160.11
|
| Rate for Payer: PHP Commercial |
$243.15
|
| Rate for Payer: PHP Commercial |
$358.22
|
| Rate for Payer: PHP Commercial |
$68.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.86
|
| Rate for Payer: Priority Health SBD |
$107.65
|
| Rate for Payer: Priority Health SBD |
$630.45
|
| Rate for Payer: Priority Health SBD |
$265.50
|
| Rate for Payer: Priority Health SBD |
$50.46
|
| Rate for Payer: Priority Health SBD |
$118.67
|
| Rate for Payer: Priority Health SBD |
$48.02
|
| Rate for Payer: Priority Health SBD |
$180.22
|
| Rate for Payer: Priority Health SBD |
$100.67
|
| Rate for Payer: Priority Health SBD |
$83.38
|
| Rate for Payer: UMR Bronson Commercial |
$33.54
|
| Rate for Payer: UMR Bronson Commercial |
$58.23
|
| Rate for Payer: UMR Bronson Commercial |
$70.31
|
| Rate for Payer: UMR Bronson Commercial |
$440.31
|
| Rate for Payer: UMR Bronson Commercial |
$82.88
|
| Rate for Payer: UMR Bronson Commercial |
$125.87
|
| Rate for Payer: UMR Bronson Commercial |
$185.43
|
| Rate for Payer: UMR Bronson Commercial |
$75.19
|
| Rate for Payer: UMR Bronson Commercial |
$35.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM
|
Facility
OP
|
$10,039.01
|
|
|
Service Code
|
CPT 14301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$852.99 |
| Max. Negotiated Rate |
$10,039.01 |
| Rate for Payer: Aetna Medicare |
$3,316.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,986.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,986.20
|
| Rate for Payer: BCBS Complete |
$1,831.74
|
| Rate for Payer: BCBS MAPPO |
$3,188.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,009.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,188.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,188.96
|
| Rate for Payer: Mclaren Medicaid |
$1,744.36
|
| Rate for Payer: Mclaren Medicare |
$3,188.96
|
| Rate for Payer: Meridian Medicaid |
$1,831.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,348.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,667.30
|
| Rate for Payer: PACE Medicare |
$3,029.51
|
| Rate for Payer: PACE SWMI |
$3,188.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,188.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,744.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,039.01
|
| Rate for Payer: Priority Health Medicare |
$3,188.96
|
| Rate for Payer: Priority Health Narrow Network |
$8,031.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3,188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$938.29
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,188.96
|
| Rate for Payer: UHC Exchange |
$852.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,284.63
|
| Rate for Payer: VA VA |
$3,188.96
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
OP
|
$770.99
|
|
|
Service Code
|
CPT 14302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$770.99 |
| Rate for Payer: BCBS Trust/PPO |
$770.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.52
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$209.56
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
OP
|
$5,102.91
|
|
|
Service Code
|
CPT 14061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$803.22 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,592.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$883.54
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$803.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS
|
Facility
OP
|
$5,102.91
|
|
|
Service Code
|
CPT 14060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$653.25 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.58
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$653.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
OP
|
$5,102.91
|
|
|
Service Code
|
CPT 14041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$747.88 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.67
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$747.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS
|
Facility
OP
|
$5,102.91
|
|
|
Service Code
|
CPT 14040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$613.30 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,969.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$674.63
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$613.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ CM OR LESS
|
Facility
OP
|
$5,102.91
|
|
|
Service Code
|
CPT 14020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$558.62 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.48
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$558.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
|
Facility
OP
|
$5,102.91
|
|
|
Service Code
|
CPT 14000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$497.71 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.48
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$497.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$17,473.96
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,688.54 |
| Max. Negotiated Rate |
$15,726.56 |
| Rate for Payer: Aetna American Axle |
$11,358.07
|
| Rate for Payer: Aetna Commercial |
$14,852.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,358.07
|
| Rate for Payer: Cash Price |
$13,979.17
|
| Rate for Payer: Cofinity Commercial |
$12,231.77
|
| Rate for Payer: Cofinity Commercial |
$15,027.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,979.17
|
| Rate for Payer: Healthscope Commercial |
$15,726.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,231.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,105.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,852.87
|
| Rate for Payer: PHP Commercial |
$14,852.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,231.77
|
| Rate for Payer: Priority Health SBD |
$11,008.59
|
| Rate for Payer: UMR Bronson Commercial |
$7,688.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,105.47
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION
|
Facility
OP
|
$17,473.96
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$15,726.56 |
| Rate for Payer: Aetna American Axle |
$11,358.07
|
| Rate for Payer: Aetna Commercial |
$14,852.87
|
| Rate for Payer: Aetna Medicare |
$39.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,358.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.96
|
| Rate for Payer: BCBS Complete |
$22.04
|
| Rate for Payer: BCBS MAPPO |
$38.37
|
| Rate for Payer: BCBS Trust/PPO |
$123.98
|
| Rate for Payer: BCN Medicare Advantage |
$38.37
|
| Rate for Payer: Cash Price |
$13,979.17
|
| Rate for Payer: Cash Price |
$13,979.17
|
| Rate for Payer: Cofinity Commercial |
$15,027.61
|
| Rate for Payer: Cofinity Commercial |
$12,231.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,979.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.37
|
| Rate for Payer: Healthscope Commercial |
$15,726.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,231.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,105.47
|
| Rate for Payer: Mclaren Medicaid |
$20.99
|
| Rate for Payer: Mclaren Medicare |
$38.37
|
| Rate for Payer: Meridian Medicaid |
$22.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,852.87
|
| Rate for Payer: PACE Medicare |
$36.45
|
| Rate for Payer: PACE SWMI |
$38.37
|
| Rate for Payer: PHP Commercial |
$14,852.87
|
| Rate for Payer: PHP Medicare Advantage |
$38.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,231.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.61
|
| Rate for Payer: Priority Health Medicare |
$38.37
|
| Rate for Payer: Priority Health Narrow Network |
$90.09
|
| Rate for Payer: Priority Health SBD |
$11,008.59
|
| Rate for Payer: Railroad Medicare Medicare |
$38.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.37
|
| Rate for Payer: UHC Medicare Advantage |
$39.52
|
| Rate for Payer: UMR Bronson Commercial |
$6,465.37
|
| Rate for Payer: VA VA |
$38.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,105.47
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION
|
Facility
OP
|
$27,958.29
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$25,162.46 |
| Rate for Payer: Aetna American Axle |
$18,172.89
|
| Rate for Payer: Aetna Commercial |
$23,764.55
|
| Rate for Payer: Aetna Medicare |
$39.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,172.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.96
|
| Rate for Payer: BCBS Complete |
$22.04
|
| Rate for Payer: BCBS MAPPO |
$38.37
|
| Rate for Payer: BCBS Trust/PPO |
$123.98
|
| Rate for Payer: BCN Medicare Advantage |
$38.37
|
| Rate for Payer: Cash Price |
$22,366.63
|
| Rate for Payer: Cash Price |
$22,366.63
|
| Rate for Payer: Cofinity Commercial |
$19,570.80
|
| Rate for Payer: Cofinity Commercial |
$24,044.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,366.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.37
|
| Rate for Payer: Healthscope Commercial |
$25,162.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,570.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,968.72
|
| Rate for Payer: Mclaren Medicaid |
$20.99
|
| Rate for Payer: Mclaren Medicare |
$38.37
|
| Rate for Payer: Meridian Medicaid |
$22.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,764.55
|
| Rate for Payer: PACE Medicare |
$36.45
|
| Rate for Payer: PACE SWMI |
$38.37
|
| Rate for Payer: PHP Commercial |
$23,764.55
|
| Rate for Payer: PHP Medicare Advantage |
$38.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,570.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.61
|
| Rate for Payer: Priority Health Medicare |
$38.37
|
| Rate for Payer: Priority Health Narrow Network |
$90.09
|
| Rate for Payer: Priority Health SBD |
$17,613.72
|
| Rate for Payer: Railroad Medicare Medicare |
$38.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.37
|
| Rate for Payer: UHC Medicare Advantage |
$39.52
|
| Rate for Payer: UMR Bronson Commercial |
$10,344.57
|
| Rate for Payer: VA VA |
$38.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,968.72
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
IP
|
$60,957.93
|
|
|
Service Code
|
MS-DRG 614
|
| Min. Negotiated Rate |
$16,975.96 |
| Max. Negotiated Rate |
$60,957.93 |
| Rate for Payer: Aetna Medicare |
$18,584.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,336.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,336.79
|
| Rate for Payer: BCBS MAPPO |
$17,869.43
|
| Rate for Payer: BCBS Trust/PPO |
$60,957.93
|
| Rate for Payer: BCN Medicare Advantage |
$17,869.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,869.43
|
| Rate for Payer: Mclaren Medicare |
$17,869.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,762.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,549.84
|
| Rate for Payer: PACE Medicare |
$16,975.96
|
| Rate for Payer: PACE SWMI |
$17,869.43
|
| Rate for Payer: PHP Medicare Advantage |
$17,869.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,321.76
|
| Rate for Payer: Priority Health Medicare |
$17,869.43
|
| Rate for Payer: Priority Health Narrow Network |
$25,857.41
|
| Rate for Payer: Railroad Medicare Medicare |
$17,869.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,358.11
|
| Rate for Payer: UHC Core |
$28,173.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,869.43
|
| Rate for Payer: UHC Exchange |
$22,397.87
|
| Rate for Payer: UHC Medicare Advantage |
$18,405.51
|
| Rate for Payer: VA VA |
$17,869.43
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$37,195.95
|
|
|
Service Code
|
MS-DRG 615
|
| Min. Negotiated Rate |
$11,256.26 |
| Max. Negotiated Rate |
$37,195.95 |
| Rate for Payer: Aetna Medicare |
$12,322.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,810.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,810.88
|
| Rate for Payer: BCBS MAPPO |
$11,848.70
|
| Rate for Payer: BCBS Trust/PPO |
$37,195.95
|
| Rate for Payer: BCN Medicare Advantage |
$11,848.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,848.70
|
| Rate for Payer: Mclaren Medicare |
$11,848.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,441.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,626.00
|
| Rate for Payer: PACE Medicare |
$11,256.26
|
| Rate for Payer: PACE SWMI |
$11,848.70
|
| Rate for Payer: PHP Medicare Advantage |
$11,848.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,110.17
|
| Rate for Payer: Priority Health Medicare |
$11,848.70
|
| Rate for Payer: Priority Health Narrow Network |
$16,888.14
|
| Rate for Payer: Railroad Medicare Medicare |
$11,848.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,440.16
|
| Rate for Payer: UHC Core |
$18,400.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,848.70
|
| Rate for Payer: UHC Exchange |
$14,628.62
|
| Rate for Payer: UHC Medicare Advantage |
$12,204.16
|
| Rate for Payer: VA VA |
$11,848.70
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
IP
|
$19,213.63
|
|
|
Service Code
|
MS-DRG 560
|
| Min. Negotiated Rate |
$8,774.52 |
| Max. Negotiated Rate |
$19,213.63 |
| Rate for Payer: Aetna Medicare |
$9,605.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,545.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,545.42
|
| Rate for Payer: BCBS MAPPO |
$9,236.34
|
| Rate for Payer: BCBS Trust/PPO |
$19,213.63
|
| Rate for Payer: BCN Medicare Advantage |
$9,236.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,236.34
|
| Rate for Payer: Mclaren Medicare |
$9,236.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,698.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,621.79
|
| Rate for Payer: PACE Medicare |
$8,774.52
|
| Rate for Payer: PACE SWMI |
$9,236.34
|
| Rate for Payer: PHP Medicare Advantage |
$9,236.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,245.54
|
| Rate for Payer: Priority Health Medicare |
$9,236.34
|
| Rate for Payer: Priority Health Narrow Network |
$12,996.43
|
| Rate for Payer: Railroad Medicare Medicare |
$9,236.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,269.05
|
| Rate for Payer: UHC Core |
$14,160.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,236.34
|
| Rate for Payer: UHC Exchange |
$11,257.60
|
| Rate for Payer: UHC Medicare Advantage |
$9,513.43
|
| Rate for Payer: VA VA |
$9,236.34
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
IP
|
$47,800.38
|
|
|
Service Code
|
MS-DRG 559
|
| Min. Negotiated Rate |
$14,033.74 |
| Max. Negotiated Rate |
$47,800.38 |
| Rate for Payer: Aetna Medicare |
$15,363.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,465.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,465.45
|
| Rate for Payer: BCBS MAPPO |
$14,772.36
|
| Rate for Payer: BCBS Trust/PPO |
$47,800.38
|
| Rate for Payer: BCN Medicare Advantage |
$14,772.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,772.36
|
| Rate for Payer: Mclaren Medicare |
$14,772.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,510.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,988.21
|
| Rate for Payer: PACE Medicare |
$14,033.74
|
| Rate for Payer: PACE SWMI |
$14,772.36
|
| Rate for Payer: PHP Medicare Advantage |
$14,772.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,554.53
|
| Rate for Payer: Priority Health Medicare |
$14,772.36
|
| Rate for Payer: Priority Health Narrow Network |
$21,243.62
|
| Rate for Payer: Railroad Medicare Medicare |
$14,772.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,227.53
|
| Rate for Payer: UHC Core |
$23,146.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,772.36
|
| Rate for Payer: UHC Exchange |
$18,401.37
|
| Rate for Payer: UHC Medicare Advantage |
$15,215.53
|
| Rate for Payer: VA VA |
$14,772.36
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
IP
|
$14,640.16
|
|
|
Service Code
|
MS-DRG 561
|
| Min. Negotiated Rate |
$6,198.37 |
| Max. Negotiated Rate |
$14,640.16 |
| Rate for Payer: Aetna Medicare |
$6,785.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,155.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,155.75
|
| Rate for Payer: BCBS MAPPO |
$6,524.60
|
| Rate for Payer: BCBS Trust/PPO |
$14,640.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,524.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,524.60
|
| Rate for Payer: Mclaren Medicare |
$6,524.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,850.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,503.29
|
| Rate for Payer: PACE Medicare |
$6,198.37
|
| Rate for Payer: PACE SWMI |
$6,524.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,524.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,195.81
|
| Rate for Payer: Priority Health Medicare |
$6,524.60
|
| Rate for Payer: Priority Health Narrow Network |
$8,956.65
|
| Rate for Payer: Railroad Medicare Medicare |
$6,524.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,901.17
|
| Rate for Payer: UHC Core |
$9,758.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,524.60
|
| Rate for Payer: UHC Exchange |
$7,758.31
|
| Rate for Payer: UHC Medicare Advantage |
$6,720.34
|
| Rate for Payer: VA VA |
$6,524.60
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
IP
|
$17,452.09
|
|
|
Service Code
|
MS-DRG 949
|
| Min. Negotiated Rate |
$8,340.42 |
| Max. Negotiated Rate |
$17,452.09 |
| Rate for Payer: Aetna Medicare |
$9,130.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,974.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,974.24
|
| Rate for Payer: BCBS MAPPO |
$8,779.39
|
| Rate for Payer: BCBS Trust/PPO |
$17,452.09
|
| Rate for Payer: BCN Medicare Advantage |
$8,779.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,779.39
|
| Rate for Payer: Mclaren Medicare |
$8,779.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,218.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,096.30
|
| Rate for Payer: PACE Medicare |
$8,340.42
|
| Rate for Payer: PACE SWMI |
$8,779.39
|
| Rate for Payer: PHP Medicare Advantage |
$8,779.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,867.95
|
| Rate for Payer: Priority Health Medicare |
$8,779.39
|
| Rate for Payer: Priority Health Narrow Network |
$11,894.36
|
| Rate for Payer: Railroad Medicare Medicare |
$8,779.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,804.67
|
| Rate for Payer: UHC Core |
$12,959.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,779.39
|
| Rate for Payer: UHC Exchange |
$10,302.98
|
| Rate for Payer: UHC Medicare Advantage |
$9,042.77
|
| Rate for Payer: VA VA |
$8,779.39
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
IP
|
$10,581.82
|
|
|
Service Code
|
MS-DRG 950
|
| Min. Negotiated Rate |
$5,161.75 |
| Max. Negotiated Rate |
$10,581.82 |
| Rate for Payer: Aetna Medicare |
$5,650.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,791.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,791.78
|
| Rate for Payer: BCBS MAPPO |
$5,433.42
|
| Rate for Payer: BCBS Trust/PPO |
$10,581.82
|
| Rate for Payer: BCN Medicare Advantage |
$5,433.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,433.42
|
| Rate for Payer: Mclaren Medicare |
$5,433.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,705.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,248.43
|
| Rate for Payer: PACE Medicare |
$5,161.75
|
| Rate for Payer: PACE SWMI |
$5,433.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,433.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,014.62
|
| Rate for Payer: Priority Health Medicare |
$5,433.42
|
| Rate for Payer: Priority Health Narrow Network |
$7,211.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5,433.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,582.56
|
| Rate for Payer: UHC Core |
$7,857.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,433.42
|
| Rate for Payer: UHC Exchange |
$6,246.82
|
| Rate for Payer: UHC Medicare Advantage |
$5,596.42
|
| Rate for Payer: VA VA |
$5,433.42
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$15,018.28
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
35775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,608.04 |
| Max. Negotiated Rate |
$13,516.45 |
| Rate for Payer: Aetna American Axle |
$9,761.88
|
| Rate for Payer: Aetna Commercial |
$12,765.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,761.88
|
| Rate for Payer: Cash Price |
$12,014.62
|
| Rate for Payer: Cofinity Commercial |
$10,512.80
|
| Rate for Payer: Cofinity Commercial |
$12,915.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,014.62
|
| Rate for Payer: Healthscope Commercial |
$13,516.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,512.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,263.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,765.54
|
| Rate for Payer: PHP Commercial |
$12,765.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,512.80
|
| Rate for Payer: Priority Health SBD |
$9,461.52
|
| Rate for Payer: UMR Bronson Commercial |
$6,608.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,263.71
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION
|
Facility
OP
|
$15,018.28
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
35775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.43 |
| Max. Negotiated Rate |
$13,516.45 |
| Rate for Payer: Aetna American Axle |
$9,761.88
|
| Rate for Payer: Aetna Commercial |
$12,765.54
|
| Rate for Payer: Aetna Medicare |
$227.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,761.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.93
|
| Rate for Payer: BCBS Complete |
$125.42
|
| Rate for Payer: BCBS MAPPO |
$218.34
|
| Rate for Payer: BCBS Trust/PPO |
$705.58
|
| Rate for Payer: BCN Medicare Advantage |
$218.34
|
| Rate for Payer: Cash Price |
$12,014.62
|
| Rate for Payer: Cash Price |
$12,014.62
|
| Rate for Payer: Cofinity Commercial |
$12,915.72
|
| Rate for Payer: Cofinity Commercial |
$10,512.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,014.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.34
|
| Rate for Payer: Healthscope Commercial |
$13,516.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,512.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,263.71
|
| Rate for Payer: Mclaren Medicaid |
$119.43
|
| Rate for Payer: Mclaren Medicare |
$218.34
|
| Rate for Payer: Meridian Medicaid |
$125.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$229.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,765.54
|
| Rate for Payer: PACE Medicare |
$207.42
|
| Rate for Payer: PACE SWMI |
$218.34
|
| Rate for Payer: PHP Commercial |
$12,765.54
|
| Rate for Payer: PHP Medicare Advantage |
$218.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,512.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$639.06
|
| Rate for Payer: Priority Health Medicare |
$218.34
|
| Rate for Payer: Priority Health Narrow Network |
$511.25
|
| Rate for Payer: Priority Health SBD |
$9,461.52
|
| Rate for Payer: Railroad Medicare Medicare |
$218.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.34
|
| Rate for Payer: UHC Medicare Advantage |
$224.89
|
| Rate for Payer: UMR Bronson Commercial |
$5,556.76
|
| Rate for Payer: VA VA |
$218.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,263.71
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION
|
Facility
OP
|
$2,640.58
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
38494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.43 |
| Max. Negotiated Rate |
$2,376.52 |
| Rate for Payer: Aetna American Axle |
$1,716.38
|
| Rate for Payer: Aetna Commercial |
$2,244.49
|
| Rate for Payer: Aetna Medicare |
$227.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.93
|
| Rate for Payer: BCBS Complete |
$125.42
|
| Rate for Payer: BCBS MAPPO |
$218.34
|
| Rate for Payer: BCBS Trust/PPO |
$705.58
|
| Rate for Payer: BCN Medicare Advantage |
$218.34
|
| Rate for Payer: Cash Price |
$2,112.46
|
| Rate for Payer: Cash Price |
$2,112.46
|
| Rate for Payer: Cofinity Commercial |
$1,848.41
|
| Rate for Payer: Cofinity Commercial |
$2,270.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,112.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.34
|
| Rate for Payer: Healthscope Commercial |
$2,376.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,848.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,980.44
|
| Rate for Payer: Mclaren Medicaid |
$119.43
|
| Rate for Payer: Mclaren Medicare |
$218.34
|
| Rate for Payer: Meridian Medicaid |
$125.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$229.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,244.49
|
| Rate for Payer: PACE Medicare |
$207.42
|
| Rate for Payer: PACE SWMI |
$218.34
|
| Rate for Payer: PHP Commercial |
$2,244.49
|
| Rate for Payer: PHP Medicare Advantage |
$218.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,848.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$639.06
|
| Rate for Payer: Priority Health Medicare |
$218.34
|
| Rate for Payer: Priority Health Narrow Network |
$511.25
|
| Rate for Payer: Priority Health SBD |
$1,663.57
|
| Rate for Payer: Railroad Medicare Medicare |
$218.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.34
|
| Rate for Payer: UHC Medicare Advantage |
$224.89
|
| Rate for Payer: UMR Bronson Commercial |
$977.01
|
| Rate for Payer: VA VA |
$218.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,980.44
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$2,640.58
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
38494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,161.86 |
| Max. Negotiated Rate |
$2,376.52 |
| Rate for Payer: Aetna American Axle |
$1,716.38
|
| Rate for Payer: Aetna Commercial |
$2,244.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.38
|
| Rate for Payer: Cash Price |
$2,112.46
|
| Rate for Payer: Cofinity Commercial |
$1,848.41
|
| Rate for Payer: Cofinity Commercial |
$2,270.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,112.46
|
| Rate for Payer: Healthscope Commercial |
$2,376.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,848.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,980.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,244.49
|
| Rate for Payer: PHP Commercial |
$2,244.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,848.41
|
| Rate for Payer: Priority Health SBD |
$1,663.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,161.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,980.44
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
IP
|
$92,004.81
|
|
|
Service Code
|
MS-DRG 245
|
| Min. Negotiated Rate |
$33,659.90 |
| Max. Negotiated Rate |
$92,004.81 |
| Rate for Payer: Aetna Medicare |
$36,848.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,289.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,289.34
|
| Rate for Payer: BCBS MAPPO |
$35,431.47
|
| Rate for Payer: BCBS Trust/PPO |
$92,004.81
|
| Rate for Payer: BCN Medicare Advantage |
$35,431.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,431.47
|
| Rate for Payer: Mclaren Medicare |
$35,431.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,203.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,746.19
|
| Rate for Payer: PACE Medicare |
$33,659.90
|
| Rate for Payer: PACE SWMI |
$35,431.47
|
| Rate for Payer: PHP Medicare Advantage |
$35,431.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65,025.23
|
| Rate for Payer: Priority Health Medicare |
$35,431.47
|
| Rate for Payer: Priority Health Narrow Network |
$52,020.18
|
| Rate for Payer: Railroad Medicare Medicare |
$35,431.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69,121.98
|
| Rate for Payer: UHC Core |
$56,678.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$35,431.47
|
| Rate for Payer: UHC Exchange |
$45,060.24
|
| Rate for Payer: UHC Medicare Advantage |
$36,494.41
|
| Rate for Payer: VA VA |
$35,431.47
|
|
