|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,902.03
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,036.89 |
| Max. Negotiated Rate |
$6,211.83 |
| Rate for Payer: Aetna American Axle |
$4,486.32
|
| Rate for Payer: Aetna Commercial |
$5,866.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,486.32
|
| Rate for Payer: Cash Price |
$5,521.62
|
| Rate for Payer: Cofinity Commercial |
$4,831.42
|
| Rate for Payer: Cofinity Commercial |
$5,935.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,521.62
|
| Rate for Payer: Healthscope Commercial |
$6,211.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,831.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,866.73
|
| Rate for Payer: PHP Commercial |
$5,866.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,831.42
|
| Rate for Payer: Priority Health SBD |
$4,348.28
|
| Rate for Payer: UMR Bronson Commercial |
$3,036.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,176.52
|
|
|
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$1,911.48
|
|
|
Service Code
|
CPT 51710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$1,911.48 |
| Rate for Payer: Aetna Medicare |
$631.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.00
|
| Rate for Payer: BCBS Complete |
$348.78
|
| Rate for Payer: BCBS MAPPO |
$607.20
|
| Rate for Payer: BCBS Trust/PPO |
$514.40
|
| Rate for Payer: BCN Medicare Advantage |
$607.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.20
|
| Rate for Payer: Mclaren Medicaid |
$332.14
|
| Rate for Payer: Mclaren Medicare |
$607.20
|
| Rate for Payer: Meridian Medicaid |
$348.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.28
|
| Rate for Payer: PACE Medicare |
$576.84
|
| Rate for Payer: PACE SWMI |
$607.20
|
| Rate for Payer: PHP Medicare Advantage |
$607.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,911.48
|
| Rate for Payer: Priority Health Medicare |
$607.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,529.18
|
| Rate for Payer: Railroad Medicare Medicare |
$607.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.09
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.20
|
| Rate for Payer: UHC Exchange |
$78.26
|
| Rate for Payer: UHC Medicare Advantage |
$625.42
|
| Rate for Payer: VA VA |
$607.20
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$228.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$229.78
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.57
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$553.26
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.47
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.68
|
| Rate for Payer: UHC Exchange |
$50.43
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$228.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$229.78
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.57
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$553.26
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.47
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.68
|
| Rate for Payer: UHC Exchange |
$50.43
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CONDUIT
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 50688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.64 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,295.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.20
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$75.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (IE, PROUD FLESH)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.11
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (IE, PROUD FLESH)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.11
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: UMR Bronson Commercial |
$34.50
|
|
|
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$247.22 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,993.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.94
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$247.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE, UNILATERAL (EG, FOR BLEPHAROSPASM, HEMIFACIAL SPASM)
|
Facility
|
OP
|
$828.79
|
|
|
Service Code
|
CPT 64612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.67
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$117.88
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
CHEMODENERVATION OF MUSCLE(S); NECK MUSCLE(S), EXCLUDING MUSCLES OF THE LARYNX, UNILATERAL (EG, FOR CERVICAL DYSTONIA, SPASMODIC TORTICOLLIS)
|
Facility
|
OP
|
$828.79
|
|
|
Service Code
|
CPT 64616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.22
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$108.38
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$101,714.65
|
|
|
Service Code
|
MS-DRG 837
|
| Min. Negotiated Rate |
$35,948.36 |
| Max. Negotiated Rate |
$101,714.65 |
| Rate for Payer: Aetna Medicare |
$39,354.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,300.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,300.48
|
| Rate for Payer: BCBS MAPPO |
$37,840.38
|
| Rate for Payer: BCBS Trust/PPO |
$101,714.65
|
| Rate for Payer: BCN Medicare Advantage |
$37,840.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,840.38
|
| Rate for Payer: Mclaren Medicare |
$37,840.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39,732.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43,516.44
|
| Rate for Payer: PACE Medicare |
$35,948.36
|
| Rate for Payer: PACE SWMI |
$37,840.38
|
| Rate for Payer: PHP Medicare Advantage |
$37,840.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68,256.83
|
| Rate for Payer: Priority Health Medicare |
$37,840.38
|
| Rate for Payer: Priority Health Narrow Network |
$54,605.46
|
| Rate for Payer: Railroad Medicare Medicare |
$37,840.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72,557.18
|
| Rate for Payer: UHC Core |
$59,495.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$37,840.38
|
| Rate for Payer: UHC Exchange |
$47,299.63
|
| Rate for Payer: UHC Medicare Advantage |
$38,975.59
|
| Rate for Payer: VA VA |
$37,840.38
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$45,398.05
|
|
|
Service Code
|
MS-DRG 838
|
| Min. Negotiated Rate |
$15,140.64 |
| Max. Negotiated Rate |
$45,398.05 |
| Rate for Payer: Aetna Medicare |
$16,575.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,921.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,921.90
|
| Rate for Payer: BCBS MAPPO |
$15,937.52
|
| Rate for Payer: BCBS Trust/PPO |
$45,398.05
|
| Rate for Payer: BCN Medicare Advantage |
$15,937.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,937.52
|
| Rate for Payer: Mclaren Medicare |
$15,937.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,734.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,328.15
|
| Rate for Payer: PACE Medicare |
$15,140.64
|
| Rate for Payer: PACE SWMI |
$15,937.52
|
| Rate for Payer: PHP Medicare Advantage |
$15,937.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,016.78
|
| Rate for Payer: Priority Health Medicare |
$15,937.52
|
| Rate for Payer: Priority Health Narrow Network |
$22,413.42
|
| Rate for Payer: Railroad Medicare Medicare |
$15,937.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,781.91
|
| Rate for Payer: UHC Core |
$24,420.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,937.52
|
| Rate for Payer: UHC Exchange |
$19,414.67
|
| Rate for Payer: UHC Medicare Advantage |
$16,415.65
|
| Rate for Payer: VA VA |
$15,937.52
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,565.84
|
|
|
Service Code
|
MS-DRG 839
|
| Min. Negotiated Rate |
$10,026.38 |
| Max. Negotiated Rate |
$22,565.84 |
| Rate for Payer: Aetna Medicare |
$10,976.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,192.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,192.60
|
| Rate for Payer: BCBS MAPPO |
$10,554.08
|
| Rate for Payer: BCBS Trust/PPO |
$22,565.84
|
| Rate for Payer: BCN Medicare Advantage |
$10,554.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,554.08
|
| Rate for Payer: Mclaren Medicare |
$10,554.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,081.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,137.19
|
| Rate for Payer: PACE Medicare |
$10,026.38
|
| Rate for Payer: PACE SWMI |
$10,554.08
|
| Rate for Payer: PHP Medicare Advantage |
$10,554.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,699.38
|
| Rate for Payer: Priority Health Medicare |
$10,554.08
|
| Rate for Payer: Priority Health Narrow Network |
$14,959.50
|
| Rate for Payer: Railroad Medicare Medicare |
$10,554.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,877.49
|
| Rate for Payer: UHC Core |
$16,299.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,554.08
|
| Rate for Payer: UHC Exchange |
$12,958.03
|
| Rate for Payer: UHC Medicare Advantage |
$10,870.70
|
| Rate for Payer: VA VA |
$10,554.08
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$23,603.67
|
|
|
Service Code
|
MS-DRG 847
|
| Min. Negotiated Rate |
$9,363.86 |
| Max. Negotiated Rate |
$23,603.67 |
| Rate for Payer: Aetna Medicare |
$10,250.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,320.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,320.88
|
| Rate for Payer: BCBS MAPPO |
$9,856.70
|
| Rate for Payer: BCBS Trust/PPO |
$23,603.67
|
| Rate for Payer: BCN Medicare Advantage |
$9,856.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,856.70
|
| Rate for Payer: Mclaren Medicare |
$9,856.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,349.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,335.20
|
| Rate for Payer: PACE Medicare |
$9,363.86
|
| Rate for Payer: PACE SWMI |
$9,856.70
|
| Rate for Payer: PHP Medicare Advantage |
$9,856.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,400.71
|
| Rate for Payer: Priority Health Medicare |
$9,856.70
|
| Rate for Payer: Priority Health Narrow Network |
$13,920.57
|
| Rate for Payer: Railroad Medicare Medicare |
$9,856.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,497.00
|
| Rate for Payer: UHC Core |
$15,167.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,856.70
|
| Rate for Payer: UHC Exchange |
$12,058.09
|
| Rate for Payer: UHC Medicare Advantage |
$10,152.40
|
| Rate for Payer: VA VA |
$9,856.70
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$44,407.97
|
|
|
Service Code
|
MS-DRG 846
|
| Min. Negotiated Rate |
$18,378.60 |
| Max. Negotiated Rate |
$44,407.97 |
| Rate for Payer: Aetna Medicare |
$20,119.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,182.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,182.38
|
| Rate for Payer: BCBS MAPPO |
$19,345.90
|
| Rate for Payer: BCBS Trust/PPO |
$44,407.97
|
| Rate for Payer: BCN Medicare Advantage |
$19,345.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,345.90
|
| Rate for Payer: Mclaren Medicare |
$19,345.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,313.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,247.78
|
| Rate for Payer: PACE Medicare |
$18,378.60
|
| Rate for Payer: PACE SWMI |
$19,345.90
|
| Rate for Payer: PHP Medicare Advantage |
$19,345.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,071.20
|
| Rate for Payer: Priority Health Medicare |
$19,345.90
|
| Rate for Payer: Priority Health Narrow Network |
$28,056.96
|
| Rate for Payer: Railroad Medicare Medicare |
$19,345.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,280.78
|
| Rate for Payer: UHC Core |
$30,569.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,345.90
|
| Rate for Payer: UHC Exchange |
$24,303.14
|
| Rate for Payer: UHC Medicare Advantage |
$19,926.28
|
| Rate for Payer: VA VA |
$19,345.90
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$13,501.81
|
|
|
Service Code
|
MS-DRG 848
|
| Min. Negotiated Rate |
$6,608.33 |
| Max. Negotiated Rate |
$13,501.81 |
| Rate for Payer: Aetna Medicare |
$7,234.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,695.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,695.18
|
| Rate for Payer: BCBS MAPPO |
$6,956.14
|
| Rate for Payer: BCBS Trust/PPO |
$13,501.81
|
| Rate for Payer: BCN Medicare Advantage |
$6,956.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,956.14
|
| Rate for Payer: Mclaren Medicare |
$6,956.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,303.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,999.56
|
| Rate for Payer: PACE Medicare |
$6,608.33
|
| Rate for Payer: PACE SWMI |
$6,956.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,956.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,898.76
|
| Rate for Payer: Priority Health Medicare |
$6,956.14
|
| Rate for Payer: Priority Health Narrow Network |
$8,719.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6,956.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,585.41
|
| Rate for Payer: UHC Core |
$9,499.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,956.14
|
| Rate for Payer: UHC Exchange |
$7,552.47
|
| Rate for Payer: UHC Medicare Advantage |
$7,164.82
|
| Rate for Payer: VA VA |
$6,956.14
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
IP
|
$136.23
|
|
|
Service Code
|
NDC 395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$122.61 |
| Rate for Payer: Aetna American Axle |
$88.55
|
| Rate for Payer: Aetna Commercial |
$115.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.55
|
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.98
|
| Rate for Payer: Healthscope Commercial |
$122.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.80
|
| Rate for Payer: PHP Commercial |
$115.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.36
|
| Rate for Payer: Priority Health SBD |
$85.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.17
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$14,795.96
|
|
|
Service Code
|
MS-DRG 313
|
| Min. Negotiated Rate |
$5,784.01 |
| Max. Negotiated Rate |
$14,795.96 |
| Rate for Payer: Aetna Medicare |
$6,331.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,610.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,610.54
|
| Rate for Payer: BCBS MAPPO |
$6,088.43
|
| Rate for Payer: BCBS Trust/PPO |
$14,795.96
|
| Rate for Payer: BCN Medicare Advantage |
$6,088.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,088.43
|
| Rate for Payer: Mclaren Medicare |
$6,088.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,392.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,001.69
|
| Rate for Payer: PACE Medicare |
$5,784.01
|
| Rate for Payer: PACE SWMI |
$6,088.43
|
| Rate for Payer: PHP Medicare Advantage |
$6,088.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,383.60
|
| Rate for Payer: Priority Health Medicare |
$6,088.43
|
| Rate for Payer: Priority Health Narrow Network |
$8,306.88
|
| Rate for Payer: Railroad Medicare Medicare |
$6,088.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,037.79
|
| Rate for Payer: UHC Core |
$9,050.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,088.43
|
| Rate for Payer: UHC Exchange |
$7,195.48
|
| Rate for Payer: UHC Medicare Advantage |
$6,271.08
|
| Rate for Payer: VA VA |
$6,088.43
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$192.72 |
| Max. Negotiated Rate |
$942.20 |
| Rate for Payer: Aetna Commercial |
$553.26
|
| Rate for Payer: Aetna Commercial |
$553.26
|
| Rate for Payer: BCBS Complete |
$685.60
|
| Rate for Payer: BCBS Complete |
$538.40
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,199.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.15
|
| Rate for Payer: Priority Health Narrow Network |
$343.15
|
| Rate for Payer: Priority Health Narrow Network |
$343.15
|
| Rate for Payer: Priority Health SBD |
$731.89
|
| Rate for Payer: Priority Health SBD |
$731.89
|
| Rate for Payer: UMR Bronson Commercial |
$619.16
|
| Rate for Payer: UMR Bronson Commercial |
$788.44
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$904.45 |
| Rate for Payer: Aetna Commercial |
$87.24
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.36
|
| Rate for Payer: Priority Health Narrow Network |
$57.36
|
| Rate for Payer: Priority Health SBD |
$116.26
|
| Rate for Payer: UMR Bronson Commercial |
$61.64
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,774.03 |
| Rate for Payer: Aetna Commercial |
$27.49
|
| Rate for Payer: Aetna Commercial |
$27.49
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.03
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$36.88
|
| Rate for Payer: Priority Health SBD |
$36.88
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$70.17 |
| Max. Negotiated Rate |
$674.64 |
| Rate for Payer: Aetna Commercial |
$394.55
|
| Rate for Payer: BCBS Complete |
$269.20
|
| Rate for Payer: BCBS Trust/PPO |
$674.64
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.17
|
| Rate for Payer: Priority Health Narrow Network |
$70.17
|
| Rate for Payer: Priority Health SBD |
$497.82
|
| Rate for Payer: UMR Bronson Commercial |
$309.58
|
|
|
CHG ANGIO ARCH ANGIOGRAM W CATH
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 75650
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$183.40 |
| Rate for Payer: BCBS Complete |
$104.80
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.40
|
| Rate for Payer: UMR Bronson Commercial |
$120.52
|
|
|
CHG ANGIO AV SHUNT COMPLETE EVAL
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
HCPCS 75791
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$347.90 |
| Rate for Payer: BCBS Complete |
$198.80
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.90
|
| Rate for Payer: UMR Bronson Commercial |
$138.92
|
| Rate for Payer: UMR Bronson Commercial |
$228.62
|
|
