|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 0002-8799-01
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.50
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$167.65
|
|
|
Service Code
|
NDC 0002-7510-01
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.77 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.50
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.36
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UMR Bronson Commercial |
$73.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$167.65
|
|
|
Service Code
|
NDC 0002-7510-01
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: BCBS Complete |
$67.06
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.50
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.36
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UMR Bronson Commercial |
$62.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION
|
Facility
|
IP
|
$56.95
|
|
|
Service Code
|
NDC 0169-1834-11
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.06 |
| Max. Negotiated Rate |
$51.26 |
| Rate for Payer: Aetna American Axle |
$37.02
|
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.02
|
| Rate for Payer: Cash Price |
$45.56
|
| Rate for Payer: Cofinity Commercial |
$39.86
|
| Rate for Payer: Cofinity Commercial |
$48.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.56
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.41
|
| Rate for Payer: PHP Commercial |
$48.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.86
|
| Rate for Payer: Priority Health SBD |
$35.88
|
| Rate for Payer: UMR Bronson Commercial |
$25.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.71
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 0338-0126-12
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna American Axle |
$43.10
|
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$46.42
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.42
|
| Rate for Payer: Priority Health SBD |
$41.78
|
| Rate for Payer: UMR Bronson Commercial |
$29.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.40
|
|
|
Service Code
|
NDC 0002-8824-01
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.90 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Commercial |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$797.64
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.88
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UMR Bronson Commercial |
$412.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.40
|
|
|
Service Code
|
NDC 0002-8824-27
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.90 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Commercial |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$797.64
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.88
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UMR Bronson Commercial |
$412.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 0002-8215-01
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.24
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$26.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
IP
|
$290.23
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.70 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna American Axle |
$188.65
|
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.65
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$203.16
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$261.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.70
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health SBD |
$182.84
|
| Rate for Payer: UMR Bronson Commercial |
$127.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.67
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
IP
|
$177.23
|
|
|
Service Code
|
NDC 0002-7510-01
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$159.51 |
| Rate for Payer: Aetna American Axle |
$115.20
|
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.20
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cofinity Commercial |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.78
|
| Rate for Payer: Healthscope Commercial |
$159.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.65
|
| Rate for Payer: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.06
|
| Rate for Payer: Priority Health SBD |
$111.65
|
| Rate for Payer: UMR Bronson Commercial |
$77.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.92
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)
|
Facility
|
IP
|
$5,065.60
|
|
|
Service Code
|
NDC 0002-8501-01
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,228.86 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna American Axle |
$3,292.64
|
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,292.64
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Commercial |
$3,545.92
|
| Rate for Payer: Cofinity Commercial |
$4,356.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,052.48
|
| Rate for Payer: Healthscope Commercial |
$4,559.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,545.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,799.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,305.76
|
| Rate for Payer: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,545.92
|
| Rate for Payer: Priority Health SBD |
$3,191.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,228.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.20
|
|
|
INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)
|
Facility
|
IP
|
$248.94
|
|
|
Service Code
|
NDC 0169-7501-11
|
| Hospital Charge Code |
180912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.53 |
| Max. Negotiated Rate |
$224.05 |
| Rate for Payer: Aetna American Axle |
$161.81
|
| Rate for Payer: Aetna Commercial |
$211.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.81
|
| Rate for Payer: Cash Price |
$199.15
|
| Rate for Payer: Cofinity Commercial |
$174.26
|
| Rate for Payer: Cofinity Commercial |
$214.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.15
|
| Rate for Payer: Healthscope Commercial |
$224.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.60
|
| Rate for Payer: PHP Commercial |
$211.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.26
|
| Rate for Payer: Priority Health SBD |
$156.83
|
| Rate for Payer: UMR Bronson Commercial |
$109.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.70
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 0002-8215-01
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.24
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$26.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INTERFERON ALFA-2B 50 MILLION UNIT (1 ML) SOLUTION FOR INJECTION
|
Facility
|
IP
|
$6,726.43
|
|
|
Service Code
|
HCPCS J9214
|
| Hospital Charge Code |
10304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,959.63 |
| Max. Negotiated Rate |
$6,053.79 |
| Rate for Payer: Aetna American Axle |
$4,372.18
|
| Rate for Payer: Aetna Commercial |
$5,717.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,372.18
|
| Rate for Payer: Cash Price |
$5,381.14
|
| Rate for Payer: Cofinity Commercial |
$5,784.73
|
| Rate for Payer: Cofinity Commercial |
$4,708.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,381.14
|
| Rate for Payer: Healthscope Commercial |
$6,053.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,708.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,044.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,717.47
|
| Rate for Payer: PHP Commercial |
$5,717.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,708.50
|
| Rate for Payer: Priority Health SBD |
$4,237.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,959.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,044.82
|
|
|
INTERFERON ALFA-2B 50 MILLION UNIT (1 ML) SOLUTION FOR INJECTION
|
Facility
|
OP
|
$6,726.43
|
|
|
Service Code
|
HCPCS J9214
|
| Hospital Charge Code |
10304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$6,053.79 |
| Rate for Payer: Aetna American Axle |
$4,372.18
|
| Rate for Payer: Aetna Commercial |
$5,717.47
|
| Rate for Payer: Aetna Medicare |
$33.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,372.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.72
|
| Rate for Payer: BCBS Complete |
$18.71
|
| Rate for Payer: BCBS MAPPO |
$32.57
|
| Rate for Payer: BCBS Trust/PPO |
$105.24
|
| Rate for Payer: BCN Medicare Advantage |
$32.57
|
| Rate for Payer: Cash Price |
$5,381.14
|
| Rate for Payer: Cash Price |
$5,381.14
|
| Rate for Payer: Cofinity Commercial |
$5,784.73
|
| Rate for Payer: Cofinity Commercial |
$4,708.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,381.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.57
|
| Rate for Payer: Healthscope Commercial |
$6,053.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,708.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,044.82
|
| Rate for Payer: Mclaren Medicaid |
$17.82
|
| Rate for Payer: Mclaren Medicare |
$32.57
|
| Rate for Payer: Meridian Medicaid |
$18.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,717.47
|
| Rate for Payer: PACE Medicare |
$30.95
|
| Rate for Payer: PACE SWMI |
$32.57
|
| Rate for Payer: PHP Commercial |
$5,717.47
|
| Rate for Payer: PHP Medicare Advantage |
$32.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,708.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.67
|
| Rate for Payer: Priority Health Medicare |
$32.57
|
| Rate for Payer: Priority Health Narrow Network |
$76.54
|
| Rate for Payer: Priority Health SBD |
$4,237.65
|
| Rate for Payer: Railroad Medicare Medicare |
$32.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.57
|
| Rate for Payer: UHC Medicare Advantage |
$33.55
|
| Rate for Payer: UMR Bronson Commercial |
$2,488.78
|
| Rate for Payer: VA VA |
$32.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,044.82
|
|
|
INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 64727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$644.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.62
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$174.20
|
|
|
INTERSTITIAL LUNG DISEASE WITH CC
|
Facility
|
IP
|
$20,975.18
|
|
|
Service Code
|
MS-DRG 197
|
| Min. Negotiated Rate |
$7,789.16 |
| Max. Negotiated Rate |
$20,975.18 |
| Rate for Payer: Aetna Medicare |
$8,527.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,248.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,248.90
|
| Rate for Payer: BCBS MAPPO |
$8,199.12
|
| Rate for Payer: BCBS Trust/PPO |
$20,975.18
|
| Rate for Payer: BCN Medicare Advantage |
$8,199.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,199.12
|
| Rate for Payer: Mclaren Medicare |
$8,199.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,609.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,428.99
|
| Rate for Payer: PACE Medicare |
$7,789.16
|
| Rate for Payer: PACE SWMI |
$8,199.12
|
| Rate for Payer: PHP Medicare Advantage |
$8,199.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,314.05
|
| Rate for Payer: Priority Health Medicare |
$8,199.12
|
| Rate for Payer: Priority Health Narrow Network |
$11,451.24
|
| Rate for Payer: Railroad Medicare Medicare |
$8,199.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,215.87
|
| Rate for Payer: UHC Core |
$12,476.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,199.12
|
| Rate for Payer: UHC Exchange |
$9,919.14
|
| Rate for Payer: UHC Medicare Advantage |
$8,445.09
|
| Rate for Payer: VA VA |
$8,199.12
|
|
|
INTERSTITIAL LUNG DISEASE WITH MCC
|
Facility
|
IP
|
$28,912.43
|
|
|
Service Code
|
MS-DRG 196
|
| Min. Negotiated Rate |
$14,362.45 |
| Max. Negotiated Rate |
$28,912.43 |
| Rate for Payer: Aetna Medicare |
$15,723.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,897.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,897.96
|
| Rate for Payer: BCBS MAPPO |
$15,118.37
|
| Rate for Payer: BCBS Trust/PPO |
$25,583.83
|
| Rate for Payer: BCN Medicare Advantage |
$15,118.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,118.37
|
| Rate for Payer: Mclaren Medicare |
$15,118.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,874.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,386.13
|
| Rate for Payer: PACE Medicare |
$14,362.45
|
| Rate for Payer: PACE SWMI |
$15,118.37
|
| Rate for Payer: PHP Medicare Advantage |
$15,118.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,198.84
|
| Rate for Payer: Priority Health Medicare |
$15,118.37
|
| Rate for Payer: Priority Health Narrow Network |
$21,759.07
|
| Rate for Payer: Railroad Medicare Medicare |
$15,118.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,912.43
|
| Rate for Payer: UHC Core |
$23,707.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,118.37
|
| Rate for Payer: UHC Exchange |
$18,847.86
|
| Rate for Payer: UHC Medicare Advantage |
$15,571.92
|
| Rate for Payer: VA VA |
$15,118.37
|
|
|
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$13,836.03
|
|
|
Service Code
|
MS-DRG 198
|
| Min. Negotiated Rate |
$6,183.72 |
| Max. Negotiated Rate |
$13,836.03 |
| Rate for Payer: Aetna Medicare |
$6,769.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,136.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,136.48
|
| Rate for Payer: BCBS MAPPO |
$6,509.18
|
| Rate for Payer: BCBS Trust/PPO |
$13,836.03
|
| Rate for Payer: BCN Medicare Advantage |
$6,509.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,509.18
|
| Rate for Payer: Mclaren Medicare |
$6,509.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,834.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,485.56
|
| Rate for Payer: PACE Medicare |
$6,183.72
|
| Rate for Payer: PACE SWMI |
$6,509.18
|
| Rate for Payer: PHP Medicare Advantage |
$6,509.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,167.11
|
| Rate for Payer: Priority Health Medicare |
$6,509.18
|
| Rate for Payer: Priority Health Narrow Network |
$8,933.69
|
| Rate for Payer: Railroad Medicare Medicare |
$6,509.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,870.66
|
| Rate for Payer: UHC Core |
$9,733.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,509.18
|
| Rate for Payer: UHC Exchange |
$7,738.42
|
| Rate for Payer: UHC Medicare Advantage |
$6,704.46
|
| Rate for Payer: VA VA |
$6,509.18
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS
|
Facility
|
IP
|
$23,435.31
|
|
|
Service Code
|
MS-DRG 065
|
| Min. Negotiated Rate |
$7,927.52 |
| Max. Negotiated Rate |
$23,435.31 |
| Rate for Payer: Aetna Medicare |
$8,678.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,430.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,430.95
|
| Rate for Payer: BCBS MAPPO |
$8,344.76
|
| Rate for Payer: BCBS Trust/PPO |
$23,435.31
|
| Rate for Payer: BCN Medicare Advantage |
$8,344.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,344.76
|
| Rate for Payer: Mclaren Medicare |
$8,344.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,762.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,596.47
|
| Rate for Payer: PACE Medicare |
$7,927.52
|
| Rate for Payer: PACE SWMI |
$8,344.76
|
| Rate for Payer: PHP Medicare Advantage |
$8,344.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,585.26
|
| Rate for Payer: Priority Health Medicare |
$8,344.76
|
| Rate for Payer: Priority Health Narrow Network |
$11,668.21
|
| Rate for Payer: Railroad Medicare Medicare |
$8,344.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,504.17
|
| Rate for Payer: UHC Core |
$12,713.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,344.76
|
| Rate for Payer: UHC Exchange |
$10,107.08
|
| Rate for Payer: UHC Medicare Advantage |
$8,595.10
|
| Rate for Payer: VA VA |
$8,344.76
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC
|
Facility
|
IP
|
$37,545.24
|
|
|
Service Code
|
MS-DRG 064
|
| Min. Negotiated Rate |
$15,150.16 |
| Max. Negotiated Rate |
$37,545.24 |
| Rate for Payer: Aetna Medicare |
$16,585.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,934.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,934.42
|
| Rate for Payer: BCBS MAPPO |
$15,947.54
|
| Rate for Payer: BCBS Trust/PPO |
$37,545.24
|
| Rate for Payer: BCN Medicare Advantage |
$15,947.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,947.54
|
| Rate for Payer: Mclaren Medicare |
$15,947.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,744.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,339.67
|
| Rate for Payer: PACE Medicare |
$15,150.16
|
| Rate for Payer: PACE SWMI |
$15,947.54
|
| Rate for Payer: PHP Medicare Advantage |
$15,947.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,742.89
|
| Rate for Payer: Priority Health Medicare |
$15,947.54
|
| Rate for Payer: Priority Health Narrow Network |
$22,994.31
|
| Rate for Payer: Railroad Medicare Medicare |
$15,947.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,553.76
|
| Rate for Payer: UHC Core |
$25,053.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,947.54
|
| Rate for Payer: UHC Exchange |
$19,917.83
|
| Rate for Payer: UHC Medicare Advantage |
$16,425.97
|
| Rate for Payer: VA VA |
$15,947.54
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$17,773.74
|
|
|
Service Code
|
MS-DRG 066
|
| Min. Negotiated Rate |
$5,519.74 |
| Max. Negotiated Rate |
$17,773.74 |
| Rate for Payer: Aetna Medicare |
$6,042.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,262.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,262.81
|
| Rate for Payer: BCBS MAPPO |
$5,810.25
|
| Rate for Payer: BCBS Trust/PPO |
$17,773.74
|
| Rate for Payer: BCN Medicare Advantage |
$5,810.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,810.25
|
| Rate for Payer: Mclaren Medicare |
$5,810.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,100.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,681.79
|
| Rate for Payer: PACE Medicare |
$5,519.74
|
| Rate for Payer: PACE SWMI |
$5,810.25
|
| Rate for Payer: PHP Medicare Advantage |
$5,810.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,865.57
|
| Rate for Payer: Priority Health Medicare |
$5,810.25
|
| Rate for Payer: Priority Health Narrow Network |
$7,892.46
|
| Rate for Payer: Railroad Medicare Medicare |
$5,810.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,487.13
|
| Rate for Payer: UHC Core |
$8,599.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,810.25
|
| Rate for Payer: UHC Exchange |
$6,836.50
|
| Rate for Payer: UHC Medicare Advantage |
$5,984.56
|
| Rate for Payer: VA VA |
$5,810.25
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC
|
Facility
|
IP
|
$134,889.96
|
|
|
Service Code
|
MS-DRG 021
|
| Min. Negotiated Rate |
$45,446.28 |
| Max. Negotiated Rate |
$134,889.96 |
| Rate for Payer: Aetna Medicare |
$49,751.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59,797.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59,797.74
|
| Rate for Payer: BCBS MAPPO |
$47,838.19
|
| Rate for Payer: BCBS Trust/PPO |
$134,889.96
|
| Rate for Payer: BCN Medicare Advantage |
$47,838.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,838.19
|
| Rate for Payer: Mclaren Medicare |
$47,838.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50,230.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55,013.92
|
| Rate for Payer: PACE Medicare |
$45,446.28
|
| Rate for Payer: PACE SWMI |
$47,838.19
|
| Rate for Payer: PHP Medicare Advantage |
$47,838.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88,128.60
|
| Rate for Payer: Priority Health Medicare |
$47,838.19
|
| Rate for Payer: Priority Health Narrow Network |
$70,502.88
|
| Rate for Payer: Railroad Medicare Medicare |
$47,838.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93,680.92
|
| Rate for Payer: UHC Core |
$76,816.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$47,838.19
|
| Rate for Payer: UHC Exchange |
$61,070.08
|
| Rate for Payer: UHC Medicare Advantage |
$49,273.34
|
| Rate for Payer: VA VA |
$47,838.19
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$184,544.86
|
|
|
Service Code
|
MS-DRG 020
|
| Min. Negotiated Rate |
$62,364.51 |
| Max. Negotiated Rate |
$184,544.86 |
| Rate for Payer: Aetna Medicare |
$68,272.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82,058.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82,058.56
|
| Rate for Payer: BCBS MAPPO |
$65,646.85
|
| Rate for Payer: BCBS Trust/PPO |
$184,544.86
|
| Rate for Payer: BCN Medicare Advantage |
$65,646.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65,646.85
|
| Rate for Payer: Mclaren Medicare |
$65,646.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68,929.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75,493.88
|
| Rate for Payer: PACE Medicare |
$62,364.51
|
| Rate for Payer: PACE SWMI |
$65,646.85
|
| Rate for Payer: PHP Medicare Advantage |
$65,646.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121,291.26
|
| Rate for Payer: Priority Health Medicare |
$65,646.85
|
| Rate for Payer: Priority Health Narrow Network |
$97,033.01
|
| Rate for Payer: Railroad Medicare Medicare |
$65,646.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128,932.91
|
| Rate for Payer: UHC Core |
$105,722.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$65,646.85
|
| Rate for Payer: UHC Exchange |
$84,050.67
|
| Rate for Payer: UHC Medicare Advantage |
$67,616.26
|
| Rate for Payer: VA VA |
$65,646.85
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$87,162.45
|
|
|
Service Code
|
MS-DRG 022
|
| Min. Negotiated Rate |
$29,203.77 |
| Max. Negotiated Rate |
$87,162.45 |
| Rate for Payer: Aetna Medicare |
$31,970.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,426.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,426.01
|
| Rate for Payer: BCBS MAPPO |
$30,740.81
|
| Rate for Payer: BCBS Trust/PPO |
$87,162.45
|
| Rate for Payer: BCN Medicare Advantage |
$30,740.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,740.81
|
| Rate for Payer: Mclaren Medicare |
$30,740.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,277.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,351.93
|
| Rate for Payer: PACE Medicare |
$29,203.77
|
| Rate for Payer: PACE SWMI |
$30,740.81
|
| Rate for Payer: PHP Medicare Advantage |
$30,740.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,890.37
|
| Rate for Payer: Priority Health Medicare |
$30,740.81
|
| Rate for Payer: Priority Health Narrow Network |
$39,912.30
|
| Rate for Payer: Railroad Medicare Medicare |
$30,740.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,033.58
|
| Rate for Payer: UHC Core |
$43,486.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$30,740.81
|
| Rate for Payer: UHC Exchange |
$34,572.30
|
| Rate for Payer: UHC Medicare Advantage |
$31,663.03
|
| Rate for Payer: VA VA |
$30,740.81
|
|
