|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
IP
|
$964.48
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$424.37 |
| Max. Negotiated Rate |
$868.03 |
| Rate for Payer: Aetna American Axle |
$626.91
|
| Rate for Payer: Aetna Commercial |
$819.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.91
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Advantage |
$675.14
|
| Rate for Payer: Cofinity Commercial |
$829.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$868.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.36
|
| Rate for Payer: PHP Commercial |
$819.81
|
| Rate for Payer: Priority Health SBD |
$607.62
|
| Rate for Payer: UMR Bronson Commercial |
$424.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.36
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
OP
|
$839.87
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna American Axle |
$545.92
|
| Rate for Payer: Aetna Commercial |
$713.89
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$751.98
|
| Rate for Payer: BCN Commercial |
$751.98
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Advantage |
$587.91
|
| Rate for Payer: Cofinity Commercial |
$722.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.90
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.90
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$713.89
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$529.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.92
|
| Rate for Payer: UHC Core |
$437.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$330.07
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: UMR Bronson Commercial |
$310.75
|
| Rate for Payer: VA VA |
$405.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.90
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
IP
|
$839.87
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.54 |
| Max. Negotiated Rate |
$755.88 |
| Rate for Payer: Aetna American Axle |
$545.92
|
| Rate for Payer: Aetna Commercial |
$713.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.92
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Advantage |
$587.91
|
| Rate for Payer: Cofinity Commercial |
$722.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.90
|
| Rate for Payer: PHP Commercial |
$713.89
|
| Rate for Payer: Priority Health SBD |
$529.12
|
| Rate for Payer: UMR Bronson Commercial |
$369.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.90
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$17.27
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.13
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: UHC Exchange |
$2.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$8,820.19
|
|
|
Service Code
|
APR-DRG 3081
|
| Min. Negotiated Rate |
$8,400.18 |
| Max. Negotiated Rate |
$8,820.19 |
| Rate for Payer: BCBS Complete |
$8,820.19
|
| Rate for Payer: Mclaren Medicaid |
$8,400.18
|
| Rate for Payer: Meridian Medicaid |
$8,820.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,400.18
|
| Rate for Payer: UHC Medicaid |
$8,400.18
|
| Rate for Payer: UHCCP Medicaid |
$8,400.18
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$11,397.06
|
|
|
Service Code
|
APR-DRG 3082
|
| Min. Negotiated Rate |
$10,854.34 |
| Max. Negotiated Rate |
$11,397.06 |
| Rate for Payer: BCBS Complete |
$11,397.06
|
| Rate for Payer: Mclaren Medicaid |
$10,854.34
|
| Rate for Payer: Meridian Medicaid |
$11,397.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,854.34
|
| Rate for Payer: UHC Medicaid |
$10,854.34
|
| Rate for Payer: UHCCP Medicaid |
$10,854.34
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$24,962.39
|
|
|
Service Code
|
APR-DRG 3084
|
| Min. Negotiated Rate |
$23,773.71 |
| Max. Negotiated Rate |
$24,962.39 |
| Rate for Payer: BCBS Complete |
$24,962.39
|
| Rate for Payer: Mclaren Medicaid |
$23,773.71
|
| Rate for Payer: Meridian Medicaid |
$24,962.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,773.71
|
| Rate for Payer: UHC Medicaid |
$23,773.71
|
| Rate for Payer: UHCCP Medicaid |
$23,773.71
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$14,283.85
|
|
|
Service Code
|
APR-DRG 3083
|
| Min. Negotiated Rate |
$13,603.67 |
| Max. Negotiated Rate |
$14,283.85 |
| Rate for Payer: BCBS Complete |
$14,283.85
|
| Rate for Payer: Mclaren Medicaid |
$13,603.67
|
| Rate for Payer: Meridian Medicaid |
$14,283.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,603.67
|
| Rate for Payer: UHC Medicaid |
$13,603.67
|
| Rate for Payer: UHCCP Medicaid |
$13,603.67
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC
|
Facility
|
IP
|
$44,651.80
|
|
|
Service Code
|
MSDRG 481
|
| Min. Negotiated Rate |
$17,203.20 |
| Max. Negotiated Rate |
$44,651.80 |
| Rate for Payer: Aetna Medicare |
$18,832.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,635.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,635.79
|
| Rate for Payer: BCBS MAPPO |
$18,108.63
|
| Rate for Payer: BCBS Trust/PPO |
$44,651.80
|
| Rate for Payer: BCN Commercial |
$44,651.80
|
| Rate for Payer: BCN Medicare Advantage |
$18,108.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,108.63
|
| Rate for Payer: Mclaren Medicare |
$18,108.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,014.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,824.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,919.49
|
| Rate for Payer: Nomi Health Commercial |
$27,019.05
|
| Rate for Payer: PACE Medicare |
$17,203.20
|
| Rate for Payer: PACE SWMI |
$18,108.63
|
| Rate for Payer: PHP Medicare Advantage |
$18,108.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,767.82
|
| Rate for Payer: Priority Health Medicare |
$18,108.63
|
| Rate for Payer: Priority Health Tiered Network |
$27,014.25
|
| Rate for Payer: Railroad Medicare Medicare |
$18,108.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,140.35
|
| Rate for Payer: UHC Core |
$28,562.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,108.63
|
| Rate for Payer: UHC Exchange |
$23,326.45
|
| Rate for Payer: VA VA |
$18,108.63
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC
|
Facility
|
IP
|
$69,969.85
|
|
|
Service Code
|
MSDRG 480
|
| Min. Negotiated Rate |
$23,700.26 |
| Max. Negotiated Rate |
$69,969.85 |
| Rate for Payer: Aetna Medicare |
$25,945.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,184.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,184.55
|
| Rate for Payer: BCBS MAPPO |
$24,947.64
|
| Rate for Payer: BCBS Trust/PPO |
$69,969.85
|
| Rate for Payer: BCN Commercial |
$69,969.85
|
| Rate for Payer: BCN Medicare Advantage |
$24,947.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,947.64
|
| Rate for Payer: Mclaren Medicare |
$24,947.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,195.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,689.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,442.40
|
| Rate for Payer: Nomi Health Commercial |
$37,568.67
|
| Rate for Payer: PACE Medicare |
$23,700.26
|
| Rate for Payer: PACE SWMI |
$24,947.64
|
| Rate for Payer: PHP Medicare Advantage |
$24,947.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46,952.51
|
| Rate for Payer: Priority Health Medicare |
$24,947.64
|
| Rate for Payer: Priority Health Tiered Network |
$37,562.00
|
| Rate for Payer: Railroad Medicare Medicare |
$24,947.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,470.49
|
| Rate for Payer: UHC Core |
$39,715.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,947.64
|
| Rate for Payer: UHC Exchange |
$32,434.29
|
| Rate for Payer: VA VA |
$24,947.64
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC
|
Facility
|
IP
|
$34,225.91
|
|
|
Service Code
|
MSDRG 482
|
| Min. Negotiated Rate |
$13,520.89 |
| Max. Negotiated Rate |
$34,225.91 |
| Rate for Payer: Aetna Medicare |
$14,801.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,790.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,790.65
|
| Rate for Payer: BCBS MAPPO |
$14,232.52
|
| Rate for Payer: BCBS Trust/PPO |
$34,225.91
|
| Rate for Payer: BCN Commercial |
$34,225.91
|
| Rate for Payer: BCN Medicare Advantage |
$14,232.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,232.52
|
| Rate for Payer: Mclaren Medicare |
$14,232.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,944.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,367.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,655.77
|
| Rate for Payer: Nomi Health Commercial |
$21,039.90
|
| Rate for Payer: PACE Medicare |
$13,520.89
|
| Rate for Payer: PACE SWMI |
$14,232.52
|
| Rate for Payer: PHP Medicare Advantage |
$14,232.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,295.21
|
| Rate for Payer: Priority Health Medicare |
$14,232.52
|
| Rate for Payer: Priority Health Tiered Network |
$21,036.17
|
| Rate for Payer: Railroad Medicare Medicare |
$14,232.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,585.30
|
| Rate for Payer: UHC Core |
$22,241.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,232.52
|
| Rate for Payer: UHC Exchange |
$18,164.45
|
| Rate for Payer: VA VA |
$14,232.52
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC
|
Facility
|
IP
|
$82,786.73
|
|
|
Service Code
|
MSDRG 521
|
| Min. Negotiated Rate |
$23,365.78 |
| Max. Negotiated Rate |
$82,786.73 |
| Rate for Payer: Aetna Medicare |
$25,579.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,744.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,744.45
|
| Rate for Payer: BCBS MAPPO |
$24,595.56
|
| Rate for Payer: BCBS Trust/PPO |
$82,786.73
|
| Rate for Payer: BCN Commercial |
$82,786.73
|
| Rate for Payer: BCN Medicare Advantage |
$24,595.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,595.56
|
| Rate for Payer: Mclaren Medicare |
$24,595.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,825.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,284.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,055.12
|
| Rate for Payer: Nomi Health Commercial |
$37,025.58
|
| Rate for Payer: PACE Medicare |
$23,365.78
|
| Rate for Payer: PACE SWMI |
$24,595.56
|
| Rate for Payer: PHP Medicare Advantage |
$24,595.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46,273.77
|
| Rate for Payer: Priority Health Medicare |
$24,595.56
|
| Rate for Payer: Priority Health Tiered Network |
$37,019.01
|
| Rate for Payer: Railroad Medicare Medicare |
$24,595.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46,784.26
|
| Rate for Payer: UHC Core |
$39,140.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,595.56
|
| Rate for Payer: UHC Exchange |
$31,965.42
|
| Rate for Payer: VA VA |
$24,595.56
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC
|
Facility
|
IP
|
$47,223.96
|
|
|
Service Code
|
MSDRG 522
|
| Min. Negotiated Rate |
$17,387.51 |
| Max. Negotiated Rate |
$47,223.96 |
| Rate for Payer: Aetna Medicare |
$19,034.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,878.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,878.30
|
| Rate for Payer: BCBS MAPPO |
$18,302.64
|
| Rate for Payer: BCBS Trust/PPO |
$47,223.96
|
| Rate for Payer: BCN Commercial |
$47,223.96
|
| Rate for Payer: BCN Medicare Advantage |
$18,302.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,302.64
|
| Rate for Payer: Mclaren Medicare |
$18,302.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,217.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,048.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,132.90
|
| Rate for Payer: Nomi Health Commercial |
$27,318.33
|
| Rate for Payer: PACE Medicare |
$17,387.51
|
| Rate for Payer: PACE SWMI |
$18,302.64
|
| Rate for Payer: PHP Medicare Advantage |
$18,302.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,141.86
|
| Rate for Payer: Priority Health Medicare |
$18,302.64
|
| Rate for Payer: Priority Health Tiered Network |
$27,313.48
|
| Rate for Payer: Railroad Medicare Medicare |
$18,302.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,518.51
|
| Rate for Payer: UHC Core |
$28,879.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,302.64
|
| Rate for Payer: UHC Exchange |
$23,584.82
|
| Rate for Payer: VA VA |
$18,302.64
|
|
|
HISTRELIN 50 MG (65 MCG/DAY) IMPLANT KIT
|
Facility
|
IP
|
$225,315.48
|
|
|
Service Code
|
HCPCS J9226
|
| Hospital Charge Code |
172291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99,138.81 |
| Max. Negotiated Rate |
$202,783.93 |
| Rate for Payer: Aetna American Axle |
$146,455.06
|
| Rate for Payer: Aetna Commercial |
$191,518.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146,455.06
|
| Rate for Payer: Cash Price |
$180,252.38
|
| Rate for Payer: Cofinity Advantage |
$157,720.84
|
| Rate for Payer: Cofinity Commercial |
$193,771.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180,252.38
|
| Rate for Payer: Healthscope Commercial |
$202,783.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157,720.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168,986.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191,518.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168,986.61
|
| Rate for Payer: PHP Commercial |
$191,518.16
|
| Rate for Payer: Priority Health SBD |
$141,948.75
|
| Rate for Payer: UMR Bronson Commercial |
$99,138.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168,986.61
|
|
|
HISTRELIN 50 MG (65 MCG/DAY) IMPLANT KIT
|
Facility
|
OP
|
$225,315.48
|
|
|
Service Code
|
HCPCS J9226
|
| Hospital Charge Code |
172291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,533.70 |
| Max. Negotiated Rate |
$202,783.93 |
| Rate for Payer: Aetna American Axle |
$146,455.06
|
| Rate for Payer: Aetna Commercial |
$191,518.16
|
| Rate for Payer: Aetna Medicare |
$42,820.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146,455.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,466.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,466.79
|
| Rate for Payer: BCBS Complete |
$22,612.45
|
| Rate for Payer: BCBS MAPPO |
$41,173.43
|
| Rate for Payer: BCBS Trust/PPO |
$140,034.88
|
| Rate for Payer: BCN Commercial |
$140,034.88
|
| Rate for Payer: BCN Medicare Advantage |
$41,173.43
|
| Rate for Payer: Cash Price |
$180,252.38
|
| Rate for Payer: Cash Price |
$180,252.38
|
| Rate for Payer: Cofinity Advantage |
$157,720.84
|
| Rate for Payer: Cofinity Commercial |
$193,771.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180,252.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,173.43
|
| Rate for Payer: Healthscope Commercial |
$202,783.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157,720.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168,986.61
|
| Rate for Payer: Mclaren Medicaid |
$41,173.43
|
| Rate for Payer: Mclaren Medicare |
$41,173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43,232.10
|
| Rate for Payer: Meridian Medicaid |
$43,232.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,349.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$45,290.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191,518.16
|
| Rate for Payer: Nomi Health Commercial |
$123,520.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168,986.61
|
| Rate for Payer: PACE Medicare |
$39,114.76
|
| Rate for Payer: PACE SWMI |
$41,173.43
|
| Rate for Payer: PHP Commercial |
$191,518.16
|
| Rate for Payer: PHP Medicare Advantage |
$41,173.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,533.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$141,993.71
|
| Rate for Payer: Priority Health Medicare |
$41,173.43
|
| Rate for Payer: Priority Health SBD |
$141,948.75
|
| Rate for Payer: Priority Health Tiered Network |
$113,594.97
|
| Rate for Payer: Railroad Medicare Medicare |
$41,173.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71,255.81
|
| Rate for Payer: UHC Core |
$71,255.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41,173.43
|
| Rate for Payer: UHC Exchange |
$71,255.81
|
| Rate for Payer: UHC Medicaid |
$21,533.70
|
| Rate for Payer: UHCCP Medicaid |
$21,533.70
|
| Rate for Payer: UMR Bronson Commercial |
$83,366.73
|
| Rate for Payer: VA VA |
$41,173.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168,986.61
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$154,568.35
|
|
|
Service Code
|
MSDRG 969
|
| Min. Negotiated Rate |
$49,194.35 |
| Max. Negotiated Rate |
$154,568.35 |
| Rate for Payer: Aetna Medicare |
$53,854.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64,729.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64,729.41
|
| Rate for Payer: BCBS MAPPO |
$51,783.53
|
| Rate for Payer: BCBS Trust/PPO |
$154,568.35
|
| Rate for Payer: BCN Commercial |
$154,568.35
|
| Rate for Payer: BCN Medicare Advantage |
$51,783.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51,783.53
|
| Rate for Payer: Mclaren Medicare |
$51,783.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54,372.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59,551.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$56,961.88
|
| Rate for Payer: Nomi Health Commercial |
$78,964.77
|
| Rate for Payer: PACE Medicare |
$49,194.35
|
| Rate for Payer: PACE SWMI |
$51,783.53
|
| Rate for Payer: PHP Medicare Advantage |
$51,783.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98,688.46
|
| Rate for Payer: Priority Health Medicare |
$51,783.53
|
| Rate for Payer: Priority Health Tiered Network |
$78,950.75
|
| Rate for Payer: Railroad Medicare Medicare |
$51,783.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99,777.19
|
| Rate for Payer: UHC Core |
$83,476.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51,783.53
|
| Rate for Payer: UHC Exchange |
$68,172.92
|
| Rate for Payer: VA VA |
$51,783.53
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$50,045.92
|
|
|
Service Code
|
MSDRG 970
|
| Min. Negotiated Rate |
$21,516.29 |
| Max. Negotiated Rate |
$50,045.92 |
| Rate for Payer: Aetna Medicare |
$23,554.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,310.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,310.91
|
| Rate for Payer: BCBS MAPPO |
$22,648.73
|
| Rate for Payer: BCBS Trust/PPO |
$50,045.92
|
| Rate for Payer: BCN Commercial |
$50,045.92
|
| Rate for Payer: BCN Medicare Advantage |
$22,648.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,648.73
|
| Rate for Payer: Mclaren Medicare |
$22,648.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,781.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,046.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,913.60
|
| Rate for Payer: Nomi Health Commercial |
$34,022.46
|
| Rate for Payer: PACE Medicare |
$21,516.29
|
| Rate for Payer: PACE SWMI |
$22,648.73
|
| Rate for Payer: PHP Medicare Advantage |
$22,648.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42,520.53
|
| Rate for Payer: Priority Health Medicare |
$22,648.73
|
| Rate for Payer: Priority Health Tiered Network |
$34,016.42
|
| Rate for Payer: Railroad Medicare Medicare |
$22,648.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,989.62
|
| Rate for Payer: UHC Core |
$35,966.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,648.73
|
| Rate for Payer: UHC Exchange |
$29,372.72
|
| Rate for Payer: VA VA |
$22,648.73
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION OR MULTIPLE HIV SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$6,458.21
|
|
|
Service Code
|
APR-DRG 8913
|
| Min. Negotiated Rate |
$6,150.68 |
| Max. Negotiated Rate |
$6,458.21 |
| Rate for Payer: BCBS Complete |
$6,458.21
|
| Rate for Payer: Mclaren Medicaid |
$6,150.68
|
| Rate for Payer: Meridian Medicaid |
$6,458.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,150.68
|
| Rate for Payer: UHC Medicaid |
$6,150.68
|
| Rate for Payer: UHCCP Medicaid |
$6,150.68
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION OR MULTIPLE HIV SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,910.40
|
|
|
Service Code
|
APR-DRG 8912
|
| Min. Negotiated Rate |
$4,676.57 |
| Max. Negotiated Rate |
$4,910.40 |
| Rate for Payer: BCBS Complete |
$4,910.40
|
| Rate for Payer: Mclaren Medicaid |
$4,676.57
|
| Rate for Payer: Meridian Medicaid |
$4,910.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,676.57
|
| Rate for Payer: UHC Medicaid |
$4,676.57
|
| Rate for Payer: UHCCP Medicaid |
$4,676.57
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION OR MULTIPLE HIV SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,665.24
|
|
|
Service Code
|
APR-DRG 8911
|
| Min. Negotiated Rate |
$4,443.09 |
| Max. Negotiated Rate |
$4,665.24 |
| Rate for Payer: BCBS Complete |
$4,665.24
|
| Rate for Payer: Mclaren Medicaid |
$4,443.09
|
| Rate for Payer: Meridian Medicaid |
$4,665.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,443.09
|
| Rate for Payer: UHC Medicaid |
$4,443.09
|
| Rate for Payer: UHCCP Medicaid |
$4,443.09
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION OR MULTIPLE HIV SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$10,619.22
|
|
|
Service Code
|
APR-DRG 8914
|
| Min. Negotiated Rate |
$10,113.54 |
| Max. Negotiated Rate |
$10,619.22 |
| Rate for Payer: BCBS Complete |
$10,619.22
|
| Rate for Payer: Mclaren Medicaid |
$10,113.54
|
| Rate for Payer: Meridian Medicaid |
$10,619.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,113.54
|
| Rate for Payer: UHC Medicaid |
$10,113.54
|
| Rate for Payer: UHCCP Medicaid |
$10,113.54
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
|
IP
|
$21,108.50
|
|
|
Service Code
|
MSDRG 975
|
| Min. Negotiated Rate |
$10,851.52 |
| Max. Negotiated Rate |
$21,108.50 |
| Rate for Payer: Aetna Medicare |
$11,879.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,278.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,278.31
|
| Rate for Payer: BCBS MAPPO |
$11,422.65
|
| Rate for Payer: BCBS Trust/PPO |
$15,633.34
|
| Rate for Payer: BCN Commercial |
$15,633.34
|
| Rate for Payer: BCN Medicare Advantage |
$11,422.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,422.65
|
| Rate for Payer: Mclaren Medicare |
$11,422.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,993.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,136.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,564.92
|
| Rate for Payer: Nomi Health Commercial |
$16,705.50
|
| Rate for Payer: PACE Medicare |
$10,851.52
|
| Rate for Payer: PACE SWMI |
$11,422.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,422.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,878.17
|
| Rate for Payer: Priority Health Medicare |
$11,422.65
|
| Rate for Payer: Priority Health Tiered Network |
$16,702.53
|
| Rate for Payer: Railroad Medicare Medicare |
$11,422.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,108.50
|
| Rate for Payer: UHC Core |
$17,659.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,422.65
|
| Rate for Payer: UHC Exchange |
$14,422.42
|
| Rate for Payer: VA VA |
$11,422.65
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
|
IP
|
$59,543.96
|
|
|
Service Code
|
MSDRG 974
|
| Min. Negotiated Rate |
$23,491.31 |
| Max. Negotiated Rate |
$59,543.96 |
| Rate for Payer: Aetna Medicare |
$25,716.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,909.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,909.62
|
| Rate for Payer: BCBS MAPPO |
$24,727.70
|
| Rate for Payer: BCBS Trust/PPO |
$59,543.96
|
| Rate for Payer: BCN Commercial |
$59,543.96
|
| Rate for Payer: BCN Medicare Advantage |
$24,727.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,727.70
|
| Rate for Payer: Mclaren Medicare |
$24,727.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,964.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,436.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,200.47
|
| Rate for Payer: Nomi Health Commercial |
$37,229.40
|
| Rate for Payer: PACE Medicare |
$23,491.31
|
| Rate for Payer: PACE SWMI |
$24,727.70
|
| Rate for Payer: PHP Medicare Advantage |
$24,727.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46,528.50
|
| Rate for Payer: Priority Health Medicare |
$24,727.70
|
| Rate for Payer: Priority Health Tiered Network |
$37,222.79
|
| Rate for Payer: Railroad Medicare Medicare |
$24,727.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,041.80
|
| Rate for Payer: UHC Core |
$39,356.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,727.70
|
| Rate for Payer: UHC Exchange |
$32,141.38
|
| Rate for Payer: VA VA |
$24,727.70
|
|
|
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,180.40
|
|
|
Service Code
|
MSDRG 976
|
| Min. Negotiated Rate |
$7,734.89 |
| Max. Negotiated Rate |
$15,180.40 |
| Rate for Payer: Aetna Medicare |
$8,467.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,177.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,177.49
|
| Rate for Payer: BCBS MAPPO |
$8,141.99
|
| Rate for Payer: BCBS Trust/PPO |
$15,180.40
|
| Rate for Payer: BCN Commercial |
$15,180.40
|
| Rate for Payer: BCN Medicare Advantage |
$8,141.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,141.99
|
| Rate for Payer: Mclaren Medicare |
$8,141.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,549.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,363.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,956.19
|
| Rate for Payer: Nomi Health Commercial |
$11,539.05
|
| Rate for Payer: PACE Medicare |
$7,734.89
|
| Rate for Payer: PACE SWMI |
$8,141.99
|
| Rate for Payer: PHP Medicare Advantage |
$8,141.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,553.46
|
| Rate for Payer: Priority Health Medicare |
$8,141.99
|
| Rate for Payer: Priority Health Tiered Network |
$11,642.76
|
| Rate for Payer: Railroad Medicare Medicare |
$8,141.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,580.35
|
| Rate for Payer: UHC Core |
$12,198.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,141.99
|
| Rate for Payer: UHC Exchange |
$9,962.05
|
| Rate for Payer: VA VA |
$8,141.99
|
|
