|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$53,757.29
|
|
|
Service Code
|
MSDRG 821
|
| Min. Negotiated Rate |
$18,348.01 |
| Max. Negotiated Rate |
$53,757.29 |
| Rate for Payer: Aetna Medicare |
$20,086.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,142.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,142.12
|
| Rate for Payer: BCBS MAPPO |
$19,313.70
|
| Rate for Payer: BCBS Trust/PPO |
$53,757.29
|
| Rate for Payer: BCN Commercial |
$53,757.29
|
| Rate for Payer: BCN Medicare Advantage |
$19,313.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,313.70
|
| Rate for Payer: Mclaren Medicare |
$19,313.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,279.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,210.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,245.07
|
| Rate for Payer: Nomi Health Commercial |
$28,877.94
|
| Rate for Payer: PACE Medicare |
$18,348.01
|
| Rate for Payer: PACE SWMI |
$19,313.70
|
| Rate for Payer: PHP Medicare Advantage |
$19,313.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,091.02
|
| Rate for Payer: Priority Health Medicare |
$19,313.70
|
| Rate for Payer: Priority Health Tiered Network |
$28,872.81
|
| Rate for Payer: Railroad Medicare Medicare |
$19,313.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,489.18
|
| Rate for Payer: UHC Core |
$30,527.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,313.70
|
| Rate for Payer: UHC Exchange |
$24,931.29
|
| Rate for Payer: VA VA |
$19,313.70
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$123,474.60
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$47,156.57 |
| Max. Negotiated Rate |
$123,474.60 |
| Rate for Payer: Aetna Medicare |
$51,624.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,048.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,048.11
|
| Rate for Payer: BCBS MAPPO |
$49,638.49
|
| Rate for Payer: BCBS Trust/PPO |
$123,474.60
|
| Rate for Payer: BCN Commercial |
$123,474.60
|
| Rate for Payer: BCN Medicare Advantage |
$49,638.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,638.49
|
| Rate for Payer: Mclaren Medicare |
$49,638.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52,120.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,084.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$54,602.34
|
| Rate for Payer: Nomi Health Commercial |
$75,655.92
|
| Rate for Payer: PACE Medicare |
$47,156.57
|
| Rate for Payer: PACE SWMI |
$49,638.49
|
| Rate for Payer: PHP Medicare Advantage |
$49,638.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94,553.13
|
| Rate for Payer: Priority Health Medicare |
$49,638.49
|
| Rate for Payer: Priority Health Tiered Network |
$75,642.49
|
| Rate for Payer: Railroad Medicare Medicare |
$49,638.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95,596.24
|
| Rate for Payer: UHC Core |
$79,978.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49,638.49
|
| Rate for Payer: UHC Exchange |
$65,316.28
|
| Rate for Payer: VA VA |
$49,638.49
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,240.03
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$10,128.59 |
| Max. Negotiated Rate |
$37,240.03 |
| Rate for Payer: Aetna Medicare |
$11,088.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,327.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,327.09
|
| Rate for Payer: BCBS MAPPO |
$10,661.67
|
| Rate for Payer: BCBS Trust/PPO |
$37,240.03
|
| Rate for Payer: BCN Commercial |
$37,240.03
|
| Rate for Payer: BCN Medicare Advantage |
$10,661.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,661.67
|
| Rate for Payer: Mclaren Medicare |
$10,661.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,194.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,260.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,727.84
|
| Rate for Payer: Nomi Health Commercial |
$15,531.60
|
| Rate for Payer: PACE Medicare |
$10,128.59
|
| Rate for Payer: PACE SWMI |
$10,661.67
|
| Rate for Payer: PHP Medicare Advantage |
$10,661.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,411.06
|
| Rate for Payer: Priority Health Medicare |
$10,661.67
|
| Rate for Payer: Priority Health Tiered Network |
$15,528.84
|
| Rate for Payer: Railroad Medicare Medicare |
$10,661.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,625.20
|
| Rate for Payer: UHC Core |
$16,418.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,661.67
|
| Rate for Payer: UHC Exchange |
$13,408.95
|
| Rate for Payer: VA VA |
$10,661.67
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$39,386.69
|
|
|
Service Code
|
MSDRG 841
|
| Min. Negotiated Rate |
$13,524.09 |
| Max. Negotiated Rate |
$39,386.69 |
| Rate for Payer: Aetna Medicare |
$14,805.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,794.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,794.85
|
| Rate for Payer: BCBS MAPPO |
$14,235.88
|
| Rate for Payer: BCBS Trust/PPO |
$39,386.69
|
| Rate for Payer: BCN Commercial |
$39,386.69
|
| Rate for Payer: BCN Medicare Advantage |
$14,235.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,235.88
|
| Rate for Payer: Mclaren Medicare |
$14,235.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,947.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,371.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,659.47
|
| Rate for Payer: Nomi Health Commercial |
$21,045.06
|
| Rate for Payer: PACE Medicare |
$13,524.09
|
| Rate for Payer: PACE SWMI |
$14,235.88
|
| Rate for Payer: PHP Medicare Advantage |
$14,235.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,301.66
|
| Rate for Payer: Priority Health Medicare |
$14,235.88
|
| Rate for Payer: Priority Health Tiered Network |
$21,041.32
|
| Rate for Payer: Railroad Medicare Medicare |
$14,235.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,591.82
|
| Rate for Payer: UHC Core |
$22,247.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,235.88
|
| Rate for Payer: UHC Exchange |
$18,168.90
|
| Rate for Payer: VA VA |
$14,235.88
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$83,967.12
|
|
|
Service Code
|
MSDRG 840
|
| Min. Negotiated Rate |
$26,263.19 |
| Max. Negotiated Rate |
$83,967.12 |
| Rate for Payer: Aetna Medicare |
$28,751.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,556.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,556.82
|
| Rate for Payer: BCBS MAPPO |
$27,645.46
|
| Rate for Payer: BCBS Trust/PPO |
$83,967.12
|
| Rate for Payer: BCN Commercial |
$83,967.12
|
| Rate for Payer: BCN Medicare Advantage |
$27,645.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,645.46
|
| Rate for Payer: Mclaren Medicare |
$27,645.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,027.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,792.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,410.01
|
| Rate for Payer: Nomi Health Commercial |
$41,730.21
|
| Rate for Payer: PACE Medicare |
$26,263.19
|
| Rate for Payer: PACE SWMI |
$27,645.46
|
| Rate for Payer: PHP Medicare Advantage |
$27,645.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$52,153.51
|
| Rate for Payer: Priority Health Medicare |
$27,645.46
|
| Rate for Payer: Priority Health Tiered Network |
$41,722.80
|
| Rate for Payer: Railroad Medicare Medicare |
$27,645.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,728.87
|
| Rate for Payer: UHC Core |
$44,114.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,645.46
|
| Rate for Payer: UHC Exchange |
$36,027.08
|
| Rate for Payer: VA VA |
$27,645.46
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$51,215.33
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$18,562.52 |
| Max. Negotiated Rate |
$51,215.33 |
| Rate for Payer: Aetna Medicare |
$20,321.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,424.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,424.36
|
| Rate for Payer: BCBS MAPPO |
$19,539.49
|
| Rate for Payer: BCBS Trust/PPO |
$51,215.33
|
| Rate for Payer: BCN Commercial |
$51,215.33
|
| Rate for Payer: BCN Medicare Advantage |
$19,539.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,539.49
|
| Rate for Payer: Mclaren Medicare |
$19,539.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,516.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,470.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,493.44
|
| Rate for Payer: Nomi Health Commercial |
$29,226.24
|
| Rate for Payer: PACE Medicare |
$18,562.52
|
| Rate for Payer: PACE SWMI |
$19,539.49
|
| Rate for Payer: PHP Medicare Advantage |
$19,539.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,526.32
|
| Rate for Payer: Priority Health Medicare |
$19,539.49
|
| Rate for Payer: Priority Health Tiered Network |
$29,221.05
|
| Rate for Payer: Railroad Medicare Medicare |
$19,539.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,929.28
|
| Rate for Payer: UHC Core |
$30,895.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,539.49
|
| Rate for Payer: UHC Exchange |
$25,231.99
|
| Rate for Payer: VA VA |
$19,539.49
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$104,711.84
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$36,987.54 |
| Max. Negotiated Rate |
$104,711.84 |
| Rate for Payer: Aetna Medicare |
$40,491.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,667.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,667.81
|
| Rate for Payer: BCBS MAPPO |
$38,934.25
|
| Rate for Payer: BCBS Trust/PPO |
$104,711.84
|
| Rate for Payer: BCN Commercial |
$104,711.84
|
| Rate for Payer: BCN Medicare Advantage |
$38,934.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,934.25
|
| Rate for Payer: Mclaren Medicare |
$38,934.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40,880.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,774.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$42,827.68
|
| Rate for Payer: Nomi Health Commercial |
$59,143.92
|
| Rate for Payer: PACE Medicare |
$36,987.54
|
| Rate for Payer: PACE SWMI |
$38,934.25
|
| Rate for Payer: PHP Medicare Advantage |
$38,934.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73,916.79
|
| Rate for Payer: Priority Health Medicare |
$38,934.25
|
| Rate for Payer: Priority Health Tiered Network |
$59,133.42
|
| Rate for Payer: Railroad Medicare Medicare |
$38,934.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74,732.24
|
| Rate for Payer: UHC Core |
$62,522.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38,934.25
|
| Rate for Payer: UHC Exchange |
$51,060.92
|
| Rate for Payer: VA VA |
$38,934.25
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$42,881.21
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$11,283.72 |
| Max. Negotiated Rate |
$42,881.21 |
| Rate for Payer: Aetna Medicare |
$12,352.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,847.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,847.00
|
| Rate for Payer: BCBS MAPPO |
$11,877.60
|
| Rate for Payer: BCBS Trust/PPO |
$42,881.21
|
| Rate for Payer: BCN Commercial |
$42,881.21
|
| Rate for Payer: BCN Medicare Advantage |
$11,877.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,877.60
|
| Rate for Payer: Mclaren Medicare |
$11,877.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,471.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,659.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,065.36
|
| Rate for Payer: Nomi Health Commercial |
$17,407.26
|
| Rate for Payer: PACE Medicare |
$11,283.72
|
| Rate for Payer: PACE SWMI |
$11,877.60
|
| Rate for Payer: PHP Medicare Advantage |
$11,877.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,755.22
|
| Rate for Payer: Priority Health Medicare |
$11,877.60
|
| Rate for Payer: Priority Health Tiered Network |
$17,404.17
|
| Rate for Payer: Railroad Medicare Medicare |
$11,877.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,995.22
|
| Rate for Payer: UHC Core |
$18,401.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,877.60
|
| Rate for Payer: UHC Exchange |
$15,028.27
|
| Rate for Payer: VA VA |
$11,877.60
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$25,087.47
|
|
|
Service Code
|
MSDRG 842
|
| Min. Negotiated Rate |
$8,590.51 |
| Max. Negotiated Rate |
$25,087.47 |
| Rate for Payer: Aetna Medicare |
$9,404.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,303.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,303.30
|
| Rate for Payer: BCBS MAPPO |
$9,042.64
|
| Rate for Payer: BCBS Trust/PPO |
$25,087.47
|
| Rate for Payer: BCN Commercial |
$25,087.47
|
| Rate for Payer: BCN Medicare Advantage |
$9,042.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,042.64
|
| Rate for Payer: Mclaren Medicare |
$9,042.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,494.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,399.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,946.90
|
| Rate for Payer: Nomi Health Commercial |
$13,034.16
|
| Rate for Payer: PACE Medicare |
$8,590.51
|
| Rate for Payer: PACE SWMI |
$9,042.64
|
| Rate for Payer: PHP Medicare Advantage |
$9,042.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,289.81
|
| Rate for Payer: Priority Health Medicare |
$9,042.64
|
| Rate for Payer: Priority Health Tiered Network |
$13,031.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9,042.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,469.52
|
| Rate for Payer: UHC Core |
$13,778.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,042.64
|
| Rate for Payer: UHC Exchange |
$11,252.82
|
| Rate for Payer: VA VA |
$9,042.64
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$8,669.46
|
|
|
Service Code
|
APR-DRG 6912
|
| Min. Negotiated Rate |
$8,256.63 |
| Max. Negotiated Rate |
$8,669.46 |
| Rate for Payer: BCBS Complete |
$8,669.46
|
| Rate for Payer: Mclaren Medicaid |
$8,256.63
|
| Rate for Payer: Meridian Medicaid |
$8,669.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,256.63
|
| Rate for Payer: UHC Medicaid |
$8,256.63
|
| Rate for Payer: UHCCP Medicaid |
$8,256.63
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$16,743.29
|
|
|
Service Code
|
APR-DRG 6913
|
| Min. Negotiated Rate |
$15,945.99 |
| Max. Negotiated Rate |
$16,743.29 |
| Rate for Payer: BCBS Complete |
$16,743.29
|
| Rate for Payer: Mclaren Medicaid |
$15,945.99
|
| Rate for Payer: Meridian Medicaid |
$16,743.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,945.99
|
| Rate for Payer: UHC Medicaid |
$15,945.99
|
| Rate for Payer: UHCCP Medicaid |
$15,945.99
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$22,414.58
|
|
|
Service Code
|
APR-DRG 6914
|
| Min. Negotiated Rate |
$21,347.22 |
| Max. Negotiated Rate |
$22,414.58 |
| Rate for Payer: BCBS Complete |
$22,414.58
|
| Rate for Payer: Mclaren Medicaid |
$21,347.22
|
| Rate for Payer: Meridian Medicaid |
$22,414.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,347.22
|
| Rate for Payer: UHC Medicaid |
$21,347.22
|
| Rate for Payer: UHCCP Medicaid |
$21,347.22
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$5,125.89
|
|
|
Service Code
|
APR-DRG 6911
|
| Min. Negotiated Rate |
$4,881.80 |
| Max. Negotiated Rate |
$5,125.89 |
| Rate for Payer: BCBS Complete |
$5,125.89
|
| Rate for Payer: Mclaren Medicaid |
$4,881.80
|
| Rate for Payer: Meridian Medicaid |
$5,125.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,881.80
|
| Rate for Payer: UHC Medicaid |
$4,881.80
|
| Rate for Payer: UHCCP Medicaid |
$4,881.80
|
|
|
LYSIS INTRANASAL SYNECHIA
|
Facility
|
OP
|
$1,737.88
|
|
|
Service Code
|
CPT 30560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.05 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$450.05
|
| Rate for Payer: BCN Commercial |
$450.05
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Mclaren Medicaid |
$537.39
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
|
|
LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 56441
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,006.33
|
| Rate for Payer: BCN Commercial |
$2,006.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 54162
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,275.78
|
| Rate for Payer: BCN Commercial |
$2,275.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
IP
|
$462.07
|
|
|
Service Code
|
NDC 49884090252
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.31 |
| Max. Negotiated Rate |
$415.86 |
| Rate for Payer: Aetna American Axle |
$300.35
|
| Rate for Payer: Aetna Commercial |
$392.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.35
|
| Rate for Payer: Cash Price |
$369.66
|
| Rate for Payer: Cofinity Advantage |
$323.45
|
| Rate for Payer: Cofinity Commercial |
$397.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.66
|
| Rate for Payer: Healthscope Commercial |
$415.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.55
|
| Rate for Payer: PHP Commercial |
$392.76
|
| Rate for Payer: Priority Health SBD |
$291.10
|
| Rate for Payer: UMR Bronson Commercial |
$203.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.55
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
IP
|
$2,310.34
|
|
|
Service Code
|
NDC 49884090278
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,016.55 |
| Max. Negotiated Rate |
$2,079.31 |
| Rate for Payer: Aetna American Axle |
$1,501.72
|
| Rate for Payer: Aetna Commercial |
$1,963.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,501.72
|
| Rate for Payer: Cash Price |
$1,848.27
|
| Rate for Payer: Cofinity Advantage |
$1,617.24
|
| Rate for Payer: Cofinity Commercial |
$1,986.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,848.27
|
| Rate for Payer: Healthscope Commercial |
$2,079.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,617.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,732.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,963.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,732.76
|
| Rate for Payer: PHP Commercial |
$1,963.79
|
| Rate for Payer: Priority Health SBD |
$1,455.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,016.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,732.76
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
OP
|
$462.07
|
|
|
Service Code
|
NDC 49884090252
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.97 |
| Max. Negotiated Rate |
$415.86 |
| Rate for Payer: Aetna American Axle |
$300.35
|
| Rate for Payer: Aetna Commercial |
$392.76
|
| Rate for Payer: Aetna Medicare |
$231.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.35
|
| Rate for Payer: BCBS Complete |
$184.83
|
| Rate for Payer: Cash Price |
$369.66
|
| Rate for Payer: Cofinity Advantage |
$323.45
|
| Rate for Payer: Cofinity Commercial |
$397.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.66
|
| Rate for Payer: Healthscope Commercial |
$415.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$369.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.55
|
| Rate for Payer: PHP Commercial |
$392.76
|
| Rate for Payer: Priority Health SBD |
$291.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.35
|
| Rate for Payer: UHC Core |
$240.74
|
| Rate for Payer: UHC Exchange |
$181.59
|
| Rate for Payer: UMR Bronson Commercial |
$170.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.55
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
IP
|
$753.46
|
|
|
Service Code
|
NDC 51079062484
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.52 |
| Max. Negotiated Rate |
$678.11 |
| Rate for Payer: Aetna American Axle |
$489.75
|
| Rate for Payer: Aetna Commercial |
$640.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.75
|
| Rate for Payer: Cash Price |
$602.77
|
| Rate for Payer: Cofinity Advantage |
$527.42
|
| Rate for Payer: Cofinity Commercial |
$647.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.77
|
| Rate for Payer: Healthscope Commercial |
$678.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$527.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$565.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$565.10
|
| Rate for Payer: PHP Commercial |
$640.44
|
| Rate for Payer: Priority Health SBD |
$474.68
|
| Rate for Payer: UMR Bronson Commercial |
$331.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$565.10
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
OP
|
$3,767.30
|
|
|
Service Code
|
NDC 51079062485
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,393.90 |
| Max. Negotiated Rate |
$3,390.57 |
| Rate for Payer: Aetna American Axle |
$2,448.74
|
| Rate for Payer: Aetna Commercial |
$3,202.20
|
| Rate for Payer: Aetna Medicare |
$1,883.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,448.74
|
| Rate for Payer: BCBS Complete |
$1,506.92
|
| Rate for Payer: Cash Price |
$3,013.84
|
| Rate for Payer: Cofinity Advantage |
$2,637.11
|
| Rate for Payer: Cofinity Commercial |
$3,239.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.84
|
| Rate for Payer: Healthscope Commercial |
$3,390.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,637.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,825.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,013.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,825.47
|
| Rate for Payer: PHP Commercial |
$3,202.20
|
| Rate for Payer: Priority Health SBD |
$2,373.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,448.74
|
| Rate for Payer: UHC Core |
$1,962.76
|
| Rate for Payer: UHC Exchange |
$1,480.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,393.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,825.47
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
OP
|
$2,310.34
|
|
|
Service Code
|
NDC 49884090278
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$854.83 |
| Max. Negotiated Rate |
$2,079.31 |
| Rate for Payer: Aetna American Axle |
$1,501.72
|
| Rate for Payer: Aetna Commercial |
$1,963.79
|
| Rate for Payer: Aetna Medicare |
$1,155.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,501.72
|
| Rate for Payer: BCBS Complete |
$924.14
|
| Rate for Payer: Cash Price |
$1,848.27
|
| Rate for Payer: Cofinity Advantage |
$1,617.24
|
| Rate for Payer: Cofinity Commercial |
$1,986.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,848.27
|
| Rate for Payer: Healthscope Commercial |
$2,079.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,617.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,732.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,848.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,963.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,732.76
|
| Rate for Payer: PHP Commercial |
$1,963.79
|
| Rate for Payer: Priority Health SBD |
$1,455.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,501.72
|
| Rate for Payer: UHC Core |
$1,203.69
|
| Rate for Payer: UHC Exchange |
$907.96
|
| Rate for Payer: UMR Bronson Commercial |
$854.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,732.76
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
IP
|
$3,767.30
|
|
|
Service Code
|
NDC 51079062485
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,657.61 |
| Max. Negotiated Rate |
$3,390.57 |
| Rate for Payer: Aetna American Axle |
$2,448.74
|
| Rate for Payer: Aetna Commercial |
$3,202.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,448.74
|
| Rate for Payer: Cash Price |
$3,013.84
|
| Rate for Payer: Cofinity Advantage |
$2,637.11
|
| Rate for Payer: Cofinity Commercial |
$3,239.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.84
|
| Rate for Payer: Healthscope Commercial |
$3,390.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,637.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,825.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,825.47
|
| Rate for Payer: PHP Commercial |
$3,202.20
|
| Rate for Payer: Priority Health SBD |
$2,373.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,657.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,825.47
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
OP
|
$753.46
|
|
|
Service Code
|
NDC 51079062484
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.78 |
| Max. Negotiated Rate |
$678.11 |
| Rate for Payer: Aetna American Axle |
$489.75
|
| Rate for Payer: Aetna Commercial |
$640.44
|
| Rate for Payer: Aetna Medicare |
$376.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.75
|
| Rate for Payer: BCBS Complete |
$301.38
|
| Rate for Payer: Cash Price |
$602.77
|
| Rate for Payer: Cofinity Advantage |
$527.42
|
| Rate for Payer: Cofinity Commercial |
$647.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.77
|
| Rate for Payer: Healthscope Commercial |
$678.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$527.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$565.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$565.10
|
| Rate for Payer: PHP Commercial |
$640.44
|
| Rate for Payer: Priority Health SBD |
$474.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.75
|
| Rate for Payer: UHC Core |
$392.55
|
| Rate for Payer: UHC Exchange |
$296.11
|
| Rate for Payer: UMR Bronson Commercial |
$278.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$565.10
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
OP
|
$247.27
|
|
|
Service Code
|
NDC 16571072360
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.49 |
| Max. Negotiated Rate |
$222.54 |
| Rate for Payer: Aetna American Axle |
$160.73
|
| Rate for Payer: Aetna Commercial |
$210.18
|
| Rate for Payer: Aetna Medicare |
$123.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.73
|
| Rate for Payer: BCBS Complete |
$98.91
|
| Rate for Payer: Cash Price |
$197.82
|
| Rate for Payer: Cofinity Advantage |
$173.09
|
| Rate for Payer: Cofinity Commercial |
$212.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.82
|
| Rate for Payer: Healthscope Commercial |
$222.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.45
|
| Rate for Payer: PHP Commercial |
$210.18
|
| Rate for Payer: Priority Health SBD |
$155.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.73
|
| Rate for Payer: UHC Core |
$128.83
|
| Rate for Payer: UHC Exchange |
$97.18
|
| Rate for Payer: UMR Bronson Commercial |
$91.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.45
|
|
