|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC
|
Facility
|
IP
|
$38,535.71
|
|
|
Service Code
|
MSDRG 435
|
| Min. Negotiated Rate |
$15,155.09 |
| Max. Negotiated Rate |
$38,535.71 |
| Rate for Payer: Aetna Medicare |
$16,590.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,940.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,940.91
|
| Rate for Payer: BCBS MAPPO |
$15,952.73
|
| Rate for Payer: BCBS Trust/PPO |
$38,535.71
|
| Rate for Payer: BCN Commercial |
$38,535.71
|
| Rate for Payer: BCN Medicare Advantage |
$15,952.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,952.73
|
| Rate for Payer: Mclaren Medicare |
$15,952.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,750.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,345.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,548.00
|
| Rate for Payer: Nomi Health Commercial |
$23,693.43
|
| Rate for Payer: PACE Medicare |
$15,155.09
|
| Rate for Payer: PACE SWMI |
$15,952.73
|
| Rate for Payer: PHP Medicare Advantage |
$15,952.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,611.53
|
| Rate for Payer: Priority Health Medicare |
$15,952.73
|
| Rate for Payer: Priority Health Tiered Network |
$23,689.22
|
| Rate for Payer: Railroad Medicare Medicare |
$15,952.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,938.21
|
| Rate for Payer: UHC Core |
$25,047.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,952.73
|
| Rate for Payer: UHC Exchange |
$20,455.33
|
| Rate for Payer: VA VA |
$15,952.73
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,827.07
|
|
|
Service Code
|
MSDRG 437
|
| Min. Negotiated Rate |
$7,342.42 |
| Max. Negotiated Rate |
$20,827.07 |
| Rate for Payer: Aetna Medicare |
$8,038.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,661.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,661.08
|
| Rate for Payer: BCBS MAPPO |
$7,728.86
|
| Rate for Payer: BCBS Trust/PPO |
$20,827.07
|
| Rate for Payer: BCN Commercial |
$20,827.07
|
| Rate for Payer: BCN Medicare Advantage |
$7,728.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,728.86
|
| Rate for Payer: Mclaren Medicare |
$7,728.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,115.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,888.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,501.75
|
| Rate for Payer: Nomi Health Commercial |
$11,007.57
|
| Rate for Payer: PACE Medicare |
$7,342.42
|
| Rate for Payer: PACE SWMI |
$7,728.86
|
| Rate for Payer: PHP Medicare Advantage |
$7,728.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,757.02
|
| Rate for Payer: Priority Health Medicare |
$7,728.86
|
| Rate for Payer: Priority Health Tiered Network |
$11,005.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7,728.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,908.79
|
| Rate for Payer: UHC Core |
$11,636.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,728.86
|
| Rate for Payer: UHC Exchange |
$9,503.20
|
| Rate for Payer: VA VA |
$7,728.86
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
|
IP
|
$17,543.53
|
|
|
Service Code
|
APR-DRG 3824
|
| Min. Negotiated Rate |
$16,708.12 |
| Max. Negotiated Rate |
$17,543.53 |
| Rate for Payer: BCBS Complete |
$17,543.53
|
| Rate for Payer: Mclaren Medicaid |
$16,708.12
|
| Rate for Payer: Meridian Medicaid |
$17,543.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,708.12
|
| Rate for Payer: UHC Medicaid |
$16,708.12
|
| Rate for Payer: UHCCP Medicaid |
$16,708.12
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
|
IP
|
$9,926.72
|
|
|
Service Code
|
APR-DRG 3823
|
| Min. Negotiated Rate |
$9,454.02 |
| Max. Negotiated Rate |
$9,926.72 |
| Rate for Payer: BCBS Complete |
$9,926.72
|
| Rate for Payer: Mclaren Medicaid |
$9,454.02
|
| Rate for Payer: Meridian Medicaid |
$9,926.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,454.02
|
| Rate for Payer: UHC Medicaid |
$9,454.02
|
| Rate for Payer: UHCCP Medicaid |
$9,454.02
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
|
IP
|
$4,897.68
|
|
|
Service Code
|
APR-DRG 3821
|
| Min. Negotiated Rate |
$4,664.46 |
| Max. Negotiated Rate |
$4,897.68 |
| Rate for Payer: BCBS Complete |
$4,897.68
|
| Rate for Payer: Mclaren Medicaid |
$4,664.46
|
| Rate for Payer: Meridian Medicaid |
$4,897.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,664.46
|
| Rate for Payer: UHC Medicaid |
$4,664.46
|
| Rate for Payer: UHCCP Medicaid |
$4,664.46
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
|
IP
|
$5,478.19
|
|
|
Service Code
|
APR-DRG 3822
|
| Min. Negotiated Rate |
$5,217.32 |
| Max. Negotiated Rate |
$5,478.19 |
| Rate for Payer: BCBS Complete |
$5,478.19
|
| Rate for Payer: Mclaren Medicaid |
$5,217.32
|
| Rate for Payer: Meridian Medicaid |
$5,478.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,217.32
|
| Rate for Payer: UHC Medicaid |
$5,217.32
|
| Rate for Payer: UHCCP Medicaid |
$5,217.32
|
|
|
MALIGNANT BREAST DISORDERS WITH CC
|
Facility
|
IP
|
$19,745.50
|
|
|
Service Code
|
MSDRG 598
|
| Min. Negotiated Rate |
$9,551.01 |
| Max. Negotiated Rate |
$19,745.50 |
| Rate for Payer: Aetna Medicare |
$10,455.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,567.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,567.12
|
| Rate for Payer: BCBS MAPPO |
$10,053.70
|
| Rate for Payer: BCBS Trust/PPO |
$19,745.50
|
| Rate for Payer: BCN Commercial |
$19,745.50
|
| Rate for Payer: BCN Medicare Advantage |
$10,053.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,053.70
|
| Rate for Payer: Mclaren Medicare |
$10,053.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,556.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,561.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,059.07
|
| Rate for Payer: Nomi Health Commercial |
$14,593.77
|
| Rate for Payer: PACE Medicare |
$9,551.01
|
| Rate for Payer: PACE SWMI |
$10,053.70
|
| Rate for Payer: PHP Medicare Advantage |
$10,053.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,238.98
|
| Rate for Payer: Priority Health Medicare |
$10,053.70
|
| Rate for Payer: Priority Health Tiered Network |
$14,591.18
|
| Rate for Payer: Railroad Medicare Medicare |
$10,053.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,440.19
|
| Rate for Payer: UHC Core |
$15,427.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,053.70
|
| Rate for Payer: UHC Exchange |
$12,599.29
|
| Rate for Payer: VA VA |
$10,053.70
|
|
|
MALIGNANT BREAST DISORDERS WITH MCC
|
Facility
|
IP
|
$37,363.56
|
|
|
Service Code
|
MSDRG 597
|
| Min. Negotiated Rate |
$13,807.70 |
| Max. Negotiated Rate |
$37,363.56 |
| Rate for Payer: Aetna Medicare |
$15,115.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,168.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,168.03
|
| Rate for Payer: BCBS MAPPO |
$14,534.42
|
| Rate for Payer: BCBS Trust/PPO |
$37,363.56
|
| Rate for Payer: BCN Commercial |
$37,363.56
|
| Rate for Payer: BCN Medicare Advantage |
$14,534.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,534.42
|
| Rate for Payer: Mclaren Medicare |
$14,534.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,261.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,714.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,987.86
|
| Rate for Payer: Nomi Health Commercial |
$21,505.59
|
| Rate for Payer: PACE Medicare |
$13,807.70
|
| Rate for Payer: PACE SWMI |
$14,534.42
|
| Rate for Payer: PHP Medicare Advantage |
$14,534.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,877.22
|
| Rate for Payer: Priority Health Medicare |
$14,534.42
|
| Rate for Payer: Priority Health Tiered Network |
$21,501.77
|
| Rate for Payer: Railroad Medicare Medicare |
$14,534.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,173.73
|
| Rate for Payer: UHC Core |
$22,734.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,534.42
|
| Rate for Payer: UHC Exchange |
$18,566.49
|
| Rate for Payer: VA VA |
$14,534.42
|
|
|
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$13,673.34
|
|
|
Service Code
|
MSDRG 599
|
| Min. Negotiated Rate |
$6,675.87 |
| Max. Negotiated Rate |
$13,673.34 |
| Rate for Payer: Aetna Medicare |
$7,308.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,784.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,784.04
|
| Rate for Payer: BCBS MAPPO |
$7,027.23
|
| Rate for Payer: BCBS Trust/PPO |
$13,673.34
|
| Rate for Payer: BCN Commercial |
$13,673.34
|
| Rate for Payer: BCN Medicare Advantage |
$7,027.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,027.23
|
| Rate for Payer: Mclaren Medicare |
$7,027.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,378.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,081.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,729.95
|
| Rate for Payer: Nomi Health Commercial |
$9,458.28
|
| Rate for Payer: PACE Medicare |
$6,675.87
|
| Rate for Payer: PACE SWMI |
$7,027.23
|
| Rate for Payer: PHP Medicare Advantage |
$7,027.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,404.37
|
| Rate for Payer: Priority Health Medicare |
$7,027.23
|
| Rate for Payer: Priority Health Tiered Network |
$9,923.50
|
| Rate for Payer: Railroad Medicare Medicare |
$7,027.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,951.16
|
| Rate for Payer: UHC Core |
$9,998.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,027.23
|
| Rate for Payer: UHC Exchange |
$8,165.65
|
| Rate for Payer: VA VA |
$7,027.23
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$2,992.12
|
|
|
Service Code
|
APR-DRG 4211
|
| Min. Negotiated Rate |
$2,849.64 |
| Max. Negotiated Rate |
$2,992.12 |
| Rate for Payer: BCBS Complete |
$2,992.12
|
| Rate for Payer: Mclaren Medicaid |
$2,849.64
|
| Rate for Payer: Meridian Medicaid |
$2,992.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,849.64
|
| Rate for Payer: UHC Medicaid |
$2,849.64
|
| Rate for Payer: UHCCP Medicaid |
$2,849.64
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$11,775.39
|
|
|
Service Code
|
APR-DRG 4214
|
| Min. Negotiated Rate |
$11,214.65 |
| Max. Negotiated Rate |
$11,775.39 |
| Rate for Payer: BCBS Complete |
$11,775.39
|
| Rate for Payer: Mclaren Medicaid |
$11,214.65
|
| Rate for Payer: Meridian Medicaid |
$11,775.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,214.65
|
| Rate for Payer: UHC Medicaid |
$11,214.65
|
| Rate for Payer: UHCCP Medicaid |
$11,214.65
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$6,241.51
|
|
|
Service Code
|
APR-DRG 4212
|
| Min. Negotiated Rate |
$5,944.29 |
| Max. Negotiated Rate |
$6,241.51 |
| Rate for Payer: BCBS Complete |
$6,241.51
|
| Rate for Payer: Mclaren Medicaid |
$5,944.29
|
| Rate for Payer: Meridian Medicaid |
$6,241.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,944.29
|
| Rate for Payer: UHC Medicaid |
$5,944.29
|
| Rate for Payer: UHCCP Medicaid |
$5,944.29
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$9,346.82
|
|
|
Service Code
|
APR-DRG 4213
|
| Min. Negotiated Rate |
$8,901.74 |
| Max. Negotiated Rate |
$9,346.82 |
| Rate for Payer: BCBS Complete |
$9,346.82
|
| Rate for Payer: Mclaren Medicaid |
$8,901.74
|
| Rate for Payer: Meridian Medicaid |
$9,346.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,901.74
|
| Rate for Payer: UHC Medicaid |
$8,901.74
|
| Rate for Payer: UHCCP Medicaid |
$8,901.74
|
|
|
MANGANESE CHLORIDE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$46.09
|
|
|
Service Code
|
NDC 00409409111
|
| Hospital Charge Code |
4744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$41.48 |
| Rate for Payer: Aetna American Axle |
$29.96
|
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.96
|
| Rate for Payer: Cash Price |
$36.87
|
| Rate for Payer: Cofinity Advantage |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.87
|
| Rate for Payer: Healthscope Commercial |
$41.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.57
|
| Rate for Payer: PHP Commercial |
$39.18
|
| Rate for Payer: Priority Health SBD |
$29.04
|
| Rate for Payer: UMR Bronson Commercial |
$20.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.57
|
|
|
MANGANESE CHLORIDE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$46.09
|
|
|
Service Code
|
NDC 00409409101
|
| Hospital Charge Code |
4744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$41.48 |
| Rate for Payer: Aetna American Axle |
$29.96
|
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna Medicare |
$23.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.96
|
| Rate for Payer: BCBS Complete |
$18.44
|
| Rate for Payer: Cash Price |
$36.87
|
| Rate for Payer: Cofinity Advantage |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.87
|
| Rate for Payer: Healthscope Commercial |
$41.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.57
|
| Rate for Payer: PHP Commercial |
$39.18
|
| Rate for Payer: Priority Health SBD |
$29.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.96
|
| Rate for Payer: UHC Core |
$24.01
|
| Rate for Payer: UHC Exchange |
$18.11
|
| Rate for Payer: UMR Bronson Commercial |
$17.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.57
|
|
|
MANGANESE CHLORIDE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$46.09
|
|
|
Service Code
|
NDC 00409409111
|
| Hospital Charge Code |
4744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$41.48 |
| Rate for Payer: Aetna American Axle |
$29.96
|
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna Medicare |
$23.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.96
|
| Rate for Payer: BCBS Complete |
$18.44
|
| Rate for Payer: Cash Price |
$36.87
|
| Rate for Payer: Cofinity Advantage |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.87
|
| Rate for Payer: Healthscope Commercial |
$41.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.57
|
| Rate for Payer: PHP Commercial |
$39.18
|
| Rate for Payer: Priority Health SBD |
$29.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.96
|
| Rate for Payer: UHC Core |
$24.01
|
| Rate for Payer: UHC Exchange |
$18.11
|
| Rate for Payer: UMR Bronson Commercial |
$17.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.57
|
|
|
MANGANESE CHLORIDE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$46.09
|
|
|
Service Code
|
NDC 00409409101
|
| Hospital Charge Code |
4744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$41.48 |
| Rate for Payer: Aetna American Axle |
$29.96
|
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.96
|
| Rate for Payer: Cash Price |
$36.87
|
| Rate for Payer: Cofinity Advantage |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.87
|
| Rate for Payer: Healthscope Commercial |
$41.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.57
|
| Rate for Payer: PHP Commercial |
$39.18
|
| Rate for Payer: Priority Health SBD |
$29.04
|
| Rate for Payer: UMR Bronson Commercial |
$20.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.57
|
|
|
MANGANESE CHLORIDE SD 25 MCG/ML IV
|
Facility
|
OP
|
$497.52
|
|
|
Service Code
|
NDC 09900001168
|
| Hospital Charge Code |
150940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$184.08 |
| Max. Negotiated Rate |
$447.77 |
| Rate for Payer: Aetna American Axle |
$323.39
|
| Rate for Payer: Aetna Commercial |
$422.89
|
| Rate for Payer: Aetna Medicare |
$248.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.39
|
| Rate for Payer: BCBS Complete |
$199.01
|
| Rate for Payer: Cash Price |
$398.02
|
| Rate for Payer: Cofinity Advantage |
$348.26
|
| Rate for Payer: Cofinity Commercial |
$427.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.02
|
| Rate for Payer: Healthscope Commercial |
$447.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.14
|
| Rate for Payer: PHP Commercial |
$422.89
|
| Rate for Payer: Priority Health SBD |
$313.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.39
|
| Rate for Payer: UHC Core |
$259.21
|
| Rate for Payer: UHC Exchange |
$195.53
|
| Rate for Payer: UMR Bronson Commercial |
$184.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.14
|
|
|
MANGANESE CHLORIDE SD 25 MCG/ML IV
|
Facility
|
IP
|
$497.52
|
|
|
Service Code
|
NDC 09900001168
|
| Hospital Charge Code |
150940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$218.91 |
| Max. Negotiated Rate |
$447.77 |
| Rate for Payer: Aetna American Axle |
$323.39
|
| Rate for Payer: Aetna Commercial |
$422.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.39
|
| Rate for Payer: Cash Price |
$398.02
|
| Rate for Payer: Cofinity Advantage |
$348.26
|
| Rate for Payer: Cofinity Commercial |
$427.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.02
|
| Rate for Payer: Healthscope Commercial |
$447.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.14
|
| Rate for Payer: PHP Commercial |
$422.89
|
| Rate for Payer: Priority Health SBD |
$313.44
|
| Rate for Payer: UMR Bronson Commercial |
$218.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.14
|
|
|
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.37
|
| Rate for Payer: BCN Commercial |
$2,159.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 23700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.76
|
| Rate for Payer: BCN Commercial |
$1,526.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.92
|
|
|
Service Code
|
NDC 338035702
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.12 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna American Axle |
$61.70
|
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna Medicare |
$47.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.70
|
| Rate for Payer: BCBS Complete |
$37.97
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Advantage |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health SBD |
$59.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.70
|
| Rate for Payer: UHC Core |
$49.45
|
| Rate for Payer: UHC Exchange |
$37.30
|
| Rate for Payer: UMR Bronson Commercial |
$35.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.19
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 00338035702
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna American Axle |
$61.70
|
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.70
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Advantage |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health SBD |
$59.80
|
| Rate for Payer: UMR Bronson Commercial |
$41.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.19
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.09
|
|
|
Service Code
|
NDC 990771503
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$94.58 |
| Rate for Payer: Aetna American Axle |
$68.31
|
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Aetna Medicare |
$52.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.31
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Advantage |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$94.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.82
|
| Rate for Payer: PHP Commercial |
$89.33
|
| Rate for Payer: Priority Health SBD |
$66.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.31
|
| Rate for Payer: UHC Core |
$54.75
|
| Rate for Payer: UHC Exchange |
$41.30
|
| Rate for Payer: UMR Bronson Commercial |
$38.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.82
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$234.32
|
|
|
Service Code
|
NDC 264757810
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$210.89 |
| Rate for Payer: Aetna American Axle |
$152.31
|
| Rate for Payer: Aetna Commercial |
$199.17
|
| Rate for Payer: Aetna Medicare |
$117.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.31
|
| Rate for Payer: BCBS Complete |
$93.73
|
| Rate for Payer: Cash Price |
$187.46
|
| Rate for Payer: Cofinity Advantage |
$164.02
|
| Rate for Payer: Cofinity Commercial |
$201.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.46
|
| Rate for Payer: Healthscope Commercial |
$210.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.74
|
| Rate for Payer: PHP Commercial |
$199.17
|
| Rate for Payer: Priority Health SBD |
$147.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.31
|
| Rate for Payer: UHC Core |
$122.08
|
| Rate for Payer: UHC Exchange |
$92.09
|
| Rate for Payer: UMR Bronson Commercial |
$86.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.74
|
|
