|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,157.30
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$13,641.57 |
| Rate for Payer: Aetna American Axle |
$9,852.25
|
| Rate for Payer: Aetna Commercial |
$12,883.70
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,852.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.02
|
| Rate for Payer: BCBS Complete |
$18.46
|
| Rate for Payer: BCBS MAPPO |
$33.62
|
| Rate for Payer: BCBS Trust/PPO |
$108.84
|
| Rate for Payer: BCN Commercial |
$108.84
|
| Rate for Payer: BCN Medicare Advantage |
$33.62
|
| Rate for Payer: Cash Price |
$12,125.84
|
| Rate for Payer: Cash Price |
$12,125.84
|
| Rate for Payer: Cofinity Advantage |
$10,610.11
|
| Rate for Payer: Cofinity Commercial |
$13,035.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,125.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.62
|
| Rate for Payer: Healthscope Commercial |
$13,641.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,610.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,367.98
|
| Rate for Payer: Mclaren Medicaid |
$33.62
|
| Rate for Payer: Mclaren Medicare |
$33.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.30
|
| Rate for Payer: Meridian Medicaid |
$35.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,883.70
|
| Rate for Payer: Nomi Health Commercial |
$100.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,367.98
|
| Rate for Payer: PACE Medicare |
$31.94
|
| Rate for Payer: PACE SWMI |
$33.62
|
| Rate for Payer: PHP Commercial |
$12,883.70
|
| Rate for Payer: PHP Medicare Advantage |
$33.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.97
|
| Rate for Payer: Priority Health Medicare |
$33.62
|
| Rate for Payer: Priority Health SBD |
$9,549.10
|
| Rate for Payer: Priority Health Tiered Network |
$83.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.39
|
| Rate for Payer: UHC Core |
$55.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.62
|
| Rate for Payer: UHC Exchange |
$55.39
|
| Rate for Payer: UHC Medicaid |
$17.58
|
| Rate for Payer: UHCCP Medicaid |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$5,608.20
|
| Rate for Payer: VA VA |
$33.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,367.98
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15,157.30
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,669.21 |
| Max. Negotiated Rate |
$13,641.57 |
| Rate for Payer: Aetna American Axle |
$9,852.25
|
| Rate for Payer: Aetna Commercial |
$12,883.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,852.25
|
| Rate for Payer: Cash Price |
$12,125.84
|
| Rate for Payer: Cofinity Advantage |
$10,610.11
|
| Rate for Payer: Cofinity Commercial |
$13,035.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,125.84
|
| Rate for Payer: Healthscope Commercial |
$13,641.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,610.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,367.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,883.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,367.98
|
| Rate for Payer: PHP Commercial |
$12,883.70
|
| Rate for Payer: Priority Health SBD |
$9,549.10
|
| Rate for Payer: UMR Bronson Commercial |
$6,669.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,367.98
|
|
|
NIVOLUMAB 120 MG/12 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18,188.82
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
198262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$16,369.94 |
| Rate for Payer: Aetna American Axle |
$11,822.73
|
| Rate for Payer: Aetna Commercial |
$15,460.50
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,822.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.02
|
| Rate for Payer: BCBS Complete |
$18.46
|
| Rate for Payer: BCBS MAPPO |
$33.62
|
| Rate for Payer: BCBS Trust/PPO |
$108.84
|
| Rate for Payer: BCN Commercial |
$108.84
|
| Rate for Payer: BCN Medicare Advantage |
$33.62
|
| Rate for Payer: Cash Price |
$14,551.06
|
| Rate for Payer: Cash Price |
$14,551.06
|
| Rate for Payer: Cofinity Advantage |
$12,732.17
|
| Rate for Payer: Cofinity Commercial |
$15,642.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,551.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.62
|
| Rate for Payer: Healthscope Commercial |
$16,369.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,732.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,641.61
|
| Rate for Payer: Mclaren Medicaid |
$33.62
|
| Rate for Payer: Mclaren Medicare |
$33.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.30
|
| Rate for Payer: Meridian Medicaid |
$35.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,460.50
|
| Rate for Payer: Nomi Health Commercial |
$100.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,641.61
|
| Rate for Payer: PACE Medicare |
$31.94
|
| Rate for Payer: PACE SWMI |
$33.62
|
| Rate for Payer: PHP Commercial |
$15,460.50
|
| Rate for Payer: PHP Medicare Advantage |
$33.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.97
|
| Rate for Payer: Priority Health Medicare |
$33.62
|
| Rate for Payer: Priority Health SBD |
$11,458.96
|
| Rate for Payer: Priority Health Tiered Network |
$83.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.39
|
| Rate for Payer: UHC Core |
$55.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.62
|
| Rate for Payer: UHC Exchange |
$55.39
|
| Rate for Payer: UHC Medicaid |
$17.58
|
| Rate for Payer: UHCCP Medicaid |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$6,729.86
|
| Rate for Payer: VA VA |
$33.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,641.61
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25,926.23
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
185666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,407.54 |
| Max. Negotiated Rate |
$23,333.61 |
| Rate for Payer: Aetna American Axle |
$16,852.05
|
| Rate for Payer: Aetna Commercial |
$22,037.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,852.05
|
| Rate for Payer: Cash Price |
$20,740.98
|
| Rate for Payer: Cofinity Advantage |
$18,148.36
|
| Rate for Payer: Cofinity Commercial |
$22,296.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,740.98
|
| Rate for Payer: Healthscope Commercial |
$23,333.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,148.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,444.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,037.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,444.67
|
| Rate for Payer: PHP Commercial |
$22,037.30
|
| Rate for Payer: Priority Health SBD |
$16,333.52
|
| Rate for Payer: UMR Bronson Commercial |
$11,407.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,444.67
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25,926.23
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
185666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$23,333.61 |
| Rate for Payer: Aetna American Axle |
$16,852.05
|
| Rate for Payer: Aetna Commercial |
$22,037.30
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,852.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.02
|
| Rate for Payer: BCBS Complete |
$18.46
|
| Rate for Payer: BCBS MAPPO |
$33.62
|
| Rate for Payer: BCBS Trust/PPO |
$108.84
|
| Rate for Payer: BCN Commercial |
$108.84
|
| Rate for Payer: BCN Medicare Advantage |
$33.62
|
| Rate for Payer: Cash Price |
$20,740.98
|
| Rate for Payer: Cash Price |
$20,740.98
|
| Rate for Payer: Cofinity Advantage |
$18,148.36
|
| Rate for Payer: Cofinity Commercial |
$22,296.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,740.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.62
|
| Rate for Payer: Healthscope Commercial |
$23,333.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,148.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,444.67
|
| Rate for Payer: Mclaren Medicaid |
$33.62
|
| Rate for Payer: Mclaren Medicare |
$33.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.30
|
| Rate for Payer: Meridian Medicaid |
$35.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,037.30
|
| Rate for Payer: Nomi Health Commercial |
$100.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,444.67
|
| Rate for Payer: PACE Medicare |
$31.94
|
| Rate for Payer: PACE SWMI |
$33.62
|
| Rate for Payer: PHP Commercial |
$22,037.30
|
| Rate for Payer: PHP Medicare Advantage |
$33.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.97
|
| Rate for Payer: Priority Health Medicare |
$33.62
|
| Rate for Payer: Priority Health SBD |
$16,333.52
|
| Rate for Payer: Priority Health Tiered Network |
$83.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.39
|
| Rate for Payer: UHC Core |
$55.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.62
|
| Rate for Payer: UHC Exchange |
$55.39
|
| Rate for Payer: UHC Medicaid |
$17.58
|
| Rate for Payer: UHCCP Medicaid |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$9,592.71
|
| Rate for Payer: VA VA |
$33.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,444.67
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$70,629.59
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
199621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.52 |
| Max. Negotiated Rate |
$63,566.63 |
| Rate for Payer: Aetna American Axle |
$45,909.23
|
| Rate for Payer: Aetna Commercial |
$60,035.15
|
| Rate for Payer: Aetna Medicare |
$209.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45,909.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$252.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$252.20
|
| Rate for Payer: BCBS Complete |
$110.81
|
| Rate for Payer: BCBS MAPPO |
$201.76
|
| Rate for Payer: BCBS Trust/PPO |
$653.87
|
| Rate for Payer: BCN Commercial |
$653.87
|
| Rate for Payer: BCN Medicare Advantage |
$201.76
|
| Rate for Payer: Cash Price |
$56,503.67
|
| Rate for Payer: Cash Price |
$56,503.67
|
| Rate for Payer: Cofinity Advantage |
$49,440.71
|
| Rate for Payer: Cofinity Commercial |
$60,741.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56,503.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.76
|
| Rate for Payer: Healthscope Commercial |
$63,566.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49,440.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52,972.19
|
| Rate for Payer: Mclaren Medicaid |
$201.76
|
| Rate for Payer: Mclaren Medicare |
$201.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.85
|
| Rate for Payer: Meridian Medicaid |
$211.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60,035.15
|
| Rate for Payer: Nomi Health Commercial |
$605.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52,972.19
|
| Rate for Payer: PACE Medicare |
$191.67
|
| Rate for Payer: PACE SWMI |
$201.76
|
| Rate for Payer: PHP Commercial |
$60,035.15
|
| Rate for Payer: PHP Medicare Advantage |
$201.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$623.95
|
| Rate for Payer: Priority Health Medicare |
$201.76
|
| Rate for Payer: Priority Health SBD |
$44,496.64
|
| Rate for Payer: Priority Health Tiered Network |
$499.16
|
| Rate for Payer: Railroad Medicare Medicare |
$201.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.72
|
| Rate for Payer: UHC Core |
$332.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.76
|
| Rate for Payer: UHC Exchange |
$332.72
|
| Rate for Payer: UHC Medicaid |
$105.52
|
| Rate for Payer: UHCCP Medicaid |
$105.52
|
| Rate for Payer: UMR Bronson Commercial |
$26,132.95
|
| Rate for Payer: VA VA |
$201.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52,972.19
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,063.00
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,667.72 |
| Max. Negotiated Rate |
$5,456.70 |
| Rate for Payer: Aetna American Axle |
$3,940.95
|
| Rate for Payer: Aetna Commercial |
$5,153.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,940.95
|
| Rate for Payer: Cash Price |
$4,850.40
|
| Rate for Payer: Cofinity Advantage |
$4,244.10
|
| Rate for Payer: Cofinity Commercial |
$5,214.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,850.40
|
| Rate for Payer: Healthscope Commercial |
$5,456.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,244.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,547.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,153.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,547.25
|
| Rate for Payer: PHP Commercial |
$5,153.55
|
| Rate for Payer: Priority Health SBD |
$3,819.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,667.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,547.25
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,063.00
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$5,456.70 |
| Rate for Payer: Aetna American Axle |
$3,940.95
|
| Rate for Payer: Aetna Commercial |
$5,153.55
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,940.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.02
|
| Rate for Payer: BCBS Complete |
$18.46
|
| Rate for Payer: BCBS MAPPO |
$33.62
|
| Rate for Payer: BCBS Trust/PPO |
$108.84
|
| Rate for Payer: BCN Commercial |
$108.84
|
| Rate for Payer: BCN Medicare Advantage |
$33.62
|
| Rate for Payer: Cash Price |
$4,850.40
|
| Rate for Payer: Cash Price |
$4,850.40
|
| Rate for Payer: Cofinity Advantage |
$4,244.10
|
| Rate for Payer: Cofinity Commercial |
$5,214.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,850.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.62
|
| Rate for Payer: Healthscope Commercial |
$5,456.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,244.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,547.25
|
| Rate for Payer: Mclaren Medicaid |
$33.62
|
| Rate for Payer: Mclaren Medicare |
$33.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.30
|
| Rate for Payer: Meridian Medicaid |
$35.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,153.55
|
| Rate for Payer: Nomi Health Commercial |
$100.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,547.25
|
| Rate for Payer: PACE Medicare |
$31.94
|
| Rate for Payer: PACE SWMI |
$33.62
|
| Rate for Payer: PHP Commercial |
$5,153.55
|
| Rate for Payer: PHP Medicare Advantage |
$33.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.97
|
| Rate for Payer: Priority Health Medicare |
$33.62
|
| Rate for Payer: Priority Health SBD |
$3,819.69
|
| Rate for Payer: Priority Health Tiered Network |
$83.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.39
|
| Rate for Payer: UHC Core |
$55.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.62
|
| Rate for Payer: UHC Exchange |
$55.39
|
| Rate for Payer: UHC Medicaid |
$17.58
|
| Rate for Payer: UHCCP Medicaid |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$2,243.31
|
| Rate for Payer: VA VA |
$33.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,547.25
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$37,406.87
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$18,795.28 |
| Max. Negotiated Rate |
$37,406.87 |
| Rate for Payer: Aetna Medicare |
$20,575.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,730.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,730.64
|
| Rate for Payer: BCBS MAPPO |
$19,784.51
|
| Rate for Payer: BCBS Trust/PPO |
$36,861.20
|
| Rate for Payer: BCN Commercial |
$36,861.20
|
| Rate for Payer: BCN Medicare Advantage |
$19,784.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,784.51
|
| Rate for Payer: Mclaren Medicare |
$19,784.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,773.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,752.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,762.96
|
| Rate for Payer: Nomi Health Commercial |
$29,604.21
|
| Rate for Payer: PACE Medicare |
$18,795.28
|
| Rate for Payer: PACE SWMI |
$19,784.51
|
| Rate for Payer: PHP Medicare Advantage |
$19,784.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,998.70
|
| Rate for Payer: Priority Health Medicare |
$19,784.51
|
| Rate for Payer: Priority Health Tiered Network |
$29,598.95
|
| Rate for Payer: Railroad Medicare Medicare |
$19,784.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,406.87
|
| Rate for Payer: UHC Core |
$31,295.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,784.51
|
| Rate for Payer: UHC Exchange |
$25,558.30
|
| Rate for Payer: VA VA |
$19,784.51
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$58,872.34
|
|
|
Service Code
|
MSDRG 097
|
| Min. Negotiated Rate |
$29,257.47 |
| Max. Negotiated Rate |
$58,872.34 |
| Rate for Payer: Aetna Medicare |
$32,029.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,496.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,496.68
|
| Rate for Payer: BCBS MAPPO |
$30,797.34
|
| Rate for Payer: BCBS Trust/PPO |
$47,874.54
|
| Rate for Payer: BCN Commercial |
$47,874.54
|
| Rate for Payer: BCN Medicare Advantage |
$30,797.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,797.34
|
| Rate for Payer: Mclaren Medicare |
$30,797.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,337.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,416.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,877.07
|
| Rate for Payer: Nomi Health Commercial |
$46,592.22
|
| Rate for Payer: PACE Medicare |
$29,257.47
|
| Rate for Payer: PACE SWMI |
$30,797.34
|
| Rate for Payer: PHP Medicare Advantage |
$30,797.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$58,229.95
|
| Rate for Payer: Priority Health Medicare |
$30,797.34
|
| Rate for Payer: Priority Health Tiered Network |
$46,583.95
|
| Rate for Payer: Railroad Medicare Medicare |
$30,797.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58,872.34
|
| Rate for Payer: UHC Core |
$49,254.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,797.34
|
| Rate for Payer: UHC Exchange |
$40,224.62
|
| Rate for Payer: VA VA |
$30,797.34
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$36,402.77
|
|
|
Service Code
|
MSDRG 099
|
| Min. Negotiated Rate |
$11,386.99 |
| Max. Negotiated Rate |
$36,402.77 |
| Rate for Payer: Aetna Medicare |
$12,465.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,982.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,982.88
|
| Rate for Payer: BCBS MAPPO |
$11,986.30
|
| Rate for Payer: BCBS Trust/PPO |
$36,402.77
|
| Rate for Payer: BCN Commercial |
$36,402.77
|
| Rate for Payer: BCN Medicare Advantage |
$11,986.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,986.30
|
| Rate for Payer: Mclaren Medicare |
$11,986.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,585.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,784.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,184.93
|
| Rate for Payer: Nomi Health Commercial |
$17,574.96
|
| Rate for Payer: PACE Medicare |
$11,386.99
|
| Rate for Payer: PACE SWMI |
$11,986.30
|
| Rate for Payer: PHP Medicare Advantage |
$11,986.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,964.80
|
| Rate for Payer: Priority Health Medicare |
$11,986.30
|
| Rate for Payer: Priority Health Tiered Network |
$17,571.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11,986.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,207.12
|
| Rate for Payer: UHC Core |
$18,579.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,986.30
|
| Rate for Payer: UHC Exchange |
$15,173.05
|
| Rate for Payer: VA VA |
$11,986.30
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$12,825.63
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$12,214.88 |
| Max. Negotiated Rate |
$12,825.63 |
| Rate for Payer: BCBS Complete |
$12,825.63
|
| Rate for Payer: Mclaren Medicaid |
$12,214.88
|
| Rate for Payer: Meridian Medicaid |
$12,825.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,214.88
|
| Rate for Payer: UHC Medicaid |
$12,214.88
|
| Rate for Payer: UHCCP Medicaid |
$12,214.88
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$33,822.53
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$32,211.94 |
| Max. Negotiated Rate |
$33,822.53 |
| Rate for Payer: BCBS Complete |
$33,822.53
|
| Rate for Payer: Mclaren Medicaid |
$32,211.94
|
| Rate for Payer: Meridian Medicaid |
$33,822.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$32,211.94
|
| Rate for Payer: UHC Medicaid |
$32,211.94
|
| Rate for Payer: UHCCP Medicaid |
$32,211.94
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$4,240.30
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$4,038.38 |
| Max. Negotiated Rate |
$4,240.30 |
| Rate for Payer: BCBS Complete |
$4,240.30
|
| Rate for Payer: Mclaren Medicaid |
$4,038.38
|
| Rate for Payer: Meridian Medicaid |
$4,240.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,038.38
|
| Rate for Payer: UHC Medicaid |
$4,038.38
|
| Rate for Payer: UHCCP Medicaid |
$4,038.38
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$9,108.93
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$8,675.17 |
| Max. Negotiated Rate |
$9,108.93 |
| Rate for Payer: BCBS Complete |
$9,108.93
|
| Rate for Payer: Mclaren Medicaid |
$8,675.17
|
| Rate for Payer: Meridian Medicaid |
$9,108.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,675.17
|
| Rate for Payer: UHC Medicaid |
$8,675.17
|
| Rate for Payer: UHCCP Medicaid |
$8,675.17
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$23,677.89
|
|
|
Service Code
|
APR-DRG 3234
|
| Min. Negotiated Rate |
$22,550.37 |
| Max. Negotiated Rate |
$23,677.89 |
| Rate for Payer: BCBS Complete |
$23,677.89
|
| Rate for Payer: Mclaren Medicaid |
$22,550.37
|
| Rate for Payer: Meridian Medicaid |
$23,677.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,550.37
|
| Rate for Payer: UHC Medicaid |
$22,550.37
|
| Rate for Payer: UHCCP Medicaid |
$22,550.37
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$10,238.47
|
|
|
Service Code
|
APR-DRG 3231
|
| Min. Negotiated Rate |
$9,750.92 |
| Max. Negotiated Rate |
$10,238.47 |
| Rate for Payer: BCBS Complete |
$10,238.47
|
| Rate for Payer: Mclaren Medicaid |
$9,750.92
|
| Rate for Payer: Meridian Medicaid |
$10,238.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,750.92
|
| Rate for Payer: UHC Medicaid |
$9,750.92
|
| Rate for Payer: UHCCP Medicaid |
$9,750.92
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$12,378.90
|
|
|
Service Code
|
APR-DRG 3232
|
| Min. Negotiated Rate |
$11,789.42 |
| Max. Negotiated Rate |
$12,378.90 |
| Rate for Payer: BCBS Complete |
$12,378.90
|
| Rate for Payer: Mclaren Medicaid |
$11,789.42
|
| Rate for Payer: Meridian Medicaid |
$12,378.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,789.42
|
| Rate for Payer: UHC Medicaid |
$11,789.42
|
| Rate for Payer: UHCCP Medicaid |
$11,789.42
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$16,360.12
|
|
|
Service Code
|
APR-DRG 3233
|
| Min. Negotiated Rate |
$15,581.07 |
| Max. Negotiated Rate |
$16,360.12 |
| Rate for Payer: BCBS Complete |
$16,360.12
|
| Rate for Payer: Mclaren Medicaid |
$15,581.07
|
| Rate for Payer: Meridian Medicaid |
$16,360.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,581.07
|
| Rate for Payer: UHC Medicaid |
$15,581.07
|
| Rate for Payer: UHCCP Medicaid |
$15,581.07
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$20,288.68
|
|
|
Service Code
|
APR-DRG 3253
|
| Min. Negotiated Rate |
$19,322.55 |
| Max. Negotiated Rate |
$20,288.68 |
| Rate for Payer: BCBS Complete |
$20,288.68
|
| Rate for Payer: Mclaren Medicaid |
$19,322.55
|
| Rate for Payer: Meridian Medicaid |
$20,288.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,322.55
|
| Rate for Payer: UHC Medicaid |
$19,322.55
|
| Rate for Payer: UHCCP Medicaid |
$19,322.55
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$16,315.93
|
|
|
Service Code
|
APR-DRG 3252
|
| Min. Negotiated Rate |
$15,538.98 |
| Max. Negotiated Rate |
$16,315.93 |
| Rate for Payer: BCBS Complete |
$16,315.93
|
| Rate for Payer: Mclaren Medicaid |
$15,538.98
|
| Rate for Payer: Meridian Medicaid |
$16,315.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,538.98
|
| Rate for Payer: UHC Medicaid |
$15,538.98
|
| Rate for Payer: UHCCP Medicaid |
$15,538.98
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$25,252.34
|
|
|
Service Code
|
APR-DRG 3254
|
| Min. Negotiated Rate |
$24,049.85 |
| Max. Negotiated Rate |
$25,252.34 |
| Rate for Payer: BCBS Complete |
$25,252.34
|
| Rate for Payer: Mclaren Medicaid |
$24,049.85
|
| Rate for Payer: Meridian Medicaid |
$25,252.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,049.85
|
| Rate for Payer: UHC Medicaid |
$24,049.85
|
| Rate for Payer: UHCCP Medicaid |
$24,049.85
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$13,374.66
|
|
|
Service Code
|
APR-DRG 3251
|
| Min. Negotiated Rate |
$12,737.77 |
| Max. Negotiated Rate |
$13,374.66 |
| Rate for Payer: BCBS Complete |
$13,374.66
|
| Rate for Payer: Mclaren Medicaid |
$12,737.77
|
| Rate for Payer: Meridian Medicaid |
$13,374.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,737.77
|
| Rate for Payer: UHC Medicaid |
$12,737.77
|
| Rate for Payer: UHCCP Medicaid |
$12,737.77
|
|
|
NON-EXTENSIVE BURNS
|
Facility
|
IP
|
$33,578.00
|
|
|
Service Code
|
MSDRG 935
|
| Min. Negotiated Rate |
$16,929.10 |
| Max. Negotiated Rate |
$33,578.00 |
| Rate for Payer: Aetna Medicare |
$18,532.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,275.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,275.14
|
| Rate for Payer: BCBS MAPPO |
$17,820.11
|
| Rate for Payer: BCBS Trust/PPO |
$27,884.73
|
| Rate for Payer: BCN Commercial |
$27,884.73
|
| Rate for Payer: BCN Medicare Advantage |
$17,820.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,820.11
|
| Rate for Payer: Mclaren Medicare |
$17,820.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,711.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,493.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,602.12
|
| Rate for Payer: Nomi Health Commercial |
$26,574.00
|
| Rate for Payer: PACE Medicare |
$16,929.10
|
| Rate for Payer: PACE SWMI |
$17,820.11
|
| Rate for Payer: PHP Medicare Advantage |
$17,820.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,211.61
|
| Rate for Payer: Priority Health Medicare |
$17,820.11
|
| Rate for Payer: Priority Health Tiered Network |
$26,569.28
|
| Rate for Payer: Railroad Medicare Medicare |
$17,820.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,578.00
|
| Rate for Payer: UHC Core |
$28,092.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,820.11
|
| Rate for Payer: UHC Exchange |
$22,942.22
|
| Rate for Payer: VA VA |
$17,820.11
|
|
