|
COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID
|
Facility
|
IP
|
$141.90
|
|
|
Service Code
|
NDC 395009416
|
| Hospital Charge Code |
119062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$127.71 |
| Rate for Payer: Aetna American Axle |
$92.24
|
| Rate for Payer: Aetna Commercial |
$120.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.24
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Cofinity Commercial |
$122.03
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.52
|
| Rate for Payer: Healthscope Commercial |
$127.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.62
|
| Rate for Payer: PHP Commercial |
$120.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.33
|
| Rate for Payer: Priority Health SBD |
$89.40
|
| Rate for Payer: UMR Bronson Commercial |
$62.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.42
|
|
|
COMPOUNDING VEHICLE SUSPENSION NO.7 ORAL
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 574030316
|
| Hospital Charge Code |
118921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.41 |
| Max. Negotiated Rate |
$178.79 |
| Rate for Payer: Aetna American Axle |
$129.13
|
| Rate for Payer: Aetna Commercial |
$168.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.13
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Commercial |
$139.06
|
| Rate for Payer: Cofinity Commercial |
$170.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$178.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.86
|
| Rate for Payer: PHP Commercial |
$168.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.06
|
| Rate for Payer: Priority Health SBD |
$125.16
|
| Rate for Payer: UMR Bronson Commercial |
$87.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.00
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
IP
|
$158.93
|
|
|
Service Code
|
NDC 3932801416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna American Axle |
$103.30
|
| Rate for Payer: Aetna Commercial |
$135.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.30
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cofinity Commercial |
$111.25
|
| Rate for Payer: Cofinity Commercial |
$136.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.14
|
| Rate for Payer: Healthscope Commercial |
$143.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.09
|
| Rate for Payer: PHP Commercial |
$135.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.25
|
| Rate for Payer: Priority Health SBD |
$100.13
|
| Rate for Payer: UMR Bronson Commercial |
$69.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.20
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23
|
Facility
|
IP
|
$141.90
|
|
|
Service Code
|
NDC 3172295901
|
| Hospital Charge Code |
187071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$127.71 |
| Rate for Payer: Aetna American Axle |
$92.24
|
| Rate for Payer: Aetna Commercial |
$120.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.24
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Cofinity Commercial |
$122.03
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.52
|
| Rate for Payer: Healthscope Commercial |
$127.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.62
|
| Rate for Payer: PHP Commercial |
$120.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.33
|
| Rate for Payer: Priority Health SBD |
$89.40
|
| Rate for Payer: UMR Bronson Commercial |
$62.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.42
|
|
|
COMPUTER-ASSISTED MUSCULOSKELETAL SURGICAL NAVIGATIONAL ORTHOPEDIC PROCEDURE, WITH IMAGE-GUIDANCE BASED ON FLUOROSCOPIC IMAGES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 0054T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: UHC Core |
$700.00
|
|
|
COMPUTER-ASSISTED SURGICAL NAVIGATIONAL PROCEDURE FOR MUSCULOSKELETAL PROCEDURES, IMAGE-LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 20985
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.88
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$140.80
|
|
|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
|
IP
|
$238,738.06
|
|
|
Service Code
|
MS-DRG 212
|
| Min. Negotiated Rate |
$79,336.14 |
| Max. Negotiated Rate |
$238,738.06 |
| Rate for Payer: Aetna Medicare |
$86,852.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104,389.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104,389.66
|
| Rate for Payer: BCBS MAPPO |
$83,511.73
|
| Rate for Payer: BCBS Trust/PPO |
$238,738.06
|
| Rate for Payer: BCN Medicare Advantage |
$83,511.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83,511.73
|
| Rate for Payer: Mclaren Medicare |
$83,511.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87,687.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96,038.49
|
| Rate for Payer: PACE Medicare |
$79,336.14
|
| Rate for Payer: PACE SWMI |
$83,511.73
|
| Rate for Payer: PHP Medicare Advantage |
$83,511.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154,558.68
|
| Rate for Payer: Priority Health Medicare |
$83,511.73
|
| Rate for Payer: Priority Health Narrow Network |
$123,646.94
|
| Rate for Payer: Railroad Medicare Medicare |
$83,511.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164,296.26
|
| Rate for Payer: UHC Core |
$134,719.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$83,511.73
|
| Rate for Payer: UHC Exchange |
$107,103.84
|
| Rate for Payer: UHC Medicare Advantage |
$86,017.08
|
| Rate for Payer: VA VA |
$83,511.73
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$23,259.40
|
|
|
Service Code
|
MS-DRG 089
|
| Min. Negotiated Rate |
$8,904.85 |
| Max. Negotiated Rate |
$23,259.40 |
| Rate for Payer: Aetna Medicare |
$9,748.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,716.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,716.91
|
| Rate for Payer: BCBS MAPPO |
$9,373.53
|
| Rate for Payer: BCBS Trust/PPO |
$23,259.40
|
| Rate for Payer: BCN Medicare Advantage |
$9,373.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,373.53
|
| Rate for Payer: Mclaren Medicare |
$9,373.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,842.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,779.56
|
| Rate for Payer: PACE Medicare |
$8,904.85
|
| Rate for Payer: PACE SWMI |
$9,373.53
|
| Rate for Payer: PHP Medicare Advantage |
$9,373.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,500.97
|
| Rate for Payer: Priority Health Medicare |
$9,373.53
|
| Rate for Payer: Priority Health Narrow Network |
$13,200.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9,373.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,540.57
|
| Rate for Payer: UHC Core |
$14,382.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,373.53
|
| Rate for Payer: UHC Exchange |
$11,434.61
|
| Rate for Payer: UHC Medicare Advantage |
$9,654.74
|
| Rate for Payer: VA VA |
$9,373.53
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$41,837.27
|
|
|
Service Code
|
MS-DRG 088
|
| Min. Negotiated Rate |
$11,715.29 |
| Max. Negotiated Rate |
$41,837.27 |
| Rate for Payer: Aetna Medicare |
$12,825.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,414.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,414.85
|
| Rate for Payer: BCBS MAPPO |
$12,331.88
|
| Rate for Payer: BCBS Trust/PPO |
$41,837.27
|
| Rate for Payer: BCN Medicare Advantage |
$12,331.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,331.88
|
| Rate for Payer: Mclaren Medicare |
$12,331.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,948.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,181.66
|
| Rate for Payer: PACE Medicare |
$11,715.29
|
| Rate for Payer: PACE SWMI |
$12,331.88
|
| Rate for Payer: PHP Medicare Advantage |
$12,331.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,009.91
|
| Rate for Payer: Priority Health Medicare |
$12,331.88
|
| Rate for Payer: Priority Health Narrow Network |
$17,607.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12,331.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,396.59
|
| Rate for Payer: UHC Core |
$19,184.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,331.88
|
| Rate for Payer: UHC Exchange |
$15,252.11
|
| Rate for Payer: UHC Medicare Advantage |
$12,701.84
|
| Rate for Payer: VA VA |
$12,331.88
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$21,713.97
|
|
|
Service Code
|
MS-DRG 090
|
| Min. Negotiated Rate |
$7,330.15 |
| Max. Negotiated Rate |
$21,713.97 |
| Rate for Payer: Aetna Medicare |
$8,024.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,644.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,644.94
|
| Rate for Payer: BCBS MAPPO |
$7,715.95
|
| Rate for Payer: BCBS Trust/PPO |
$21,713.97
|
| Rate for Payer: BCN Medicare Advantage |
$7,715.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,715.95
|
| Rate for Payer: Mclaren Medicare |
$7,715.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,101.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,873.34
|
| Rate for Payer: PACE Medicare |
$7,330.15
|
| Rate for Payer: PACE SWMI |
$7,715.95
|
| Rate for Payer: PHP Medicare Advantage |
$7,715.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,414.31
|
| Rate for Payer: Priority Health Medicare |
$7,715.95
|
| Rate for Payer: Priority Health Narrow Network |
$10,731.45
|
| Rate for Payer: Railroad Medicare Medicare |
$7,715.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,259.44
|
| Rate for Payer: UHC Core |
$11,692.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,715.95
|
| Rate for Payer: UHC Exchange |
$9,295.65
|
| Rate for Payer: UHC Medicare Advantage |
$7,947.43
|
| Rate for Payer: VA VA |
$7,715.95
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,838.87
|
| Rate for Payer: BCCCP Commercial |
$374.86
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.17
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$294.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,201.07
|
| Rate for Payer: BCCCP Commercial |
$322.14
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.78
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$253.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
IP
|
$2,376.14
|
|
|
Service Code
|
NDC 0046-1100-81
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,045.50 |
| Max. Negotiated Rate |
$2,138.53 |
| Rate for Payer: Aetna American Axle |
$1,544.49
|
| Rate for Payer: Aetna Commercial |
$2,019.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,544.49
|
| Rate for Payer: Cash Price |
$1,900.91
|
| Rate for Payer: Cofinity Commercial |
$1,663.30
|
| Rate for Payer: Cofinity Commercial |
$2,043.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,900.91
|
| Rate for Payer: Healthscope Commercial |
$2,138.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,663.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,782.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,019.72
|
| Rate for Payer: PHP Commercial |
$2,019.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.30
|
| Rate for Payer: Priority Health SBD |
$1,496.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,045.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,782.10
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,464.96
|
|
|
Service Code
|
NDC 0046-0872-21
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$644.58 |
| Max. Negotiated Rate |
$1,318.46 |
| Rate for Payer: Aetna American Axle |
$952.22
|
| Rate for Payer: Aetna Commercial |
$1,245.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$952.22
|
| Rate for Payer: Cash Price |
$1,171.97
|
| Rate for Payer: Cofinity Commercial |
$1,025.47
|
| Rate for Payer: Cofinity Commercial |
$1,259.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,171.97
|
| Rate for Payer: Healthscope Commercial |
$1,318.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,025.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,098.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,245.22
|
| Rate for Payer: PHP Commercial |
$1,245.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.47
|
| Rate for Payer: Priority Health SBD |
$922.92
|
| Rate for Payer: UMR Bronson Commercial |
$644.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,098.72
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
IP
|
$2,376.14
|
|
|
Service Code
|
NDC 0046-1102-81
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,045.50 |
| Max. Negotiated Rate |
$2,138.53 |
| Rate for Payer: Aetna American Axle |
$1,544.49
|
| Rate for Payer: Aetna Commercial |
$2,019.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,544.49
|
| Rate for Payer: Cash Price |
$1,900.91
|
| Rate for Payer: Cofinity Commercial |
$1,663.30
|
| Rate for Payer: Cofinity Commercial |
$2,043.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,900.91
|
| Rate for Payer: Healthscope Commercial |
$2,138.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,663.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,782.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,019.72
|
| Rate for Payer: PHP Commercial |
$2,019.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.30
|
| Rate for Payer: Priority Health SBD |
$1,496.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,045.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,782.10
|
|
|
CONJUGATED ESTROGENS 1.25 MG TABLET
|
Facility
|
IP
|
$2,376.14
|
|
|
Service Code
|
NDC 0046-1104-81
|
| Hospital Charge Code |
2938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,045.50 |
| Max. Negotiated Rate |
$2,138.53 |
| Rate for Payer: Aetna American Axle |
$1,544.49
|
| Rate for Payer: Aetna Commercial |
$2,019.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,544.49
|
| Rate for Payer: Cash Price |
$1,900.91
|
| Rate for Payer: Cofinity Commercial |
$1,663.30
|
| Rate for Payer: Cofinity Commercial |
$2,043.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,900.91
|
| Rate for Payer: Healthscope Commercial |
$2,138.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,663.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,782.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,019.72
|
| Rate for Payer: PHP Commercial |
$2,019.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.30
|
| Rate for Payer: Priority Health SBD |
$1,496.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,045.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,782.10
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,095.33
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$481.95 |
| Max. Negotiated Rate |
$985.80 |
| Rate for Payer: Aetna American Axle |
$711.96
|
| Rate for Payer: Aetna Commercial |
$931.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.96
|
| Rate for Payer: Cash Price |
$876.26
|
| Rate for Payer: Cofinity Commercial |
$766.73
|
| Rate for Payer: Cofinity Commercial |
$941.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$876.26
|
| Rate for Payer: Healthscope Commercial |
$985.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$766.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$821.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$931.03
|
| Rate for Payer: PHP Commercial |
$931.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$766.73
|
| Rate for Payer: Priority Health SBD |
$690.06
|
| Rate for Payer: UMR Bronson Commercial |
$481.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$821.50
|
|
|
CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT
|
Facility
|
OP
|
$6,538.91
|
|
|
Service Code
|
CPT 68320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$526.20 |
| Max. Negotiated Rate |
$6,538.91 |
| Rate for Payer: Aetna Medicare |
$2,160.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,596.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,596.41
|
| Rate for Payer: BCBS Complete |
$1,193.10
|
| Rate for Payer: BCBS MAPPO |
$2,077.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,657.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,077.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,077.13
|
| Rate for Payer: Mclaren Medicaid |
$1,136.19
|
| Rate for Payer: Mclaren Medicare |
$2,077.13
|
| Rate for Payer: Meridian Medicaid |
$1,193.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,180.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,388.70
|
| Rate for Payer: PACE Medicare |
$1,973.27
|
| Rate for Payer: PACE SWMI |
$2,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,077.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,136.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.91
|
| Rate for Payer: Priority Health Medicare |
$2,077.13
|
| Rate for Payer: Priority Health Narrow Network |
$5,231.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2,077.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.82
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,077.13
|
| Rate for Payer: UHC Exchange |
$526.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,139.44
|
| Rate for Payer: VA VA |
$2,077.13
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$25,815.02
|
|
|
Service Code
|
MS-DRG 546
|
| Min. Negotiated Rate |
$9,266.49 |
| Max. Negotiated Rate |
$25,815.02 |
| Rate for Payer: Aetna Medicare |
$10,144.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,192.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,192.75
|
| Rate for Payer: BCBS MAPPO |
$9,754.20
|
| Rate for Payer: BCBS Trust/PPO |
$25,815.02
|
| Rate for Payer: BCN Medicare Advantage |
$9,754.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,754.20
|
| Rate for Payer: Mclaren Medicare |
$9,754.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,241.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,217.33
|
| Rate for Payer: PACE Medicare |
$9,266.49
|
| Rate for Payer: PACE SWMI |
$9,754.20
|
| Rate for Payer: PHP Medicare Advantage |
$9,754.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,209.86
|
| Rate for Payer: Priority Health Medicare |
$9,754.20
|
| Rate for Payer: Priority Health Narrow Network |
$13,767.89
|
| Rate for Payer: Railroad Medicare Medicare |
$9,754.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,294.12
|
| Rate for Payer: UHC Core |
$15,000.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,754.20
|
| Rate for Payer: UHC Exchange |
$11,925.84
|
| Rate for Payer: UHC Medicare Advantage |
$10,046.83
|
| Rate for Payer: VA VA |
$9,754.20
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$52,768.39
|
|
|
Service Code
|
MS-DRG 545
|
| Min. Negotiated Rate |
$18,738.79 |
| Max. Negotiated Rate |
$52,768.39 |
| Rate for Payer: Aetna Medicare |
$20,514.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,656.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,656.30
|
| Rate for Payer: BCBS MAPPO |
$19,725.04
|
| Rate for Payer: BCBS Trust/PPO |
$52,768.39
|
| Rate for Payer: BCN Medicare Advantage |
$19,725.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,725.04
|
| Rate for Payer: Mclaren Medicare |
$19,725.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,711.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,683.80
|
| Rate for Payer: PACE Medicare |
$18,738.79
|
| Rate for Payer: PACE SWMI |
$19,725.04
|
| Rate for Payer: PHP Medicare Advantage |
$19,725.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,777.22
|
| Rate for Payer: Priority Health Medicare |
$19,725.04
|
| Rate for Payer: Priority Health Narrow Network |
$28,621.78
|
| Rate for Payer: Railroad Medicare Medicare |
$19,725.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,031.27
|
| Rate for Payer: UHC Core |
$31,184.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,725.04
|
| Rate for Payer: UHC Exchange |
$24,792.38
|
| Rate for Payer: UHC Medicare Advantage |
$20,316.79
|
| Rate for Payer: VA VA |
$19,725.04
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,982.72
|
|
|
Service Code
|
MS-DRG 547
|
| Min. Negotiated Rate |
$6,513.89 |
| Max. Negotiated Rate |
$20,982.72 |
| Rate for Payer: Aetna Medicare |
$7,131.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,570.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,570.91
|
| Rate for Payer: BCBS MAPPO |
$6,856.73
|
| Rate for Payer: BCBS Trust/PPO |
$20,982.72
|
| Rate for Payer: BCN Medicare Advantage |
$6,856.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,856.73
|
| Rate for Payer: Mclaren Medicare |
$6,856.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,199.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,885.24
|
| Rate for Payer: PACE Medicare |
$6,513.89
|
| Rate for Payer: PACE SWMI |
$6,856.73
|
| Rate for Payer: PHP Medicare Advantage |
$6,856.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,672.22
|
| Rate for Payer: Priority Health Medicare |
$6,856.73
|
| Rate for Payer: Priority Health Narrow Network |
$9,337.78
|
| Rate for Payer: Railroad Medicare Medicare |
$6,856.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,407.60
|
| Rate for Payer: UHC Core |
$10,174.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,856.73
|
| Rate for Payer: UHC Exchange |
$8,088.45
|
| Rate for Payer: UHC Medicare Advantage |
$7,062.43
|
| Rate for Payer: VA VA |
$6,856.73
|
|
|
CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;
|
Facility
|
OP
|
$6,538.91
|
|
|
Service Code
|
CPT 67880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$358.88 |
| Max. Negotiated Rate |
$6,538.91 |
| Rate for Payer: Aetna Medicare |
$2,160.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,596.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,596.41
|
| Rate for Payer: BCBS Complete |
$1,193.10
|
| Rate for Payer: BCBS MAPPO |
$2,077.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,371.95
|
| Rate for Payer: BCN Medicare Advantage |
$2,077.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,077.13
|
| Rate for Payer: Mclaren Medicaid |
$1,136.19
|
| Rate for Payer: Mclaren Medicare |
$2,077.13
|
| Rate for Payer: Meridian Medicaid |
$1,193.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,180.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,388.70
|
| Rate for Payer: PACE Medicare |
$1,973.27
|
| Rate for Payer: PACE SWMI |
$2,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,077.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,136.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.91
|
| Rate for Payer: Priority Health Medicare |
$2,077.13
|
| Rate for Payer: Priority Health Narrow Network |
$5,231.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2,077.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.77
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,077.13
|
| Rate for Payer: UHC Exchange |
$358.88
|
| Rate for Payer: UHC Medicare Advantage |
$2,139.44
|
| Rate for Payer: VA VA |
$2,077.13
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 30903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$118.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$222.83
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.43
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$285.94
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.84
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.55
|
| Rate for Payer: UHC Exchange |
$75.31
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 30901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$118.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$171.21
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.43
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$285.94
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.55
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 30905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$118.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$237.77
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.43
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$285.94
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.55
|
| Rate for Payer: UHC Exchange |
$103.47
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
