|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$224.51
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
12587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.78 |
| Max. Negotiated Rate |
$202.06 |
| Rate for Payer: Aetna American Axle |
$145.93
|
| Rate for Payer: Aetna American Axle |
$133.84
|
| Rate for Payer: Aetna American Axle |
$119.12
|
| Rate for Payer: Aetna American Axle |
$106.85
|
| Rate for Payer: Aetna American Axle |
$116.35
|
| Rate for Payer: Aetna American Axle |
$115.53
|
| Rate for Payer: Aetna Commercial |
$190.83
|
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna Commercial |
$155.77
|
| Rate for Payer: Aetna Commercial |
$151.08
|
| Rate for Payer: Aetna Commercial |
$175.02
|
| Rate for Payer: Aetna Commercial |
$139.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Cash Price |
$179.61
|
| Rate for Payer: Cash Price |
$164.73
|
| Rate for Payer: Cash Price |
$146.61
|
| Rate for Payer: Cash Price |
$131.51
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$142.19
|
| Rate for Payer: Cofinity Advantage |
$128.28
|
| Rate for Payer: Cofinity Advantage |
$124.42
|
| Rate for Payer: Cofinity Advantage |
$115.07
|
| Rate for Payer: Cofinity Advantage |
$144.14
|
| Rate for Payer: Cofinity Advantage |
$125.30
|
| Rate for Payer: Cofinity Advantage |
$157.16
|
| Rate for Payer: Cofinity Commercial |
$152.86
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$141.38
|
| Rate for Payer: Cofinity Commercial |
$153.94
|
| Rate for Payer: Cofinity Commercial |
$193.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.61
|
| Rate for Payer: Healthscope Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$147.95
|
| Rate for Payer: Healthscope Commercial |
$164.93
|
| Rate for Payer: Healthscope Commercial |
$159.97
|
| Rate for Payer: Healthscope Commercial |
$161.10
|
| Rate for Payer: Healthscope Commercial |
$202.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.25
|
| Rate for Payer: PHP Commercial |
$152.15
|
| Rate for Payer: PHP Commercial |
$190.83
|
| Rate for Payer: PHP Commercial |
$175.02
|
| Rate for Payer: PHP Commercial |
$155.77
|
| Rate for Payer: PHP Commercial |
$139.73
|
| Rate for Payer: PHP Commercial |
$151.08
|
| Rate for Payer: Priority Health SBD |
$129.72
|
| Rate for Payer: Priority Health SBD |
$111.98
|
| Rate for Payer: Priority Health SBD |
$103.57
|
| Rate for Payer: Priority Health SBD |
$112.77
|
| Rate for Payer: Priority Health SBD |
$115.45
|
| Rate for Payer: Priority Health SBD |
$141.44
|
| Rate for Payer: UMR Bronson Commercial |
$90.60
|
| Rate for Payer: UMR Bronson Commercial |
$78.76
|
| Rate for Payer: UMR Bronson Commercial |
$80.63
|
| Rate for Payer: UMR Bronson Commercial |
$78.21
|
| Rate for Payer: UMR Bronson Commercial |
$98.78
|
| Rate for Payer: UMR Bronson Commercial |
$72.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.25
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna American Axle |
$13.43
|
| Rate for Payer: Aetna American Axle |
$13.01
|
| Rate for Payer: Aetna Commercial |
$17.01
|
| Rate for Payer: Aetna Commercial |
$17.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.43
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Advantage |
$14.01
|
| Rate for Payer: Cofinity Commercial |
$17.21
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.53
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Healthscope Commercial |
$18.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.01
|
| Rate for Payer: PHP Commercial |
$17.56
|
| Rate for Payer: Priority Health SBD |
$12.61
|
| Rate for Payer: Priority Health SBD |
$13.02
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.01
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.01
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$18.01 |
| Rate for Payer: Aetna American Axle |
$13.01
|
| Rate for Payer: Aetna American Axle |
$13.43
|
| Rate for Payer: Aetna Commercial |
$17.01
|
| Rate for Payer: Aetna Commercial |
$17.56
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Aetna Medicare |
$10.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.43
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Cofinity Advantage |
$14.01
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.21
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.53
|
| Rate for Payer: Healthscope Commercial |
$18.01
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.01
|
| Rate for Payer: PHP Commercial |
$17.01
|
| Rate for Payer: PHP Commercial |
$17.56
|
| Rate for Payer: Priority Health SBD |
$12.61
|
| Rate for Payer: Priority Health SBD |
$13.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: UMR Bronson Commercial |
$7.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna American Axle |
$18.47
|
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Advantage |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.31
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: UMR Bronson Commercial |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna American Axle |
$18.47
|
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$14.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: BCBS Complete |
$11.36
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Advantage |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.31
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
PIPERACILLIN-TAZOBACTAM (ZOSYN) 13.5 GRAM /560 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$99.68
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$89.71 |
| Rate for Payer: Aetna American Axle |
$64.79
|
| Rate for Payer: Aetna Commercial |
$84.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Advantage |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$89.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.76
|
| Rate for Payer: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health SBD |
$62.80
|
| Rate for Payer: UMR Bronson Commercial |
$43.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.76
|
|
|
PIPERACILLIN-TAZOBACTAM (ZOSYN) 13.5 GRAM /560 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
OP
|
$99.68
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$89.71 |
| Rate for Payer: Aetna American Axle |
$64.79
|
| Rate for Payer: Aetna Commercial |
$84.73
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: BCBS Complete |
$39.87
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Advantage |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$89.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.76
|
| Rate for Payer: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health SBD |
$62.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$36.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.76
|
|
|
PLACEMENT, ENTEROSTOMY OR CECOSTOMY, TUBE OPEN (EG, FOR FEEDING OR DECOMPRESSION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 44300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,719.84
|
| Rate for Payer: BCN Commercial |
$3,719.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,912.01
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
PLACEMENT OF NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, NEW ACCESS
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 50433
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,801.50 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,801.50
|
| Rate for Payer: BCN Commercial |
$1,801.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,299.61
|
| Rate for Payer: BCN Commercial |
$3,299.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$2,765.68
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS, WITH SEPARATE NEPHROSTOMY CATHETER
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 50695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,684.88
|
| Rate for Payer: BCN Commercial |
$2,684.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
PLASMALYTE A 1 L/HEPARIN 30000UNIT IRRIGATION
|
Facility
|
IP
|
$35.43
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
500532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$31.89 |
| Rate for Payer: Aetna American Axle |
$23.03
|
| Rate for Payer: Aetna Commercial |
$30.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.03
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cofinity Advantage |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$30.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.34
|
| Rate for Payer: Healthscope Commercial |
$31.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.57
|
| Rate for Payer: PHP Commercial |
$30.12
|
| Rate for Payer: Priority Health SBD |
$22.32
|
| Rate for Payer: UMR Bronson Commercial |
$15.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.57
|
|
|
PLASMALYTE A 1 L/HEPARIN 30000UNIT IRRIGATION
|
Facility
|
OP
|
$35.43
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
500532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$31.89 |
| Rate for Payer: Aetna American Axle |
$23.03
|
| Rate for Payer: Aetna Commercial |
$30.12
|
| Rate for Payer: Aetna Medicare |
$17.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.03
|
| Rate for Payer: BCBS Complete |
$14.17
|
| Rate for Payer: BCBS Trust/PPO |
$0.57
|
| Rate for Payer: BCN Commercial |
$0.57
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cofinity Advantage |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$30.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.34
|
| Rate for Payer: Healthscope Commercial |
$31.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.57
|
| Rate for Payer: PHP Commercial |
$30.12
|
| Rate for Payer: Priority Health SBD |
$22.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.30
|
| Rate for Payer: UHC Core |
$0.30
|
| Rate for Payer: UHC Exchange |
$0.30
|
| Rate for Payer: UMR Bronson Commercial |
$13.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.57
|
|
|
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY, PARTIAL OR COMPLETE, UNILATERAL
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 40700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,474.67
|
| Rate for Payer: BCN Commercial |
$4,474.67
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$19,487.46
|
|
|
Service Code
|
MSDRG 187
|
| Min. Negotiated Rate |
$8,421.28 |
| Max. Negotiated Rate |
$19,487.46 |
| Rate for Payer: Aetna Medicare |
$9,219.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,080.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,080.64
|
| Rate for Payer: BCBS MAPPO |
$8,864.51
|
| Rate for Payer: BCBS Trust/PPO |
$19,487.46
|
| Rate for Payer: BCN Commercial |
$19,487.46
|
| Rate for Payer: BCN Medicare Advantage |
$8,864.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,864.51
|
| Rate for Payer: Mclaren Medicare |
$8,864.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,307.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,194.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,750.96
|
| Rate for Payer: Nomi Health Commercial |
$12,759.39
|
| Rate for Payer: PACE Medicare |
$8,421.28
|
| Rate for Payer: PACE SWMI |
$8,864.51
|
| Rate for Payer: PHP Medicare Advantage |
$8,864.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,946.41
|
| Rate for Payer: Priority Health Medicare |
$8,864.51
|
| Rate for Payer: Priority Health Tiered Network |
$12,757.12
|
| Rate for Payer: Railroad Medicare Medicare |
$8,864.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,122.33
|
| Rate for Payer: UHC Core |
$13,488.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,864.51
|
| Rate for Payer: UHC Exchange |
$11,015.61
|
| Rate for Payer: VA VA |
$8,864.51
|
|
|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$29,144.73
|
|
|
Service Code
|
MSDRG 186
|
| Min. Negotiated Rate |
$12,944.91 |
| Max. Negotiated Rate |
$29,144.73 |
| Rate for Payer: Aetna Medicare |
$14,171.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,032.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,032.78
|
| Rate for Payer: BCBS MAPPO |
$13,626.22
|
| Rate for Payer: BCBS Trust/PPO |
$29,144.73
|
| Rate for Payer: BCN Commercial |
$29,144.73
|
| Rate for Payer: BCN Medicare Advantage |
$13,626.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,626.22
|
| Rate for Payer: Mclaren Medicare |
$13,626.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,307.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,670.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,988.84
|
| Rate for Payer: Nomi Health Commercial |
$20,104.65
|
| Rate for Payer: PACE Medicare |
$12,944.91
|
| Rate for Payer: PACE SWMI |
$13,626.22
|
| Rate for Payer: PHP Medicare Advantage |
$13,626.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,126.36
|
| Rate for Payer: Priority Health Medicare |
$13,626.22
|
| Rate for Payer: Priority Health Tiered Network |
$20,101.08
|
| Rate for Payer: Railroad Medicare Medicare |
$13,626.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,403.55
|
| Rate for Payer: UHC Core |
$21,253.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,626.22
|
| Rate for Payer: UHC Exchange |
$17,357.01
|
| Rate for Payer: VA VA |
$13,626.22
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$14,601.19
|
|
|
Service Code
|
MSDRG 188
|
| Min. Negotiated Rate |
$6,261.15 |
| Max. Negotiated Rate |
$14,601.19 |
| Rate for Payer: Aetna Medicare |
$6,854.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,238.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,238.35
|
| Rate for Payer: BCBS MAPPO |
$6,590.68
|
| Rate for Payer: BCBS Trust/PPO |
$14,601.19
|
| Rate for Payer: BCN Commercial |
$14,601.19
|
| Rate for Payer: BCN Medicare Advantage |
$6,590.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,590.68
|
| Rate for Payer: Mclaren Medicare |
$6,590.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,920.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,579.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,249.75
|
| Rate for Payer: Nomi Health Commercial |
$9,251.88
|
| Rate for Payer: PACE Medicare |
$6,261.15
|
| Rate for Payer: PACE SWMI |
$6,590.68
|
| Rate for Payer: PHP Medicare Advantage |
$6,590.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,562.80
|
| Rate for Payer: Priority Health Medicare |
$6,590.68
|
| Rate for Payer: Priority Health Tiered Network |
$9,250.24
|
| Rate for Payer: Railroad Medicare Medicare |
$6,590.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,690.36
|
| Rate for Payer: UHC Core |
$9,780.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,590.68
|
| Rate for Payer: UHC Exchange |
$7,987.46
|
| Rate for Payer: VA VA |
$6,590.68
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$775.68
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.32 |
| Max. Negotiated Rate |
$952.39 |
| Rate for Payer: Aetna American Axle |
$504.19
|
| Rate for Payer: Aetna Commercial |
$659.33
|
| Rate for Payer: Aetna Medicare |
$387.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.19
|
| Rate for Payer: BCBS Complete |
$310.27
|
| Rate for Payer: BCBS Trust/PPO |
$952.39
|
| Rate for Payer: BCN Commercial |
$952.39
|
| Rate for Payer: Cash Price |
$620.54
|
| Rate for Payer: Cash Price |
$620.54
|
| Rate for Payer: Cofinity Advantage |
$542.98
|
| Rate for Payer: Cofinity Commercial |
$667.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.54
|
| Rate for Payer: Healthscope Commercial |
$698.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$620.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$581.76
|
| Rate for Payer: PHP Commercial |
$659.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$312.90
|
| Rate for Payer: Priority Health SBD |
$488.68
|
| Rate for Payer: Priority Health Tiered Network |
$250.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.29
|
| Rate for Payer: UHC Core |
$516.29
|
| Rate for Payer: UHC Exchange |
$516.29
|
| Rate for Payer: UMR Bronson Commercial |
$287.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.76
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$775.68
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$341.30 |
| Max. Negotiated Rate |
$698.11 |
| Rate for Payer: Aetna American Axle |
$504.19
|
| Rate for Payer: Aetna Commercial |
$659.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.19
|
| Rate for Payer: Cash Price |
$620.54
|
| Rate for Payer: Cofinity Advantage |
$542.98
|
| Rate for Payer: Cofinity Commercial |
$667.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.54
|
| Rate for Payer: Healthscope Commercial |
$698.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$581.76
|
| Rate for Payer: PHP Commercial |
$659.33
|
| Rate for Payer: Priority Health SBD |
$488.68
|
| Rate for Payer: UMR Bronson Commercial |
$341.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.76
|
|
|
PNEUMOTHORAX WITH CC
|
Facility
|
IP
|
$19,155.31
|
|
|
Service Code
|
MSDRG 200
|
| Min. Negotiated Rate |
$9,296.78 |
| Max. Negotiated Rate |
$19,155.31 |
| Rate for Payer: Aetna Medicare |
$10,177.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,232.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,232.60
|
| Rate for Payer: BCBS MAPPO |
$9,786.08
|
| Rate for Payer: BCBS Trust/PPO |
$19,155.31
|
| Rate for Payer: BCN Commercial |
$19,155.31
|
| Rate for Payer: BCN Medicare Advantage |
$9,786.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,786.08
|
| Rate for Payer: Mclaren Medicare |
$9,786.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,275.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,253.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,764.69
|
| Rate for Payer: Nomi Health Commercial |
$14,180.97
|
| Rate for Payer: PACE Medicare |
$9,296.78
|
| Rate for Payer: PACE SWMI |
$9,786.08
|
| Rate for Payer: PHP Medicare Advantage |
$9,786.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,723.07
|
| Rate for Payer: Priority Health Medicare |
$9,786.08
|
| Rate for Payer: Priority Health Tiered Network |
$14,178.45
|
| Rate for Payer: Railroad Medicare Medicare |
$9,786.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,918.59
|
| Rate for Payer: UHC Core |
$14,991.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,786.08
|
| Rate for Payer: UHC Exchange |
$12,242.90
|
| Rate for Payer: VA VA |
$9,786.08
|
|
|
PNEUMOTHORAX WITH MCC
|
Facility
|
IP
|
$28,754.83
|
|
|
Service Code
|
MSDRG 199
|
| Min. Negotiated Rate |
$14,578.32 |
| Max. Negotiated Rate |
$28,754.83 |
| Rate for Payer: Aetna Medicare |
$15,959.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,182.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,182.00
|
| Rate for Payer: BCBS MAPPO |
$15,345.60
|
| Rate for Payer: BCBS Trust/PPO |
$26,506.69
|
| Rate for Payer: BCN Commercial |
$26,506.69
|
| Rate for Payer: BCN Medicare Advantage |
$15,345.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,345.60
|
| Rate for Payer: Mclaren Medicare |
$15,345.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,112.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,647.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,880.16
|
| Rate for Payer: Nomi Health Commercial |
$22,756.89
|
| Rate for Payer: PACE Medicare |
$14,578.32
|
| Rate for Payer: PACE SWMI |
$15,345.60
|
| Rate for Payer: PHP Medicare Advantage |
$15,345.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,441.07
|
| Rate for Payer: Priority Health Medicare |
$15,345.60
|
| Rate for Payer: Priority Health Tiered Network |
$22,752.85
|
| Rate for Payer: Railroad Medicare Medicare |
$15,345.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,754.83
|
| Rate for Payer: UHC Core |
$24,057.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,345.60
|
| Rate for Payer: UHC Exchange |
$19,646.78
|
| Rate for Payer: VA VA |
$15,345.60
|
|
|
PNEUMOTHORAX WITHOUT CC/MCC
|
Facility
|
IP
|
$13,030.99
|
|
|
Service Code
|
MSDRG 201
|
| Min. Negotiated Rate |
$6,244.47 |
| Max. Negotiated Rate |
$13,030.99 |
| Rate for Payer: Aetna Medicare |
$6,836.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,216.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,216.41
|
| Rate for Payer: BCBS MAPPO |
$6,573.13
|
| Rate for Payer: BCBS Trust/PPO |
$13,030.99
|
| Rate for Payer: BCN Commercial |
$13,030.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,573.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,573.13
|
| Rate for Payer: Mclaren Medicare |
$6,573.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,901.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,559.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,230.44
|
| Rate for Payer: Nomi Health Commercial |
$9,224.79
|
| Rate for Payer: PACE Medicare |
$6,244.47
|
| Rate for Payer: PACE SWMI |
$6,573.13
|
| Rate for Payer: PHP Medicare Advantage |
$6,573.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,528.94
|
| Rate for Payer: Priority Health Medicare |
$6,573.13
|
| Rate for Payer: Priority Health Tiered Network |
$9,223.15
|
| Rate for Payer: Railroad Medicare Medicare |
$6,573.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,656.13
|
| Rate for Payer: UHC Core |
$9,751.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,573.13
|
| Rate for Payer: UHC Exchange |
$7,964.07
|
| Rate for Payer: VA VA |
$6,573.13
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC
|
Facility
|
IP
|
$28,560.02
|
|
|
Service Code
|
MSDRG 917
|
| Min. Negotiated Rate |
$13,023.57 |
| Max. Negotiated Rate |
$28,560.02 |
| Rate for Payer: Aetna Medicare |
$14,257.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,136.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,136.28
|
| Rate for Payer: BCBS MAPPO |
$13,709.02
|
| Rate for Payer: BCBS Trust/PPO |
$28,560.02
|
| Rate for Payer: BCN Commercial |
$28,560.02
|
| Rate for Payer: BCN Medicare Advantage |
$13,709.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,709.02
|
| Rate for Payer: Mclaren Medicare |
$13,709.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,394.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,765.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,079.92
|
| Rate for Payer: Nomi Health Commercial |
$20,232.36
|
| Rate for Payer: PACE Medicare |
$13,023.57
|
| Rate for Payer: PACE SWMI |
$13,709.02
|
| Rate for Payer: PHP Medicare Advantage |
$13,709.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,285.96
|
| Rate for Payer: Priority Health Medicare |
$13,709.02
|
| Rate for Payer: Priority Health Tiered Network |
$20,228.77
|
| Rate for Payer: Railroad Medicare Medicare |
$13,709.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,564.92
|
| Rate for Payer: UHC Core |
$21,388.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,709.02
|
| Rate for Payer: UHC Exchange |
$17,467.27
|
| Rate for Payer: VA VA |
$13,709.02
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
|
IP
|
$13,970.73
|
|
|
Service Code
|
MSDRG 918
|
| Min. Negotiated Rate |
$7,372.60 |
| Max. Negotiated Rate |
$13,970.73 |
| Rate for Payer: Aetna Medicare |
$8,071.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,700.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,700.79
|
| Rate for Payer: BCBS MAPPO |
$7,760.63
|
| Rate for Payer: BCBS Trust/PPO |
$11,672.17
|
| Rate for Payer: BCN Commercial |
$11,672.17
|
| Rate for Payer: BCN Medicare Advantage |
$7,760.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,760.63
|
| Rate for Payer: Mclaren Medicare |
$7,760.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,148.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,924.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,536.69
|
| Rate for Payer: Nomi Health Commercial |
$11,056.59
|
| Rate for Payer: PACE Medicare |
$7,372.60
|
| Rate for Payer: PACE SWMI |
$7,760.63
|
| Rate for Payer: PHP Medicare Advantage |
$7,760.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,818.29
|
| Rate for Payer: Priority Health Medicare |
$7,760.63
|
| Rate for Payer: Priority Health Tiered Network |
$11,054.63
|
| Rate for Payer: Railroad Medicare Medicare |
$7,760.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,970.73
|
| Rate for Payer: UHC Core |
$11,688.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,760.63
|
| Rate for Payer: UHC Exchange |
$9,545.52
|
| Rate for Payer: VA VA |
$7,760.63
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$2,714.28
|
|
|
Service Code
|
APR-DRG 8121
|
| Min. Negotiated Rate |
$2,585.03 |
| Max. Negotiated Rate |
$2,714.28 |
| Rate for Payer: BCBS Complete |
$2,714.28
|
| Rate for Payer: Mclaren Medicaid |
$2,585.03
|
| Rate for Payer: Meridian Medicaid |
$2,714.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,585.03
|
| Rate for Payer: UHC Medicaid |
$2,585.03
|
| Rate for Payer: UHCCP Medicaid |
$2,585.03
|
|
