|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$338.95
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.54 |
| Max. Negotiated Rate |
$305.06 |
| Rate for Payer: Aetna Commercial |
$288.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.32
|
| Rate for Payer: Cash Price |
$271.16
|
| Rate for Payer: Cofinity Advantage |
$237.26
|
| Rate for Payer: Cofinity Commercial |
$291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.16
|
| Rate for Payer: Healthscope Commercial |
$305.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.21
|
| Rate for Payer: PHP Commercial |
$288.11
|
| Rate for Payer: Priority Health SBD |
$213.54
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN
|
Facility
|
IP
|
$7,785.57
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
82228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,904.91 |
| Max. Negotiated Rate |
$7,007.01 |
| Rate for Payer: Aetna Commercial |
$6,617.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,060.62
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cofinity Advantage |
$5,449.90
|
| Rate for Payer: Cofinity Commercial |
$6,695.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,228.46
|
| Rate for Payer: Healthscope Commercial |
$7,007.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,617.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,839.18
|
| Rate for Payer: PHP Commercial |
$6,617.73
|
| Rate for Payer: Priority Health SBD |
$4,904.91
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN
|
Facility
|
OP
|
$7,785.57
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
82228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$7,007.01 |
| Rate for Payer: Aetna Commercial |
$6,617.73
|
| Rate for Payer: Aetna Medicare |
$31.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,060.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.60
|
| Rate for Payer: BCBS Complete |
$16.52
|
| Rate for Payer: BCBS MAPPO |
$30.08
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: BCN Medicare Advantage |
$30.08
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cofinity Advantage |
$5,449.90
|
| Rate for Payer: Cofinity Commercial |
$6,695.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,228.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$7,007.01
|
| Rate for Payer: Mclaren Medicaid |
$15.73
|
| Rate for Payer: Mclaren Medicare |
$30.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.58
|
| Rate for Payer: Meridian Medicaid |
$31.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,617.73
|
| Rate for Payer: Nomi Health Commercial |
$90.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,839.18
|
| Rate for Payer: PACE Medicare |
$28.58
|
| Rate for Payer: PACE SWMI |
$30.08
|
| Rate for Payer: PHP Commercial |
$6,617.73
|
| Rate for Payer: PHP Medicare Advantage |
$30.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$84.25
|
| Rate for Payer: Priority Health Medicare |
$30.08
|
| Rate for Payer: Priority Health SBD |
$4,904.91
|
| Rate for Payer: Priority Health Tiered Network |
$67.40
|
| Rate for Payer: Railroad Medicare Medicare |
$30.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$33.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.08
|
| Rate for Payer: UHC Exchange |
$33.53
|
| Rate for Payer: UHC Medicaid |
$15.73
|
| Rate for Payer: UHCCP Medicaid |
$15.73
|
| Rate for Payer: VA VA |
$30.08
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
|
IP
|
$30,381.24
|
|
|
Service Code
|
MSDRG 557
|
| Min. Negotiated Rate |
$11,466.60 |
| Max. Negotiated Rate |
$30,381.24 |
| Rate for Payer: Aetna Medicare |
$12,552.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,087.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,087.64
|
| Rate for Payer: BCBS MAPPO |
$12,070.11
|
| Rate for Payer: BCBS Trust/PPO |
$30,381.24
|
| Rate for Payer: BCN Commercial |
$30,381.24
|
| Rate for Payer: BCN Medicare Advantage |
$12,070.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,070.11
|
| Rate for Payer: Mclaren Medicare |
$12,070.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,673.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,880.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,277.12
|
| Rate for Payer: Nomi Health Commercial |
$19,181.01
|
| Rate for Payer: PACE Medicare |
$11,466.60
|
| Rate for Payer: PACE SWMI |
$12,070.11
|
| Rate for Payer: PHP Medicare Advantage |
$12,070.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,972.01
|
| Rate for Payer: Priority Health Medicare |
$12,070.11
|
| Rate for Payer: Priority Health Tiered Network |
$19,177.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12,070.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,236.47
|
| Rate for Payer: UHC Core |
$20,276.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,070.11
|
| Rate for Payer: UHC Exchange |
$16,559.61
|
| Rate for Payer: VA VA |
$12,070.11
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
|
IP
|
$14,559.16
|
|
|
Service Code
|
MSDRG 558
|
| Min. Negotiated Rate |
$7,107.77 |
| Max. Negotiated Rate |
$14,559.16 |
| Rate for Payer: Aetna Medicare |
$7,781.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,352.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,352.33
|
| Rate for Payer: BCBS MAPPO |
$7,481.86
|
| Rate for Payer: BCBS Trust/PPO |
$9,934.36
|
| Rate for Payer: BCN Commercial |
$9,934.36
|
| Rate for Payer: BCN Medicare Advantage |
$7,481.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,481.86
|
| Rate for Payer: Mclaren Medicare |
$7,481.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,855.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,604.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,230.05
|
| Rate for Payer: Nomi Health Commercial |
$11,522.28
|
| Rate for Payer: PACE Medicare |
$7,107.77
|
| Rate for Payer: PACE SWMI |
$7,481.86
|
| Rate for Payer: PHP Medicare Advantage |
$7,481.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,400.30
|
| Rate for Payer: Priority Health Medicare |
$7,481.86
|
| Rate for Payer: Priority Health Tiered Network |
$11,520.23
|
| Rate for Payer: Railroad Medicare Medicare |
$7,481.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,559.16
|
| Rate for Payer: UHC Core |
$12,180.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,481.86
|
| Rate for Payer: UHC Exchange |
$9,947.57
|
| Rate for Payer: VA VA |
$7,481.86
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$12,230.21
|
|
|
Service Code
|
APR-DRG 3173
|
| Min. Negotiated Rate |
$11,647.82 |
| Max. Negotiated Rate |
$12,230.21 |
| Rate for Payer: BCBS Complete |
$12,230.21
|
| Rate for Payer: Mclaren Medicaid |
$11,647.82
|
| Rate for Payer: Meridian Medicaid |
$12,230.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,647.82
|
| Rate for Payer: UHC Medicaid |
$11,647.82
|
| Rate for Payer: UHCCP Medicaid |
$11,647.82
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$7,841.02
|
|
|
Service Code
|
APR-DRG 3171
|
| Min. Negotiated Rate |
$7,467.64 |
| Max. Negotiated Rate |
$7,841.02 |
| Rate for Payer: BCBS Complete |
$7,841.02
|
| Rate for Payer: Mclaren Medicaid |
$7,467.64
|
| Rate for Payer: Meridian Medicaid |
$7,841.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,467.64
|
| Rate for Payer: UHC Medicaid |
$7,467.64
|
| Rate for Payer: UHCCP Medicaid |
$7,467.64
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$10,122.18
|
|
|
Service Code
|
APR-DRG 3172
|
| Min. Negotiated Rate |
$9,640.18 |
| Max. Negotiated Rate |
$10,122.18 |
| Rate for Payer: BCBS Complete |
$10,122.18
|
| Rate for Payer: Mclaren Medicaid |
$9,640.18
|
| Rate for Payer: Meridian Medicaid |
$10,122.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,640.18
|
| Rate for Payer: UHC Medicaid |
$9,640.18
|
| Rate for Payer: UHCCP Medicaid |
$9,640.18
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$18,799.65
|
|
|
Service Code
|
APR-DRG 3174
|
| Min. Negotiated Rate |
$17,904.43 |
| Max. Negotiated Rate |
$18,799.65 |
| Rate for Payer: BCBS Complete |
$18,799.65
|
| Rate for Payer: Mclaren Medicaid |
$17,904.43
|
| Rate for Payer: Meridian Medicaid |
$18,799.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,904.43
|
| Rate for Payer: UHC Medicaid |
$17,904.43
|
| Rate for Payer: UHCCP Medicaid |
$17,904.43
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.50
|
| Rate for Payer: BCN Commercial |
$1,130.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TENECTEPLASE 25 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
212669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,423.13 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,039.74
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Advantage |
$21,581.26
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: Priority Health SBD |
$19,423.13
|
|
|
TENECTEPLASE 25 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
212669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.26 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna Medicare |
$205.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,039.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.80
|
| Rate for Payer: BCBS Complete |
$108.43
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS Trust/PPO |
$469.06
|
| Rate for Payer: BCN Commercial |
$469.06
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Advantage |
$21,581.26
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Mclaren Medicaid |
$103.26
|
| Rate for Payer: Mclaren Medicare |
$197.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Medicaid |
$207.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$592.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PACE Medicare |
$187.57
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$543.17
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health SBD |
$19,423.13
|
| Rate for Payer: Priority Health Tiered Network |
$434.54
|
| Rate for Payer: Railroad Medicare Medicare |
$197.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.50
|
| Rate for Payer: UHC Core |
$308.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Exchange |
$308.50
|
| Rate for Payer: UHC Medicaid |
$103.26
|
| Rate for Payer: UHCCP Medicaid |
$103.26
|
| Rate for Payer: VA VA |
$197.44
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,423.13 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna Commercial |
$25,442.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,039.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,456.05
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Advantage |
$21,581.26
|
| Rate for Payer: Cofinity Advantage |
$20,952.67
|
| Rate for Payer: Cofinity Commercial |
$25,741.85
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Healthscope Commercial |
$26,939.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,449.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PHP Commercial |
$25,442.52
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: Priority Health SBD |
$19,423.13
|
| Rate for Payer: Priority Health SBD |
$18,857.40
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.26 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna Commercial |
$25,442.52
|
| Rate for Payer: Aetna Medicare |
$205.34
|
| Rate for Payer: Aetna Medicare |
$205.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,456.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,039.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.80
|
| Rate for Payer: BCBS Complete |
$108.43
|
| Rate for Payer: BCBS Complete |
$108.43
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS Trust/PPO |
$469.06
|
| Rate for Payer: BCBS Trust/PPO |
$469.06
|
| Rate for Payer: BCN Commercial |
$469.06
|
| Rate for Payer: BCN Commercial |
$469.06
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Advantage |
$21,581.26
|
| Rate for Payer: Cofinity Advantage |
$20,952.67
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Cofinity Commercial |
$25,741.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Healthscope Commercial |
$26,939.14
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Mclaren Medicaid |
$103.26
|
| Rate for Payer: Mclaren Medicaid |
$103.26
|
| Rate for Payer: Mclaren Medicare |
$197.44
|
| Rate for Payer: Mclaren Medicare |
$197.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Medicaid |
$207.31
|
| Rate for Payer: Meridian Medicaid |
$207.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$592.32
|
| Rate for Payer: Nomi Health Commercial |
$592.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,449.28
|
| Rate for Payer: PACE Medicare |
$187.57
|
| Rate for Payer: PACE Medicare |
$187.57
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PHP Commercial |
$25,442.52
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$543.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$543.17
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health SBD |
$19,423.13
|
| Rate for Payer: Priority Health SBD |
$18,857.40
|
| Rate for Payer: Priority Health Tiered Network |
$434.54
|
| Rate for Payer: Priority Health Tiered Network |
$434.54
|
| Rate for Payer: Railroad Medicare Medicare |
$197.44
|
| Rate for Payer: Railroad Medicare Medicare |
$197.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.50
|
| Rate for Payer: UHC Core |
$308.50
|
| Rate for Payer: UHC Core |
$308.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Exchange |
$308.50
|
| Rate for Payer: UHC Exchange |
$308.50
|
| Rate for Payer: UHC Medicaid |
$103.26
|
| Rate for Payer: UHC Medicaid |
$103.26
|
| Rate for Payer: UHCCP Medicaid |
$103.26
|
| Rate for Payer: UHCCP Medicaid |
$103.26
|
| Rate for Payer: VA VA |
$197.44
|
| Rate for Payer: VA VA |
$197.44
|
|
|
TENODESIS OF LONG TENDON OF BICEPS
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 23430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,837.10
|
| Rate for Payer: BCN Commercial |
$3,837.10
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 24358
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,628.11 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,628.11
|
| Rate for Payer: BCN Commercial |
$1,628.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48,676.40
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30,666.13 |
| Max. Negotiated Rate |
$43,808.76 |
| Rate for Payer: Aetna Commercial |
$41,374.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31,639.66
|
| Rate for Payer: Cash Price |
$38,941.12
|
| Rate for Payer: Cofinity Advantage |
$34,073.48
|
| Rate for Payer: Cofinity Commercial |
$41,861.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,941.12
|
| Rate for Payer: Healthscope Commercial |
$43,808.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,374.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,507.30
|
| Rate for Payer: PHP Commercial |
$41,374.94
|
| Rate for Payer: Priority Health SBD |
$30,666.13
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$48,676.40
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.42 |
| Max. Negotiated Rate |
$43,808.76 |
| Rate for Payer: Aetna Commercial |
$41,374.94
|
| Rate for Payer: Aetna Medicare |
$382.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31,639.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$459.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$459.89
|
| Rate for Payer: BCBS Complete |
$202.06
|
| Rate for Payer: BCBS MAPPO |
$367.91
|
| Rate for Payer: BCBS Trust/PPO |
$926.55
|
| Rate for Payer: BCN Commercial |
$926.55
|
| Rate for Payer: BCN Medicare Advantage |
$367.91
|
| Rate for Payer: Cash Price |
$38,941.12
|
| Rate for Payer: Cash Price |
$38,941.12
|
| Rate for Payer: Cofinity Advantage |
$34,073.48
|
| Rate for Payer: Cofinity Commercial |
$41,861.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,941.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$367.91
|
| Rate for Payer: Healthscope Commercial |
$43,808.76
|
| Rate for Payer: Mclaren Medicaid |
$192.42
|
| Rate for Payer: Mclaren Medicare |
$367.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$386.31
|
| Rate for Payer: Meridian Medicaid |
$386.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$423.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$404.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,374.94
|
| Rate for Payer: Nomi Health Commercial |
$1,103.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,507.30
|
| Rate for Payer: PACE Medicare |
$349.51
|
| Rate for Payer: PACE SWMI |
$367.91
|
| Rate for Payer: PHP Commercial |
$41,374.94
|
| Rate for Payer: PHP Medicare Advantage |
$367.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,132.87
|
| Rate for Payer: Priority Health Medicare |
$367.91
|
| Rate for Payer: Priority Health SBD |
$30,666.13
|
| Rate for Payer: Priority Health Tiered Network |
$906.30
|
| Rate for Payer: Railroad Medicare Medicare |
$367.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.36
|
| Rate for Payer: UHC Core |
$609.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$367.91
|
| Rate for Payer: UHC Exchange |
$609.36
|
| Rate for Payer: UHC Medicaid |
$192.42
|
| Rate for Payer: UHCCP Medicaid |
$192.42
|
| Rate for Payer: VA VA |
$367.91
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$21.32
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$19.19 |
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna Medicare |
$10.66
|
| Rate for Payer: Aetna Medicare |
$8.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS Trust/PPO |
$9.85
|
| Rate for Payer: BCBS Trust/PPO |
$9.85
|
| Rate for Payer: BCN Commercial |
$9.85
|
| Rate for Payer: BCN Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Advantage |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.99
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Core |
$4.08
|
| Rate for Payer: UHC Core |
$4.08
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Exchange |
$4.08
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$16.91
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Advantage |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.99
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: Priority Health SBD |
$13.43
|
|
|
TESTES PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$33,965.94
|
|
|
Service Code
|
MSDRG 711
|
| Min. Negotiated Rate |
$15,848.92 |
| Max. Negotiated Rate |
$33,965.94 |
| Rate for Payer: Aetna Medicare |
$17,350.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,853.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,853.84
|
| Rate for Payer: BCBS MAPPO |
$16,683.07
|
| Rate for Payer: BCBS Trust/PPO |
$33,267.45
|
| Rate for Payer: BCN Commercial |
$33,267.45
|
| Rate for Payer: BCN Medicare Advantage |
$16,683.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,683.07
|
| Rate for Payer: Mclaren Medicare |
$16,683.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,517.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,185.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,351.38
|
| Rate for Payer: Nomi Health Commercial |
$26,881.02
|
| Rate for Payer: PACE Medicare |
$15,848.92
|
| Rate for Payer: PACE SWMI |
$16,683.07
|
| Rate for Payer: PHP Medicare Advantage |
$16,683.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,595.32
|
| Rate for Payer: Priority Health Medicare |
$16,683.07
|
| Rate for Payer: Priority Health Tiered Network |
$26,876.25
|
| Rate for Payer: Railroad Medicare Medicare |
$16,683.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,965.94
|
| Rate for Payer: UHC Core |
$28,416.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,683.07
|
| Rate for Payer: UHC Exchange |
$23,207.28
|
| Rate for Payer: VA VA |
$16,683.07
|
|
|
TESTES PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,337.83
|
|
|
Service Code
|
MSDRG 712
|
| Min. Negotiated Rate |
$8,623.84 |
| Max. Negotiated Rate |
$18,337.83 |
| Rate for Payer: Aetna Medicare |
$9,440.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,347.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,347.16
|
| Rate for Payer: BCBS MAPPO |
$9,077.73
|
| Rate for Payer: BCBS Trust/PPO |
$18,337.83
|
| Rate for Payer: BCN Commercial |
$18,337.83
|
| Rate for Payer: BCN Medicare Advantage |
$9,077.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,077.73
|
| Rate for Payer: Mclaren Medicare |
$9,077.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,531.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,439.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,985.50
|
| Rate for Payer: Nomi Health Commercial |
$14,186.13
|
| Rate for Payer: PACE Medicare |
$8,623.84
|
| Rate for Payer: PACE SWMI |
$9,077.73
|
| Rate for Payer: PHP Medicare Advantage |
$9,077.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,729.52
|
| Rate for Payer: Priority Health Medicare |
$9,077.73
|
| Rate for Payer: Priority Health Tiered Network |
$14,183.61
|
| Rate for Payer: Railroad Medicare Medicare |
$9,077.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,925.11
|
| Rate for Payer: UHC Core |
$14,996.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,077.73
|
| Rate for Payer: UHC Exchange |
$12,247.36
|
| Rate for Payer: VA VA |
$9,077.73
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$88.05
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.47 |
| Max. Negotiated Rate |
$79.25 |
| Rate for Payer: Aetna Commercial |
$74.84
|
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna Commercial |
$31.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.23
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Advantage |
$29.05
|
| Rate for Payer: Cofinity Advantage |
$61.63
|
| Rate for Payer: Cofinity Advantage |
$77.42
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$31.52
|
| Rate for Payer: Cofinity Commercial |
$75.72
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.44
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Healthscope Commercial |
$37.35
|
| Rate for Payer: Healthscope Commercial |
$32.98
|
| Rate for Payer: Healthscope Commercial |
$79.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.04
|
| Rate for Payer: PHP Commercial |
$31.15
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: PHP Commercial |
$74.84
|
| Rate for Payer: PHP Commercial |
$35.27
|
| Rate for Payer: Priority Health SBD |
$26.14
|
| Rate for Payer: Priority Health SBD |
$23.09
|
| Rate for Payer: Priority Health SBD |
$55.47
|
| Rate for Payer: Priority Health SBD |
$69.68
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$36.65
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Aetna Commercial |
$31.15
|
| Rate for Payer: Aetna Commercial |
$74.84
|
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna Medicare |
$18.32
|
| Rate for Payer: Aetna Medicare |
$44.02
|
| Rate for Payer: Aetna Medicare |
$20.75
|
| Rate for Payer: Aetna Medicare |
$55.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.82
|
| Rate for Payer: BCBS Complete |
$35.22
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Complete |
$44.24
|
| Rate for Payer: BCBS Complete |
$16.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cofinity Advantage |
$61.63
|
| Rate for Payer: Cofinity Advantage |
$77.42
|
| Rate for Payer: Cofinity Advantage |
$29.05
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Cofinity Commercial |
$75.72
|
| Rate for Payer: Cofinity Commercial |
$31.52
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.32
|
| Rate for Payer: Healthscope Commercial |
$37.35
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Healthscope Commercial |
$79.25
|
| Rate for Payer: Healthscope Commercial |
$32.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.04
|
| Rate for Payer: PHP Commercial |
$35.27
|
| Rate for Payer: PHP Commercial |
$31.15
|
| Rate for Payer: PHP Commercial |
$74.84
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: Priority Health SBD |
$69.68
|
| Rate for Payer: Priority Health SBD |
$26.14
|
| Rate for Payer: Priority Health SBD |
$55.47
|
| Rate for Payer: Priority Health SBD |
$23.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,694.95
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,067.82 |
| Max. Negotiated Rate |
$1,525.45 |
| Rate for Payer: Aetna Commercial |
$1,440.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.72
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cofinity Advantage |
$1,186.46
|
| Rate for Payer: Cofinity Commercial |
$1,457.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,355.96
|
| Rate for Payer: Healthscope Commercial |
$1,525.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,440.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.21
|
| Rate for Payer: PHP Commercial |
$1,440.71
|
| Rate for Payer: Priority Health SBD |
$1,067.82
|
|
