|
TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 24340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$637.96 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,368.43
|
| Rate for Payer: BCN Commercial |
$2,368.43
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.96
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
TENODESIS OF LONG TENDON OF BICEPS
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 23430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$794.12 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,995.68
|
| Rate for Payer: BCN Commercial |
$2,995.68
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$794.12
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 27680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$447.16 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$1,271.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.16
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 24358
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$566.08 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$1,271.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.08
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN WITH TENDON REPAIR OR REATTACHMENT
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 24359
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$709.43 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.48
|
| Rate for Payer: BCN Commercial |
$1,949.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$709.43
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 28234
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$283.81 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$828.91
|
| Rate for Payer: BCN Commercial |
$828.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.81
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$882.81
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$466.82 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$1,271.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.82
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 28232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.39 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$201.39
|
| Rate for Payer: BCN Commercial |
$201.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.46
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$882.81
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44,245.82
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27,874.87 |
| Max. Negotiated Rate |
$39,821.24 |
| Rate for Payer: Aetna Commercial |
$37,608.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,759.78
|
| Rate for Payer: Cash Price |
$35,396.66
|
| Rate for Payer: Cofinity Commercial |
$30,972.07
|
| Rate for Payer: Cofinity Commercial |
$38,051.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$30,972.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,396.66
|
| Rate for Payer: Healthscope Commercial |
$39,821.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,608.95
|
| Rate for Payer: PHP Commercial |
$37,608.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,759.78
|
| Rate for Payer: Priority Health SBD |
$27,874.87
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44,245.82
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.05 |
| Max. Negotiated Rate |
$39,821.24 |
| Rate for Payer: Aetna Commercial |
$37,608.95
|
| Rate for Payer: Aetna Medicare |
$360.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,759.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$433.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$433.88
|
| Rate for Payer: BCBS Complete |
$195.35
|
| Rate for Payer: BCBS MAPPO |
$347.10
|
| Rate for Payer: BCBS Trust/PPO |
$971.40
|
| Rate for Payer: BCN Commercial |
$971.40
|
| Rate for Payer: BCN Medicare Advantage |
$347.10
|
| Rate for Payer: Cash Price |
$35,396.66
|
| Rate for Payer: Cash Price |
$35,396.66
|
| Rate for Payer: Cofinity Commercial |
$30,972.07
|
| Rate for Payer: Cofinity Commercial |
$38,051.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$30,972.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,396.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.10
|
| Rate for Payer: Healthscope Commercial |
$39,821.24
|
| Rate for Payer: Mclaren Medicaid |
$186.05
|
| Rate for Payer: Mclaren Medicare |
$347.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.46
|
| Rate for Payer: Meridian Medicaid |
$195.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,608.95
|
| Rate for Payer: Nomi Health Commercial |
$1,041.30
|
| Rate for Payer: PACE Medicare |
$329.74
|
| Rate for Payer: PACE SWMI |
$347.10
|
| Rate for Payer: PHP Commercial |
$37,608.95
|
| Rate for Payer: PHP Medicare Advantage |
$347.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,759.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$989.72
|
| Rate for Payer: Priority Health Medicare |
$347.10
|
| Rate for Payer: Priority Health Narrow Network |
$791.78
|
| Rate for Payer: Priority Health SBD |
$27,874.87
|
| Rate for Payer: Railroad Medicare Medicare |
$347.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.10
|
| Rate for Payer: UHC Medicare Advantage |
$347.10
|
| Rate for Payer: UHCCP Medicaid |
$195.42
|
| Rate for Payer: VA VA |
$347.10
|
|
|
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 Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.99
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: Priority Health SBD |
$10.65
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$16.91
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| 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 |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$6.38
|
| Rate for Payer: BCN Commercial |
$6.38
|
| Rate for Payer: BCN Commercial |
$6.38
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.37
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: Priority Health SBD |
$10.65
|
|
|
TERCONAZOLE 0.8 % VAGINAL CREAM
|
Facility
|
IP
|
$117.25
|
|
|
Service Code
|
NDC 51672130200
|
| Hospital Charge Code |
11511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.87 |
| Max. Negotiated Rate |
$105.52 |
| Rate for Payer: Aetna Commercial |
$99.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.21
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Cofinity Commercial |
$100.84
|
| Rate for Payer: Cofinity Commercial |
$82.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.80
|
| Rate for Payer: Healthscope Commercial |
$105.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.66
|
| Rate for Payer: PHP Commercial |
$99.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.21
|
| Rate for Payer: Priority Health SBD |
$73.87
|
|
|
TERCONAZOLE 0.8 % VAGINAL CREAM
|
Facility
|
OP
|
$117.25
|
|
|
Service Code
|
NDC 51672130200
|
| Hospital Charge Code |
11511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$105.52 |
| Rate for Payer: Aetna Commercial |
$99.66
|
| Rate for Payer: Aetna Medicare |
$58.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.21
|
| Rate for Payer: BCBS Complete |
$46.90
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Cofinity Commercial |
$100.84
|
| Rate for Payer: Cofinity Commercial |
$82.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.80
|
| Rate for Payer: Healthscope Commercial |
$105.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.66
|
| Rate for Payer: PHP Commercial |
$99.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.21
|
| Rate for Payer: Priority Health SBD |
$73.87
|
|
|
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 |
$79.24 |
| Rate for Payer: Aetna Commercial |
$74.84
|
| Rate for Payer: Aetna Commercial |
$93.84
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: Cash Price |
$88.32
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cofinity Commercial |
$77.28
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Cofinity Commercial |
$61.64
|
| Rate for Payer: Cofinity Commercial |
$75.72
|
| Rate for Payer: Cofinity Commercial |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$79.24
|
| Rate for Payer: Healthscope Commercial |
$87.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: PHP Commercial |
$74.84
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: PHP Commercial |
$93.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.76
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: Priority Health SBD |
$55.47
|
| Rate for Payer: Priority Health SBD |
$69.55
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna Commercial |
$93.84
|
| Rate for Payer: Aetna Commercial |
$74.84
|
| Rate for Payer: Aetna Medicare |
$55.20
|
| Rate for Payer: Aetna Medicare |
$44.02
|
| Rate for Payer: Aetna Medicare |
$48.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: BCBS Complete |
$35.22
|
| Rate for Payer: BCBS Complete |
$44.16
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cash Price |
$88.32
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cash Price |
$88.32
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$61.64
|
| Rate for Payer: Cofinity Commercial |
$77.28
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Cofinity Commercial |
$75.72
|
| Rate for Payer: Cofinity Commercial |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$79.24
|
| Rate for Payer: Healthscope Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$87.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: PHP Commercial |
$74.84
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: PHP Commercial |
$93.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.76
|
| Rate for Payer: Priority Health SBD |
$69.55
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: Priority Health SBD |
$55.47
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,678.15
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$306.63 |
| Max. Negotiated Rate |
$1,716.21 |
| Rate for Payer: Aetna Commercial |
$1,426.43
|
| Rate for Payer: Aetna Medicare |
$594.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,090.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$715.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$715.09
|
| Rate for Payer: BCBS Complete |
$321.96
|
| Rate for Payer: BCBS MAPPO |
$572.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.40
|
| Rate for Payer: BCN Commercial |
$1,643.40
|
| Rate for Payer: BCN Medicare Advantage |
$572.07
|
| Rate for Payer: Cash Price |
$1,342.52
|
| Rate for Payer: Cash Price |
$1,342.52
|
| Rate for Payer: Cofinity Commercial |
$1,443.21
|
| Rate for Payer: Cofinity Commercial |
$1,174.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,174.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.07
|
| Rate for Payer: Healthscope Commercial |
$1,510.34
|
| Rate for Payer: Mclaren Medicaid |
$306.63
|
| Rate for Payer: Mclaren Medicare |
$572.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$600.67
|
| Rate for Payer: Meridian Medicaid |
$321.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$657.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.43
|
| Rate for Payer: Nomi Health Commercial |
$1,716.21
|
| Rate for Payer: PACE Medicare |
$543.47
|
| Rate for Payer: PACE SWMI |
$572.07
|
| Rate for Payer: PHP Commercial |
$1,426.43
|
| Rate for Payer: PHP Medicare Advantage |
$572.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$306.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,674.36
|
| Rate for Payer: Priority Health Medicare |
$572.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,339.49
|
| Rate for Payer: Priority Health SBD |
$1,057.23
|
| Rate for Payer: Railroad Medicare Medicare |
$572.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,610.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.07
|
| Rate for Payer: UHC Medicare Advantage |
$572.07
|
| Rate for Payer: UHCCP Medicaid |
$322.08
|
| Rate for Payer: VA VA |
$572.07
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,678.15
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,057.23 |
| Max. Negotiated Rate |
$1,510.34 |
| Rate for Payer: Aetna Commercial |
$1,426.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,090.80
|
| Rate for Payer: Cash Price |
$1,342.52
|
| Rate for Payer: Cofinity Commercial |
$1,174.70
|
| Rate for Payer: Cofinity Commercial |
$1,443.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,174.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.52
|
| Rate for Payer: Healthscope Commercial |
$1,510.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.43
|
| Rate for Payer: PHP Commercial |
$1,426.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.80
|
| Rate for Payer: Priority Health SBD |
$1,057.23
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
IP
|
$38.25
|
|
|
Service Code
|
NDC 00065074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.86
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.51
|
| Rate for Payer: PHP Commercial |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.86
|
| Rate for Payer: Priority Health SBD |
$24.10
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
OP
|
$38.25
|
|
|
Service Code
|
NDC 00065074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: Aetna Medicare |
$19.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.86
|
| Rate for Payer: BCBS Complete |
$15.30
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.51
|
| Rate for Payer: PHP Commercial |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.86
|
| Rate for Payer: Priority Health SBD |
$24.10
|
|
|
TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$250.73
|
|
|
Service Code
|
NDC 17478004532
|
| Hospital Charge Code |
11517
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$100.29 |
| Max. Negotiated Rate |
$225.66 |
| Rate for Payer: Aetna Commercial |
$213.12
|
| Rate for Payer: Aetna Medicare |
$125.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.97
|
| Rate for Payer: BCBS Complete |
$100.29
|
| Rate for Payer: Cash Price |
$200.58
|
| Rate for Payer: Cofinity Commercial |
$175.51
|
| Rate for Payer: Cofinity Commercial |
$215.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.58
|
| Rate for Payer: Healthscope Commercial |
$225.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.12
|
| Rate for Payer: PHP Commercial |
$213.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.97
|
| Rate for Payer: Priority Health SBD |
$157.96
|
|
|
TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$250.73
|
|
|
Service Code
|
NDC 17478004532
|
| Hospital Charge Code |
11517
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.96 |
| Max. Negotiated Rate |
$225.66 |
| Rate for Payer: Aetna Commercial |
$213.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.97
|
| Rate for Payer: Cash Price |
$200.58
|
| Rate for Payer: Cofinity Commercial |
$175.51
|
| Rate for Payer: Cofinity Commercial |
$215.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.58
|
| Rate for Payer: Healthscope Commercial |
$225.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.12
|
| Rate for Payer: PHP Commercial |
$213.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.97
|
| Rate for Payer: Priority Health SBD |
$157.96
|
|
|
TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$11,358.16
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
199104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,155.64 |
| Max. Negotiated Rate |
$10,222.34 |
| Rate for Payer: Aetna Commercial |
$9,654.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,382.80
|
| Rate for Payer: Cash Price |
$9,086.53
|
| Rate for Payer: Cofinity Commercial |
$7,950.71
|
| Rate for Payer: Cofinity Commercial |
$9,768.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,950.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,086.53
|
| Rate for Payer: Healthscope Commercial |
$10,222.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,654.44
|
| Rate for Payer: PHP Commercial |
$9,654.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,382.80
|
| Rate for Payer: Priority Health SBD |
$7,155.64
|
|
|
TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$11,358.16
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
199104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$10,222.34 |
| Rate for Payer: Aetna Commercial |
$9,654.44
|
| Rate for Payer: Aetna Medicare |
$18.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,382.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.70
|
| Rate for Payer: BCBS Complete |
$10.22
|
| Rate for Payer: BCBS MAPPO |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$51.15
|
| Rate for Payer: BCN Commercial |
$51.15
|
| Rate for Payer: BCN Medicare Advantage |
$18.16
|
| Rate for Payer: Cash Price |
$9,086.53
|
| Rate for Payer: Cash Price |
$9,086.53
|
| Rate for Payer: Cofinity Commercial |
$9,768.02
|
| Rate for Payer: Cofinity Commercial |
$7,950.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,950.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,086.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.16
|
| Rate for Payer: Healthscope Commercial |
$10,222.34
|
| Rate for Payer: Mclaren Medicaid |
$9.73
|
| Rate for Payer: Mclaren Medicare |
$18.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.07
|
| Rate for Payer: Meridian Medicaid |
$10.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,654.44
|
| Rate for Payer: Nomi Health Commercial |
$54.48
|
| Rate for Payer: PACE Medicare |
$17.25
|
| Rate for Payer: PACE SWMI |
$18.16
|
| Rate for Payer: PHP Commercial |
$9,654.44
|
| Rate for Payer: PHP Medicare Advantage |
$18.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,382.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.12
|
| Rate for Payer: Priority Health Medicare |
$18.16
|
| Rate for Payer: Priority Health Narrow Network |
$41.70
|
| Rate for Payer: Priority Health SBD |
$7,155.64
|
| Rate for Payer: Railroad Medicare Medicare |
$18.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.16
|
| Rate for Payer: UHC Medicare Advantage |
$18.16
|
| Rate for Payer: UHCCP Medicaid |
$10.22
|
| Rate for Payer: VA VA |
$18.16
|
|
|
THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR
|
Facility
|
IP
|
$44.64
|
|
|
Service Code
|
NDC 00121482040
|
| Hospital Charge Code |
7820
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna Commercial |
$37.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: Cash Price |
$35.71
|
| Rate for Payer: Cofinity Commercial |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$38.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.71
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.94
|
| Rate for Payer: PHP Commercial |
$37.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health SBD |
$28.12
|
|
