|
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; INITIAL VEIN
|
Facility
|
OP
|
$34,922.52
|
|
|
Service Code
|
CPT 37238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$324.04 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$8,756.70
|
| Rate for Payer: BCN Commercial |
$8,756.70
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.04
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$6,255.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), CENTRAL DIALYSIS SEGMENT, PERFORMED THROUGH DIALYSIS CIRCUIT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION REQUIRED TO PERFORM THE STENTING, AND ALL ANGIOPLASTY IN THE CENTRAL DIALYSIS SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,499.33
|
|
|
Service Code
|
CPT 36908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$218.18 |
| Max. Negotiated Rate |
$5,499.33 |
| Rate for Payer: BCBS Trust/PPO |
$5,499.33
|
| Rate for Payer: BCN Commercial |
$5,499.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.18
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL
|
Facility
|
OP
|
$6,013.44
|
|
|
Service Code
|
CPT 64772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$910.85
|
| Rate for Payer: BCN Commercial |
$910.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Nomi Health Commercial |
$4,017.89
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.00
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,077.18
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$789.08 |
| 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) |
$789.08
|
| 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
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY, CENTRAL DIALYSIS SEGMENT, PERFORMED THROUGH DIALYSIS CIRCUIT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION REQUIRED TO PERFORM THE ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,493.03
|
|
|
Service Code
|
CPT 36907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.32 |
| Max. Negotiated Rate |
$1,493.03 |
| Rate for Payer: BCBS Trust/PPO |
$1,493.03
|
| Rate for Payer: BCN Commercial |
$1,493.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.32
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY (EXCEPT DIALYSIS CIRCUIT), OPEN OR PERCUTANEOUS, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME VEIN; INITIAL VEIN
|
Facility
|
OP
|
$17,557.45
|
|
|
Service Code
|
CPT 37248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$311.65 |
| Max. Negotiated Rate |
$17,557.45 |
| Rate for Payer: Aetna Medicare |
$5,809.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,982.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,982.80
|
| Rate for Payer: BCBS Complete |
$3,143.94
|
| Rate for Payer: BCBS MAPPO |
$5,586.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,604.12
|
| Rate for Payer: BCN Commercial |
$4,604.12
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,586.24
|
| Rate for Payer: Mclaren Medicaid |
$2,994.22
|
| Rate for Payer: Mclaren Medicare |
$5,586.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.55
|
| Rate for Payer: Meridian Medicaid |
$3,143.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,424.18
|
| Rate for Payer: Nomi Health Commercial |
$11,731.10
|
| Rate for Payer: PACE Medicare |
$5,306.93
|
| Rate for Payer: PACE SWMI |
$5,586.24
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,994.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,557.45
|
| Rate for Payer: Priority Health Medicare |
$5,586.24
|
| Rate for Payer: Priority Health Narrow Network |
$14,045.96
|
| Rate for Payer: Railroad Medicare Medicare |
$5,586.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.65
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.24
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.24
|
| Rate for Payer: UHCCP Medicaid |
$3,145.05
|
| Rate for Payer: VA VA |
$5,586.24
|
|
|
TRANSPERINEAL PLACEMENT OF BIODEGRADABLE MATERIAL, PERI-PROSTATIC, SINGLE OR MULTIPLE INJECTION(S), INCLUDING IMAGE GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 55874
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,435.28
|
| Rate for Payer: BCN Commercial |
$5,435.28
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.54
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,804.21
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
TRANSTRACHEAL (PERCUTANEOUS) INTRODUCTION OF NEEDLE WIRE DILATOR/STENT OR INDWELLING TUBE FOR OXYGEN THERAPY
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$158.65 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$508.81
|
| Rate for Payer: BCN Commercial |
$508.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.65
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$951.24
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$770.41 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,344.85
|
| Rate for Payer: BCN Commercial |
$2,344.85
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.41
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,804.21
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 52500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.92 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,231.48
|
| Rate for Payer: BCN Commercial |
$1,231.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$521.92
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,902.51
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 52640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.43 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.55
|
| Rate for Payer: BCN Commercial |
$1,055.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.43
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,902.51
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$428.77 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.45
|
| Rate for Payer: BCN Commercial |
$1,428.45
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$428.77
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,804.21
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY INJECTIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 64488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$836.34
|
| Rate for Payer: BCN Commercial |
$836.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.96
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,997.31
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
183257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$6,297.58 |
| Rate for Payer: Aetna Commercial |
$5,947.71
|
| Rate for Payer: Aetna Medicare |
$80.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,548.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.31
|
| Rate for Payer: BCBS Complete |
$43.36
|
| Rate for Payer: BCBS MAPPO |
$77.05
|
| Rate for Payer: BCBS Trust/PPO |
$220.16
|
| Rate for Payer: BCN Commercial |
$220.16
|
| Rate for Payer: BCN Medicare Advantage |
$77.05
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cofinity Commercial |
$6,017.69
|
| Rate for Payer: Cofinity Commercial |
$4,898.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,898.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,597.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.05
|
| Rate for Payer: Healthscope Commercial |
$6,297.58
|
| Rate for Payer: Mclaren Medicaid |
$41.30
|
| Rate for Payer: Mclaren Medicare |
$77.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.90
|
| Rate for Payer: Meridian Medicaid |
$43.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,947.71
|
| Rate for Payer: Nomi Health Commercial |
$231.15
|
| Rate for Payer: PACE Medicare |
$73.20
|
| Rate for Payer: PACE SWMI |
$77.05
|
| Rate for Payer: PHP Commercial |
$5,947.71
|
| Rate for Payer: PHP Medicare Advantage |
$77.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,548.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.32
|
| Rate for Payer: Priority Health Medicare |
$77.05
|
| Rate for Payer: Priority Health Narrow Network |
$179.46
|
| Rate for Payer: Priority Health SBD |
$4,408.31
|
| Rate for Payer: Railroad Medicare Medicare |
$77.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.05
|
| Rate for Payer: UHC Medicare Advantage |
$77.05
|
| Rate for Payer: UHCCP Medicaid |
$43.38
|
| Rate for Payer: VA VA |
$77.05
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,337.86
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
190713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$14,704.07 |
| Rate for Payer: Aetna Commercial |
$13,887.18
|
| Rate for Payer: Aetna Medicare |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,619.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.36
|
| Rate for Payer: BCBS Complete |
$19.52
|
| Rate for Payer: BCBS MAPPO |
$34.69
|
| Rate for Payer: BCBS Trust/PPO |
$86.45
|
| Rate for Payer: BCN Commercial |
$86.45
|
| Rate for Payer: BCN Medicare Advantage |
$34.69
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cofinity Commercial |
$14,050.56
|
| Rate for Payer: Cofinity Commercial |
$11,436.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,436.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,070.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.69
|
| Rate for Payer: Healthscope Commercial |
$14,704.07
|
| Rate for Payer: Mclaren Medicaid |
$18.59
|
| Rate for Payer: Mclaren Medicare |
$34.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.42
|
| Rate for Payer: Meridian Medicaid |
$19.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,887.18
|
| Rate for Payer: Nomi Health Commercial |
$104.07
|
| Rate for Payer: PACE Medicare |
$32.96
|
| Rate for Payer: PACE SWMI |
$34.69
|
| Rate for Payer: PHP Commercial |
$13,887.18
|
| Rate for Payer: PHP Medicare Advantage |
$34.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,619.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.03
|
| Rate for Payer: Priority Health Medicare |
$34.69
|
| Rate for Payer: Priority Health Narrow Network |
$56.02
|
| Rate for Payer: Priority Health SBD |
$10,292.85
|
| Rate for Payer: Railroad Medicare Medicare |
$34.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.69
|
| Rate for Payer: UHC Medicare Advantage |
$34.69
|
| Rate for Payer: UHCCP Medicaid |
$19.53
|
| Rate for Payer: VA VA |
$34.69
|
|
|
TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,572.29
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
192041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.79 |
| Max. Negotiated Rate |
$9,515.06 |
| Rate for Payer: Aetna Commercial |
$8,986.45
|
| Rate for Payer: Aetna Medicare |
$53.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,871.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.80
|
| Rate for Payer: BCBS Complete |
$29.18
|
| Rate for Payer: BCBS MAPPO |
$51.84
|
| Rate for Payer: BCBS Trust/PPO |
$144.53
|
| Rate for Payer: BCN Commercial |
$144.53
|
| Rate for Payer: BCN Medicare Advantage |
$51.84
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cofinity Commercial |
$7,400.60
|
| Rate for Payer: Cofinity Commercial |
$9,092.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,400.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,457.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.84
|
| Rate for Payer: Healthscope Commercial |
$9,515.06
|
| Rate for Payer: Mclaren Medicaid |
$27.79
|
| Rate for Payer: Mclaren Medicare |
$51.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$29.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,986.45
|
| Rate for Payer: Nomi Health Commercial |
$155.52
|
| Rate for Payer: PACE Medicare |
$49.25
|
| Rate for Payer: PACE SWMI |
$51.84
|
| Rate for Payer: PHP Commercial |
$8,986.45
|
| Rate for Payer: PHP Medicare Advantage |
$51.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,871.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.88
|
| Rate for Payer: Priority Health Medicare |
$51.84
|
| Rate for Payer: Priority Health Narrow Network |
$124.70
|
| Rate for Payer: Priority Health SBD |
$6,660.54
|
| Rate for Payer: Railroad Medicare Medicare |
$51.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.84
|
| Rate for Payer: UHC Medicare Advantage |
$51.84
|
| Rate for Payer: UHCCP Medicaid |
$29.19
|
| Rate for Payer: VA VA |
$51.84
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17,191.45
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,830.61 |
| Max. Negotiated Rate |
$15,472.30 |
| Rate for Payer: Aetna Commercial |
$14,612.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,174.44
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cofinity Commercial |
$12,034.02
|
| Rate for Payer: Cofinity Commercial |
$14,784.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,034.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,753.16
|
| Rate for Payer: Healthscope Commercial |
$15,472.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,612.73
|
| Rate for Payer: PHP Commercial |
$14,612.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,174.44
|
| Rate for Payer: Priority Health SBD |
$10,830.61
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,191.45
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.58 |
| Max. Negotiated Rate |
$15,472.30 |
| Rate for Payer: Aetna Commercial |
$14,612.73
|
| Rate for Payer: Aetna Medicare |
$74.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,174.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.98
|
| Rate for Payer: BCBS Complete |
$40.51
|
| Rate for Payer: BCBS MAPPO |
$71.98
|
| Rate for Payer: BCBS Trust/PPO |
$198.10
|
| Rate for Payer: BCN Commercial |
$198.10
|
| Rate for Payer: BCN Medicare Advantage |
$71.98
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cofinity Commercial |
$14,784.65
|
| Rate for Payer: Cofinity Commercial |
$12,034.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,034.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,753.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.98
|
| Rate for Payer: Healthscope Commercial |
$15,472.30
|
| Rate for Payer: Mclaren Medicaid |
$38.58
|
| Rate for Payer: Mclaren Medicare |
$71.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.58
|
| Rate for Payer: Meridian Medicaid |
$40.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,612.73
|
| Rate for Payer: Nomi Health Commercial |
$215.94
|
| Rate for Payer: PACE Medicare |
$68.38
|
| Rate for Payer: PACE SWMI |
$71.98
|
| Rate for Payer: PHP Commercial |
$14,612.73
|
| Rate for Payer: PHP Medicare Advantage |
$71.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,174.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.94
|
| Rate for Payer: Priority Health Medicare |
$71.98
|
| Rate for Payer: Priority Health Narrow Network |
$139.15
|
| Rate for Payer: Priority Health SBD |
$10,830.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.98
|
| Rate for Payer: UHC Medicare Advantage |
$71.98
|
| Rate for Payer: UHCCP Medicaid |
$40.52
|
| Rate for Payer: VA VA |
$71.98
|
|
|
TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,923.37
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
196476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,471.72 |
| Max. Negotiated Rate |
$3,531.03 |
| Rate for Payer: Aetna Commercial |
$3,334.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,550.19
|
| Rate for Payer: Cash Price |
$3,138.70
|
| Rate for Payer: Cofinity Commercial |
$2,746.36
|
| Rate for Payer: Cofinity Commercial |
$3,374.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,746.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,138.70
|
| Rate for Payer: Healthscope Commercial |
$3,531.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,334.86
|
| Rate for Payer: PHP Commercial |
$3,334.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,550.19
|
| Rate for Payer: Priority Health SBD |
$2,471.72
|
|
|
TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,923.37
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
196476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$3,531.03 |
| Rate for Payer: Aetna Commercial |
$3,334.86
|
| Rate for Payer: Aetna Medicare |
$19.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,550.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.71
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS MAPPO |
$18.97
|
| Rate for Payer: BCBS Trust/PPO |
$109.46
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: BCN Medicare Advantage |
$18.97
|
| Rate for Payer: Cash Price |
$3,138.70
|
| Rate for Payer: Cash Price |
$3,138.70
|
| Rate for Payer: Cofinity Commercial |
$3,374.10
|
| Rate for Payer: Cofinity Commercial |
$2,746.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,746.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,138.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.97
|
| Rate for Payer: Healthscope Commercial |
$3,531.03
|
| Rate for Payer: Mclaren Medicaid |
$10.17
|
| Rate for Payer: Mclaren Medicare |
$18.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.92
|
| Rate for Payer: Meridian Medicaid |
$10.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,334.86
|
| Rate for Payer: Nomi Health Commercial |
$56.91
|
| Rate for Payer: PACE Medicare |
$18.02
|
| Rate for Payer: PACE SWMI |
$18.97
|
| Rate for Payer: PHP Commercial |
$3,334.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,550.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.18
|
| Rate for Payer: Priority Health Medicare |
$18.97
|
| Rate for Payer: Priority Health Narrow Network |
$44.14
|
| Rate for Payer: Priority Health SBD |
$2,471.72
|
| Rate for Payer: Railroad Medicare Medicare |
$18.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.97
|
| Rate for Payer: UHC Medicare Advantage |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$10.68
|
| Rate for Payer: VA VA |
$18.97
|
|
|
TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10,985.55
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
192875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,920.90 |
| Max. Negotiated Rate |
$9,887.00 |
| Rate for Payer: Aetna Commercial |
$9,337.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Commercial |
$7,689.88
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,689.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,788.44
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,337.72
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,140.61
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
|
|
TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,985.55
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
192875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$9,887.00 |
| Rate for Payer: Aetna Commercial |
$9,337.72
|
| Rate for Payer: Aetna Medicare |
$19.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.71
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS MAPPO |
$18.97
|
| Rate for Payer: BCBS Trust/PPO |
$109.46
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: BCN Medicare Advantage |
$18.97
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Cofinity Commercial |
$7,689.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,689.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,788.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.97
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Mclaren Medicaid |
$10.17
|
| Rate for Payer: Mclaren Medicare |
$18.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.92
|
| Rate for Payer: Meridian Medicaid |
$10.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,337.72
|
| Rate for Payer: Nomi Health Commercial |
$56.91
|
| Rate for Payer: PACE Medicare |
$18.02
|
| Rate for Payer: PACE SWMI |
$18.97
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,140.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.18
|
| Rate for Payer: Priority Health Medicare |
$18.97
|
| Rate for Payer: Priority Health Narrow Network |
$44.14
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.97
|
| Rate for Payer: UHC Medicare Advantage |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$10.68
|
| Rate for Payer: VA VA |
$18.97
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 60687045411
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.32
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 00904686961
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.19 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health SBD |
$213.19
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 60687045411
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.32
|
|
