|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$315.40
|
|
|
Service Code
|
NDC 60687016301
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.70 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.01
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$220.78
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health SBD |
$198.70
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health SBD |
$80.80
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
NDC 60687016311
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.05
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.69
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health SBD |
$1.99
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 50268015211
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health SBD |
$1.62
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
IP
|
$21,549.94
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,576.46 |
| Max. Negotiated Rate |
$19,394.95 |
| Rate for Payer: Aetna Commercial |
$18,317.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,007.46
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cofinity Commercial |
$15,084.96
|
| Rate for Payer: Cofinity Commercial |
$18,532.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,084.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,239.95
|
| Rate for Payer: Healthscope Commercial |
$19,394.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,317.45
|
| Rate for Payer: PHP Commercial |
$18,317.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,007.46
|
| Rate for Payer: Priority Health SBD |
$13,576.46
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
OP
|
$21,549.94
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$19,394.95 |
| Rate for Payer: Aetna Commercial |
$18,317.45
|
| Rate for Payer: Aetna Medicare |
$4.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,007.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.89
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS MAPPO |
$3.91
|
| Rate for Payer: BCN Medicare Advantage |
$3.91
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cofinity Commercial |
$18,532.95
|
| Rate for Payer: Cofinity Commercial |
$15,084.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,084.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,239.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.91
|
| Rate for Payer: Healthscope Commercial |
$19,394.95
|
| Rate for Payer: Mclaren Medicaid |
$2.10
|
| Rate for Payer: Mclaren Medicare |
$3.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.11
|
| Rate for Payer: Meridian Medicaid |
$2.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,317.45
|
| Rate for Payer: PACE Medicare |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.91
|
| Rate for Payer: PHP Commercial |
$18,317.45
|
| Rate for Payer: PHP Medicare Advantage |
$3.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,007.46
|
| Rate for Payer: Priority Health Medicare |
$3.91
|
| Rate for Payer: Priority Health SBD |
$13,576.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.91
|
| Rate for Payer: UHC Medicare Advantage |
$3.91
|
| Rate for Payer: UHCCP Medicaid |
$2.20
|
| Rate for Payer: VA VA |
$3.91
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,555.41
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$3,199.87 |
| Rate for Payer: Aetna Commercial |
$3,022.10
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,311.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.96
|
| Rate for Payer: BCBS Complete |
$44.11
|
| Rate for Payer: BCBS MAPPO |
$78.37
|
| Rate for Payer: BCN Medicare Advantage |
$78.37
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cofinity Commercial |
$3,057.65
|
| Rate for Payer: Cofinity Commercial |
$2,488.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.37
|
| Rate for Payer: Healthscope Commercial |
$3,199.87
|
| Rate for Payer: Mclaren Medicaid |
$42.01
|
| Rate for Payer: Mclaren Medicare |
$78.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.29
|
| Rate for Payer: Meridian Medicaid |
$44.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,022.10
|
| Rate for Payer: PACE Medicare |
$74.45
|
| Rate for Payer: PACE SWMI |
$78.37
|
| Rate for Payer: PHP Commercial |
$3,022.10
|
| Rate for Payer: PHP Medicare Advantage |
$78.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.02
|
| Rate for Payer: Priority Health Medicare |
$78.37
|
| Rate for Payer: Priority Health SBD |
$2,239.91
|
| Rate for Payer: Railroad Medicare Medicare |
$78.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.37
|
| Rate for Payer: UHC Medicare Advantage |
$78.37
|
| Rate for Payer: UHCCP Medicaid |
$44.12
|
| Rate for Payer: VA VA |
$78.37
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,555.41
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,239.91 |
| Max. Negotiated Rate |
$3,199.87 |
| Rate for Payer: Aetna Commercial |
$3,022.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,311.02
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cofinity Commercial |
$2,488.79
|
| Rate for Payer: Cofinity Commercial |
$3,057.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.33
|
| Rate for Payer: Healthscope Commercial |
$3,199.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,022.10
|
| Rate for Payer: PHP Commercial |
$3,022.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.02
|
| Rate for Payer: Priority Health SBD |
$2,239.91
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,110.37
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$6,399.33 |
| Rate for Payer: Aetna Commercial |
$6,043.81
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,621.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.96
|
| Rate for Payer: BCBS Complete |
$44.11
|
| Rate for Payer: BCBS MAPPO |
$78.37
|
| Rate for Payer: BCN Medicare Advantage |
$78.37
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cofinity Commercial |
$6,114.92
|
| Rate for Payer: Cofinity Commercial |
$4,977.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,977.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,688.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.37
|
| Rate for Payer: Healthscope Commercial |
$6,399.33
|
| Rate for Payer: Mclaren Medicaid |
$42.01
|
| Rate for Payer: Mclaren Medicare |
$78.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.29
|
| Rate for Payer: Meridian Medicaid |
$44.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,043.81
|
| Rate for Payer: PACE Medicare |
$74.45
|
| Rate for Payer: PACE SWMI |
$78.37
|
| Rate for Payer: PHP Commercial |
$6,043.81
|
| Rate for Payer: PHP Medicare Advantage |
$78.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,621.74
|
| Rate for Payer: Priority Health Medicare |
$78.37
|
| Rate for Payer: Priority Health SBD |
$4,479.53
|
| Rate for Payer: Railroad Medicare Medicare |
$78.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.37
|
| Rate for Payer: UHC Medicare Advantage |
$78.37
|
| Rate for Payer: UHCCP Medicaid |
$44.12
|
| Rate for Payer: VA VA |
$78.37
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,110.37
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,479.53 |
| Max. Negotiated Rate |
$6,399.33 |
| Rate for Payer: Aetna Commercial |
$6,043.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,621.74
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cofinity Commercial |
$4,977.26
|
| Rate for Payer: Cofinity Commercial |
$6,114.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,977.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,688.30
|
| Rate for Payer: Healthscope Commercial |
$6,399.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,043.81
|
| Rate for Payer: PHP Commercial |
$6,043.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,621.74
|
| Rate for Payer: Priority Health SBD |
$4,479.53
|
|
|
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$1,832.42
|
|
|
Service Code
|
CPT 51710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$366.50
|
| Rate for Payer: VA VA |
$650.97
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$667.69
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$133.54
|
| Rate for Payer: VA VA |
$237.20
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$647.41
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
OP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna Medicare |
$76.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: BCBS Complete |
$61.30
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.62
|
| Rate for Payer: Priority Health SBD |
$96.55
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
IP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.62
|
| Rate for Payer: Priority Health SBD |
$96.55
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,748.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$444.32 |
| Max. Negotiated Rate |
$1,136.20 |
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Medicare |
$462.09
|
| Rate for Payer: Aetna Medicare |
$462.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.82
|
| Rate for Payer: BCBS Complete |
$699.20
|
| Rate for Payer: BCBS Complete |
$549.20
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Healthscope Commercial |
$821.99
|
| Rate for Payer: Healthscope Commercial |
$821.99
|
| Rate for Payer: Healthscope Commercial |
$710.91
|
| Rate for Payer: Healthscope Commercial |
$710.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$892.45
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.20
|
| Rate for Payer: Priority Health Medicare |
$444.32
|
| Rate for Payer: Priority Health Medicare |
$444.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna Commercial |
$97.71
|
| Rate for Payer: Aetna Medicare |
$75.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.00
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$72.92
|
| Rate for Payer: BCN Medicare Advantage |
$72.92
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$97.71
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.92
|
| Rate for Payer: Healthscope Commercial |
$116.67
|
| Rate for Payer: Healthscope Commercial |
$134.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.05
|
| Rate for Payer: Nomi Health Commercial |
$87.50
|
| Rate for Payer: PACE SWMI |
$72.92
|
| Rate for Payer: PHP Medicare Advantage |
$72.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health Medicare |
$72.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.92
|
| Rate for Payer: UHC Medicare Advantage |
$72.92
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$31.41
|
| Rate for Payer: Aetna Commercial |
$31.41
|
| Rate for Payer: Aetna Medicare |
$24.38
|
| Rate for Payer: Aetna Medicare |
$24.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.41
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Healthscope Commercial |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$37.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Nomi Health Commercial |
$28.13
|
| Rate for Payer: Nomi Health Commercial |
$28.13
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$23.44
|
| Rate for Payer: Priority Health Medicare |
$23.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$517.48 |
| Rate for Payer: Aetna Commercial |
$374.82
|
| Rate for Payer: Aetna Medicare |
$290.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.80
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: BCBS MAPPO |
$279.72
|
| Rate for Payer: BCN Medicare Advantage |
$279.72
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$402.80
|
| Rate for Payer: Cofinity Commercial |
$374.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.72
|
| Rate for Payer: Healthscope Commercial |
$447.55
|
| Rate for Payer: Healthscope Commercial |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.90
|
| Rate for Payer: Nomi Health Commercial |
$335.66
|
| Rate for Payer: PACE SWMI |
$279.72
|
| Rate for Payer: PHP Medicare Advantage |
$279.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health Medicare |
$279.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.72
|
| Rate for Payer: UHC Medicare Advantage |
$279.72
|
|
|
CHG ANGIO ARCH ANGIOGRAM W CATH
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 75650
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
|
|
CHG ANGIO AV SHUNT COMPLETE EVAL
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 75791
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS Complete |
$202.80
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.55
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 75716
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$279.59 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Aetna Medicare |
$157.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.51
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: BCBS MAPPO |
$151.13
|
| Rate for Payer: BCN Medicare Advantage |
$151.13
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$217.63
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.13
|
| Rate for Payer: Healthscope Commercial |
$241.81
|
| Rate for Payer: Healthscope Commercial |
$279.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.70
|
| Rate for Payer: Nomi Health Commercial |
$181.36
|
| Rate for Payer: PACE SWMI |
$151.13
|
| Rate for Payer: PHP Medicare Advantage |
$151.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health Medicare |
$151.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.13
|
| Rate for Payer: UHC Medicare Advantage |
$151.13
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna Medicare |
$143.43
|
| Rate for Payer: Aetna Medicare |
$143.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.80
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS Complete |
$172.00
|
| Rate for Payer: BCBS MAPPO |
$137.91
|
| Rate for Payer: BCBS MAPPO |
$137.91
|
| Rate for Payer: BCN Medicare Advantage |
$137.91
|
| Rate for Payer: BCN Medicare Advantage |
$137.91
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$198.59
|
| Rate for Payer: Cofinity Commercial |
$198.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.91
|
| Rate for Payer: Healthscope Commercial |
$255.13
|
| Rate for Payer: Healthscope Commercial |
$255.13
|
| Rate for Payer: Healthscope Commercial |
$220.66
|
| Rate for Payer: Healthscope Commercial |
$220.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.30
|
| Rate for Payer: Nomi Health Commercial |
$165.49
|
| Rate for Payer: Nomi Health Commercial |
$165.49
|
| Rate for Payer: PACE SWMI |
$137.91
|
| Rate for Payer: PACE SWMI |
$137.91
|
| Rate for Payer: PHP Medicare Advantage |
$137.91
|
| Rate for Payer: PHP Medicare Advantage |
$137.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Medicare |
$137.91
|
| Rate for Payer: Priority Health Medicare |
$137.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.91
|
| Rate for Payer: UHC Medicare Advantage |
$137.91
|
| Rate for Payer: UHC Medicare Advantage |
$137.91
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$273.91 |
| Rate for Payer: Aetna Commercial |
$198.40
|
| Rate for Payer: Aetna Medicare |
$153.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.40
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: BCBS MAPPO |
$148.06
|
| Rate for Payer: BCN Medicare Advantage |
$148.06
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$213.21
|
| Rate for Payer: Cofinity Commercial |
$198.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.06
|
| Rate for Payer: Healthscope Commercial |
$273.91
|
| Rate for Payer: Healthscope Commercial |
$236.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.50
|
| Rate for Payer: Nomi Health Commercial |
$177.67
|
| Rate for Payer: PACE SWMI |
$148.06
|
| Rate for Payer: PHP Medicare Advantage |
$148.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health Medicare |
$148.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.06
|
| Rate for Payer: UHC Medicare Advantage |
$148.06
|
|
