|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$155.22
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.79 |
| Max. Negotiated Rate |
$139.70 |
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$146.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Cash Price |
$137.49
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$147.80
|
| Rate for Payer: Cofinity Commercial |
$120.30
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Healthscope Commercial |
$154.67
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.20
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$146.08
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$108.27
|
| Rate for Payer: Priority Health SBD |
$97.79
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$153.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$138.18 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS Trust/PPO |
$20.17
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.50
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health SBD |
$96.72
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$74.40
|
|
|
Service Code
|
NDC 0168-0040-15
|
| Hospital Charge Code |
1031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.87 |
| Max. Negotiated Rate |
$66.96 |
| Rate for Payer: Aetna Commercial |
$63.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.36
|
| Rate for Payer: Cash Price |
$59.52
|
| Rate for Payer: Cofinity Commercial |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$63.98
|
| Rate for Payer: Healthscope Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.24
|
| Rate for Payer: PHP Commercial |
$63.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.08
|
| Rate for Payer: Priority Health SBD |
$46.87
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$35.97
|
|
|
Service Code
|
NDC 0713-0326-15
|
| Hospital Charge Code |
1031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$32.37 |
| Rate for Payer: Aetna Commercial |
$30.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.38
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$25.18
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$32.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.57
|
| Rate for Payer: PHP Commercial |
$30.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.18
|
| Rate for Payer: Priority Health SBD |
$22.66
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,041.53
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,916.16 |
| Max. Negotiated Rate |
$2,737.38 |
| Rate for Payer: Aetna Commercial |
$2,585.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.99
|
| Rate for Payer: Cash Price |
$2,433.22
|
| Rate for Payer: Cofinity Commercial |
$2,129.07
|
| Rate for Payer: Cofinity Commercial |
$2,615.72
|
| Rate for Payer: Healthscope Commercial |
$2,737.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,585.30
|
| Rate for Payer: PHP Commercial |
$2,585.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.07
|
| Rate for Payer: Priority Health SBD |
$1,916.16
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,166.11
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$10,949.50 |
| Rate for Payer: Aetna Commercial |
$10,341.19
|
| Rate for Payer: Aetna Commercial |
$2,585.30
|
| Rate for Payer: Aetna Medicare |
$77.04
|
| Rate for Payer: Aetna Medicare |
$77.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,907.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.59
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: BCBS MAPPO |
$74.07
|
| Rate for Payer: BCBS MAPPO |
$74.07
|
| Rate for Payer: BCBS Trust/PPO |
$219.29
|
| Rate for Payer: BCBS Trust/PPO |
$219.29
|
| Rate for Payer: BCN Medicare Advantage |
$74.07
|
| Rate for Payer: BCN Medicare Advantage |
$74.07
|
| Rate for Payer: Cash Price |
$9,732.89
|
| Rate for Payer: Cash Price |
$9,732.89
|
| Rate for Payer: Cash Price |
$2,433.22
|
| Rate for Payer: Cash Price |
$2,433.22
|
| Rate for Payer: Cofinity Commercial |
$8,516.28
|
| Rate for Payer: Cofinity Commercial |
$2,615.72
|
| Rate for Payer: Cofinity Commercial |
$2,129.07
|
| Rate for Payer: Cofinity Commercial |
$10,462.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.07
|
| Rate for Payer: Healthscope Commercial |
$2,737.38
|
| Rate for Payer: Healthscope Commercial |
$10,949.50
|
| Rate for Payer: Mclaren Medicaid |
$40.52
|
| Rate for Payer: Mclaren Medicaid |
$40.52
|
| Rate for Payer: Mclaren Medicare |
$74.07
|
| Rate for Payer: Mclaren Medicare |
$74.07
|
| Rate for Payer: Meridian Medicaid |
$42.55
|
| Rate for Payer: Meridian Medicaid |
$42.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,585.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,341.19
|
| Rate for Payer: PACE Medicare |
$70.37
|
| Rate for Payer: PACE Medicare |
$70.37
|
| Rate for Payer: PACE SWMI |
$74.07
|
| Rate for Payer: PACE SWMI |
$74.07
|
| Rate for Payer: PHP Commercial |
$10,341.19
|
| Rate for Payer: PHP Commercial |
$2,585.30
|
| Rate for Payer: PHP Medicare Advantage |
$74.07
|
| Rate for Payer: PHP Medicare Advantage |
$74.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,516.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.07
|
| Rate for Payer: Priority Health Medicare |
$74.07
|
| Rate for Payer: Priority Health Medicare |
$74.07
|
| Rate for Payer: Priority Health SBD |
$7,664.65
|
| Rate for Payer: Priority Health SBD |
$1,916.16
|
| Rate for Payer: Railroad Medicare Medicare |
$74.07
|
| Rate for Payer: Railroad Medicare Medicare |
$74.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.07
|
| Rate for Payer: UHC Medicare Advantage |
$76.30
|
| Rate for Payer: UHC Medicare Advantage |
$76.30
|
| Rate for Payer: VA VA |
$74.07
|
| Rate for Payer: VA VA |
$74.07
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,973.43
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
190598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$10,776.09 |
| Rate for Payer: Aetna Commercial |
$10,177.42
|
| Rate for Payer: Aetna Commercial |
$2,544.43
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,782.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.02
|
| Rate for Payer: BCBS Complete |
$14.72
|
| Rate for Payer: BCBS Complete |
$14.72
|
| Rate for Payer: BCBS MAPPO |
$25.62
|
| Rate for Payer: BCBS MAPPO |
$25.62
|
| Rate for Payer: BCBS Trust/PPO |
$75.40
|
| Rate for Payer: BCBS Trust/PPO |
$75.40
|
| Rate for Payer: BCN Medicare Advantage |
$25.62
|
| Rate for Payer: BCN Medicare Advantage |
$25.62
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cofinity Commercial |
$2,574.37
|
| Rate for Payer: Cofinity Commercial |
$2,095.42
|
| Rate for Payer: Cofinity Commercial |
$10,297.15
|
| Rate for Payer: Cofinity Commercial |
$8,381.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.62
|
| Rate for Payer: Healthscope Commercial |
$10,776.09
|
| Rate for Payer: Healthscope Commercial |
$2,694.10
|
| Rate for Payer: Mclaren Medicaid |
$14.01
|
| Rate for Payer: Mclaren Medicaid |
$14.01
|
| Rate for Payer: Mclaren Medicare |
$25.62
|
| Rate for Payer: Mclaren Medicare |
$25.62
|
| Rate for Payer: Meridian Medicaid |
$14.72
|
| Rate for Payer: Meridian Medicaid |
$14.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,544.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,177.42
|
| Rate for Payer: PACE Medicare |
$24.34
|
| Rate for Payer: PACE Medicare |
$24.34
|
| Rate for Payer: PACE SWMI |
$25.62
|
| Rate for Payer: PACE SWMI |
$25.62
|
| Rate for Payer: PHP Commercial |
$2,544.43
|
| Rate for Payer: PHP Commercial |
$10,177.42
|
| Rate for Payer: PHP Medicare Advantage |
$25.62
|
| Rate for Payer: PHP Medicare Advantage |
$25.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,381.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.42
|
| Rate for Payer: Priority Health Medicare |
$25.62
|
| Rate for Payer: Priority Health Medicare |
$25.62
|
| Rate for Payer: Priority Health SBD |
$1,885.87
|
| Rate for Payer: Priority Health SBD |
$7,543.26
|
| Rate for Payer: Railroad Medicare Medicare |
$25.62
|
| Rate for Payer: Railroad Medicare Medicare |
$25.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.62
|
| Rate for Payer: UHC Medicare Advantage |
$26.39
|
| Rate for Payer: UHC Medicare Advantage |
$26.39
|
| Rate for Payer: VA VA |
$25.62
|
| Rate for Payer: VA VA |
$25.62
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,710.11
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$8,739.10 |
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.89
|
| Rate for Payer: BCBS Complete |
$12.36
|
| Rate for Payer: BCBS Complete |
$12.36
|
| Rate for Payer: BCBS MAPPO |
$21.51
|
| Rate for Payer: BCBS MAPPO |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$49.95
|
| Rate for Payer: BCBS Trust/PPO |
$49.95
|
| Rate for Payer: BCN Medicare Advantage |
$21.51
|
| Rate for Payer: BCN Medicare Advantage |
$21.51
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Cofinity Commercial |
$6,797.08
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Cofinity Commercial |
$1,699.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.51
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Mclaren Medicaid |
$11.77
|
| Rate for Payer: Mclaren Medicaid |
$11.77
|
| Rate for Payer: Mclaren Medicare |
$21.51
|
| Rate for Payer: Mclaren Medicare |
$21.51
|
| Rate for Payer: Meridian Medicaid |
$12.36
|
| Rate for Payer: Meridian Medicaid |
$12.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,253.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,063.40
|
| Rate for Payer: PACE Medicare |
$20.44
|
| Rate for Payer: PACE Medicare |
$20.44
|
| Rate for Payer: PACE SWMI |
$21.51
|
| Rate for Payer: PACE SWMI |
$21.51
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.51
|
| Rate for Payer: PHP Medicare Advantage |
$21.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,699.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,797.08
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Railroad Medicare Medicare |
$21.51
|
| Rate for Payer: Railroad Medicare Medicare |
$21.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.51
|
| Rate for Payer: UHC Medicare Advantage |
$22.16
|
| Rate for Payer: UHC Medicare Advantage |
$22.16
|
| Rate for Payer: VA VA |
$21.51
|
| Rate for Payer: VA VA |
$21.51
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 16729-023-10
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.06
|
| Rate for Payer: Priority Health SBD |
$63.96
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$76.38
|
|
|
Service Code
|
NDC 0904-6019-46
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.12 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Cofinity Commercial |
$53.47
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.92
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.47
|
| Rate for Payer: Priority Health SBD |
$48.12
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$86.93
|
|
|
Service Code
|
NDC 47335-485-83
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$78.24 |
| Rate for Payer: Aetna Commercial |
$73.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.50
|
| Rate for Payer: Cash Price |
$69.54
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Cofinity Commercial |
$74.76
|
| Rate for Payer: Healthscope Commercial |
$78.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.89
|
| Rate for Payer: PHP Commercial |
$73.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.85
|
| Rate for Payer: Priority Health SBD |
$54.77
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
IP
|
$14,362.18
|
|
|
Service Code
|
NDC 61958-2501-3
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,048.17 |
| Max. Negotiated Rate |
$12,925.96 |
| Rate for Payer: Aetna Commercial |
$12,207.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,335.42
|
| Rate for Payer: Cash Price |
$11,489.74
|
| Rate for Payer: Cofinity Commercial |
$10,053.53
|
| Rate for Payer: Cofinity Commercial |
$12,351.47
|
| Rate for Payer: Healthscope Commercial |
$12,925.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,207.85
|
| Rate for Payer: PHP Commercial |
$12,207.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,053.53
|
| Rate for Payer: Priority Health SBD |
$9,048.17
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
IP
|
$14,362.18
|
|
|
Service Code
|
NDC 61958-2501-1
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,048.17 |
| Max. Negotiated Rate |
$12,925.96 |
| Rate for Payer: Aetna Commercial |
$12,207.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,335.42
|
| Rate for Payer: Cash Price |
$11,489.74
|
| Rate for Payer: Cofinity Commercial |
$10,053.53
|
| Rate for Payer: Cofinity Commercial |
$12,351.47
|
| Rate for Payer: Healthscope Commercial |
$12,925.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,207.85
|
| Rate for Payer: PHP Commercial |
$12,207.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,053.53
|
| Rate for Payer: Priority Health SBD |
$9,048.17
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$104,009.40
|
|
|
Service Code
|
MS-DRG 461
|
| Min. Negotiated Rate |
$47,118.25 |
| Max. Negotiated Rate |
$104,009.40 |
| Rate for Payer: Aetna Medicare |
$51,582.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61,997.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61,997.70
|
| Rate for Payer: BCBS MAPPO |
$49,598.16
|
| Rate for Payer: BCBS Trust/PPO |
$97,381.58
|
| Rate for Payer: BCN Medicare Advantage |
$49,598.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,598.16
|
| Rate for Payer: Mclaren Medicare |
$49,598.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52,078.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,037.88
|
| Rate for Payer: PACE Medicare |
$47,118.25
|
| Rate for Payer: PACE SWMI |
$49,598.16
|
| Rate for Payer: PHP Medicare Advantage |
$49,598.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97,844.93
|
| Rate for Payer: Priority Health Medicare |
$49,598.16
|
| Rate for Payer: Priority Health Narrow Network |
$78,275.94
|
| Rate for Payer: Railroad Medicare Medicare |
$49,598.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104,009.40
|
| Rate for Payer: UHC Core |
$63,821.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$49,598.16
|
| Rate for Payer: UHC Exchange |
$68,355.46
|
| Rate for Payer: UHC Medicare Advantage |
$51,086.10
|
| Rate for Payer: VA VA |
$49,598.16
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$52,457.86
|
|
|
Service Code
|
MS-DRG 462
|
| Min. Negotiated Rate |
$19,941.64 |
| Max. Negotiated Rate |
$52,457.86 |
| Rate for Payer: Aetna Medicare |
$21,830.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,239.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,239.00
|
| Rate for Payer: BCBS MAPPO |
$20,991.20
|
| Rate for Payer: BCBS Trust/PPO |
$52,457.86
|
| Rate for Payer: BCN Medicare Advantage |
$20,991.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,991.20
|
| Rate for Payer: Mclaren Medicare |
$20,991.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,040.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,139.88
|
| Rate for Payer: PACE Medicare |
$19,941.64
|
| Rate for Payer: PACE SWMI |
$20,991.20
|
| Rate for Payer: PHP Medicare Advantage |
$20,991.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,844.18
|
| Rate for Payer: Priority Health Medicare |
$20,991.20
|
| Rate for Payer: Priority Health Narrow Network |
$32,675.34
|
| Rate for Payer: Railroad Medicare Medicare |
$20,991.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,417.46
|
| Rate for Payer: UHC Core |
$26,641.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,991.20
|
| Rate for Payer: UHC Exchange |
$28,534.16
|
| Rate for Payer: UHC Medicare Advantage |
$21,620.94
|
| Rate for Payer: VA VA |
$20,991.20
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$52,323.91
|
|
|
Service Code
|
MS-DRG 409
|
| Min. Negotiated Rate |
$13,859.36 |
| Max. Negotiated Rate |
$52,323.91 |
| Rate for Payer: Aetna Medicare |
$15,172.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,236.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,236.00
|
| Rate for Payer: BCBS MAPPO |
$14,588.80
|
| Rate for Payer: BCBS Trust/PPO |
$52,323.91
|
| Rate for Payer: BCN Medicare Advantage |
$14,588.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,588.80
|
| Rate for Payer: Mclaren Medicare |
$14,588.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,318.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,777.12
|
| Rate for Payer: PACE Medicare |
$13,859.36
|
| Rate for Payer: PACE SWMI |
$14,588.80
|
| Rate for Payer: PHP Medicare Advantage |
$14,588.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,087.10
|
| Rate for Payer: Priority Health Medicare |
$14,588.80
|
| Rate for Payer: Priority Health Narrow Network |
$22,469.68
|
| Rate for Payer: Railroad Medicare Medicare |
$14,588.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,856.65
|
| Rate for Payer: UHC Core |
$18,320.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,588.80
|
| Rate for Payer: UHC Exchange |
$19,621.93
|
| Rate for Payer: UHC Medicare Advantage |
$15,026.46
|
| Rate for Payer: VA VA |
$14,588.80
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$84,594.85
|
|
|
Service Code
|
MS-DRG 408
|
| Min. Negotiated Rate |
$25,934.28 |
| Max. Negotiated Rate |
$84,594.85 |
| Rate for Payer: Aetna Medicare |
$28,391.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,124.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,124.05
|
| Rate for Payer: BCBS MAPPO |
$27,299.24
|
| Rate for Payer: BCBS Trust/PPO |
$84,594.85
|
| Rate for Payer: BCN Medicare Advantage |
$27,299.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,299.24
|
| Rate for Payer: Mclaren Medicare |
$27,299.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,664.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,394.13
|
| Rate for Payer: PACE Medicare |
$25,934.28
|
| Rate for Payer: PACE SWMI |
$27,299.24
|
| Rate for Payer: PHP Medicare Advantage |
$27,299.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53,413.27
|
| Rate for Payer: Priority Health Medicare |
$27,299.24
|
| Rate for Payer: Priority Health Narrow Network |
$42,730.62
|
| Rate for Payer: Railroad Medicare Medicare |
$27,299.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56,778.44
|
| Rate for Payer: UHC Core |
$34,839.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,299.24
|
| Rate for Payer: UHC Exchange |
$37,315.06
|
| Rate for Payer: UHC Medicare Advantage |
$28,118.22
|
| Rate for Payer: VA VA |
$27,299.24
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$33,513.83
|
|
|
Service Code
|
MS-DRG 410
|
| Min. Negotiated Rate |
$11,176.73 |
| Max. Negotiated Rate |
$33,513.83 |
| Rate for Payer: Aetna Medicare |
$12,235.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,706.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,706.22
|
| Rate for Payer: BCBS MAPPO |
$11,764.98
|
| Rate for Payer: BCBS Trust/PPO |
$33,513.83
|
| Rate for Payer: BCN Medicare Advantage |
$11,764.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,764.98
|
| Rate for Payer: Mclaren Medicare |
$11,764.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,353.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,529.73
|
| Rate for Payer: PACE Medicare |
$11,176.73
|
| Rate for Payer: PACE SWMI |
$11,764.98
|
| Rate for Payer: PHP Medicare Advantage |
$11,764.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,460.49
|
| Rate for Payer: Priority Health Medicare |
$11,764.98
|
| Rate for Payer: Priority Health Narrow Network |
$17,968.39
|
| Rate for Payer: Railroad Medicare Medicare |
$11,764.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,875.56
|
| Rate for Payer: UHC Core |
$14,650.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,764.98
|
| Rate for Payer: UHC Exchange |
$15,691.13
|
| Rate for Payer: UHC Medicare Advantage |
$12,117.93
|
| Rate for Payer: VA VA |
$11,764.98
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$36,812.07
|
|
|
Service Code
|
MS-DRG 478
|
| Min. Negotiated Rate |
$16,776.66 |
| Max. Negotiated Rate |
$36,812.07 |
| Rate for Payer: Aetna Medicare |
$18,366.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,074.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,074.55
|
| Rate for Payer: BCBS MAPPO |
$17,659.64
|
| Rate for Payer: BCBS Trust/PPO |
$36,812.07
|
| Rate for Payer: BCN Medicare Advantage |
$17,659.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,659.64
|
| Rate for Payer: Mclaren Medicare |
$17,659.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,542.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,308.59
|
| Rate for Payer: PACE Medicare |
$16,776.66
|
| Rate for Payer: PACE SWMI |
$17,659.64
|
| Rate for Payer: PHP Medicare Advantage |
$17,659.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,205.90
|
| Rate for Payer: Priority Health Medicare |
$17,659.64
|
| Rate for Payer: Priority Health Narrow Network |
$27,364.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17,659.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,360.96
|
| Rate for Payer: UHC Core |
$22,311.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,659.64
|
| Rate for Payer: UHC Exchange |
$23,896.59
|
| Rate for Payer: UHC Medicare Advantage |
$18,189.43
|
| Rate for Payer: VA VA |
$17,659.64
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$51,390.73
|
|
|
Service Code
|
MS-DRG 477
|
| Min. Negotiated Rate |
$23,517.78 |
| Max. Negotiated Rate |
$51,390.73 |
| Rate for Payer: Aetna Medicare |
$25,745.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,944.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,944.45
|
| Rate for Payer: BCBS MAPPO |
$24,755.56
|
| Rate for Payer: BCBS Trust/PPO |
$46,831.96
|
| Rate for Payer: BCN Medicare Advantage |
$24,755.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,755.56
|
| Rate for Payer: Mclaren Medicare |
$24,755.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,993.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,468.89
|
| Rate for Payer: PACE Medicare |
$23,517.78
|
| Rate for Payer: PACE SWMI |
$24,755.56
|
| Rate for Payer: PHP Medicare Advantage |
$24,755.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48,344.88
|
| Rate for Payer: Priority Health Medicare |
$24,755.56
|
| Rate for Payer: Priority Health Narrow Network |
$38,675.90
|
| Rate for Payer: Railroad Medicare Medicare |
$24,755.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,390.73
|
| Rate for Payer: UHC Core |
$31,533.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,755.56
|
| Rate for Payer: UHC Exchange |
$33,774.23
|
| Rate for Payer: UHC Medicare Advantage |
$25,498.23
|
| Rate for Payer: VA VA |
$24,755.56
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$28,433.46
|
|
|
Service Code
|
MS-DRG 479
|
| Min. Negotiated Rate |
$13,221.03 |
| Max. Negotiated Rate |
$28,433.46 |
| Rate for Payer: Aetna Medicare |
$14,473.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,396.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,396.09
|
| Rate for Payer: BCBS MAPPO |
$13,916.87
|
| Rate for Payer: BCBS Trust/PPO |
$24,980.56
|
| Rate for Payer: BCN Medicare Advantage |
$13,916.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,916.87
|
| Rate for Payer: Mclaren Medicare |
$13,916.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,612.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,004.40
|
| Rate for Payer: PACE Medicare |
$13,221.03
|
| Rate for Payer: PACE SWMI |
$13,916.87
|
| Rate for Payer: PHP Medicare Advantage |
$13,916.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,748.25
|
| Rate for Payer: Priority Health Medicare |
$13,916.87
|
| Rate for Payer: Priority Health Narrow Network |
$21,398.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13,916.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,433.46
|
| Rate for Payer: UHC Core |
$17,447.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,916.87
|
| Rate for Payer: UHC Exchange |
$18,686.60
|
| Rate for Payer: UHC Medicare Advantage |
$14,334.38
|
| Rate for Payer: VA VA |
$13,916.87
|
|
|
BIOPSY, BONE, OPEN; SUPERFICIAL (EG, STERNUM, SPINOUS PROCESS, RIB, PATELLA, OLECRANON PROCESS, CALCANEUS, TARSAL, METATARSAL, CARPAL, METACARPAL, PHALANX)
|
Facility
|
OP
|
$7,745.99
|
|
|
Service Code
|
CPT 20240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.87 |
| Max. Negotiated Rate |
$7,745.99 |
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,812.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,745.99
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health Narrow Network |
$6,196.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.56
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$136.87
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR)
|
Facility
|
OP
|
$4,496.47
|
|
|
Service Code
|
CPT 20225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$4,496.47 |
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$904.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,496.47
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.24
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$124.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
BIOPSY, MUSCLE; DEEP
|
Facility
|
OP
|
$7,745.99
|
|
|
Service Code
|
CPT 20205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.59 |
| Max. Negotiated Rate |
$7,745.99 |
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.91
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,745.99
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health Narrow Network |
$6,196.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.85
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE
|
Facility
|
OP
|
$4,496.47
|
|
|
Service Code
|
CPT 20206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$4,496.47 |
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$554.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,496.47
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
