|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)
|
Facility
OP
|
$4,239.58
|
|
|
Service Code
|
CPT 38525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$436.81 |
| Max. Negotiated Rate |
$4,239.58 |
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,818.13
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.49
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Exchange |
$436.81
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)
|
Facility
OP
|
$4,239.58
|
|
|
Service Code
|
CPT 38525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.81 |
| Max. Negotiated Rate |
$4,239.58 |
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,818.13
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.49
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Exchange |
$436.81
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)
|
Facility
OP
|
$4,239.58
|
|
|
Service Code
|
CPT 38510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$411.92 |
| Max. Negotiated Rate |
$4,239.58 |
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,263.46
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.11
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Exchange |
$411.92
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INGUINOFEMORAL NODE(S)
|
Facility
OP
|
$5,427.00
|
|
|
Service Code
|
CPT 38531
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$442.70 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.97
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Exchange |
$442.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL
|
Facility
OP
|
$4,239.58
|
|
|
Service Code
|
CPT 38500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$4,239.58 |
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,802.73
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.34
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Exchange |
$252.13
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH
|
Facility
OP
|
$5,575.00
|
|
|
Service Code
|
CPT 55700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.39 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$865.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.03
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$126.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH
|
Facility
OP
|
$5,575.00
|
|
|
Service Code
|
CPT 55700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.39 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$865.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.03
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$126.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$124.06
|
|
|
Service Code
|
NDC 8142102105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.16 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.64
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.45
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.84
|
| Rate for Payer: Priority Health SBD |
$78.16
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$185.65
|
|
|
Service Code
|
NDC 0574-7050-50
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.96 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: Priority Health SBD |
$116.96
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$72.43
|
|
|
Service Code
|
NDC 8142102103
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$65.19 |
| Rate for Payer: Aetna Commercial |
$61.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.08
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$50.70
|
| Rate for Payer: Cofinity Commercial |
$62.29
|
| Rate for Payer: Healthscope Commercial |
$65.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.57
|
| Rate for Payer: PHP Commercial |
$61.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health SBD |
$45.63
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
IP
|
$5.88
|
|
|
Service Code
|
NDC 0904-6407-61
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.82
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$4.12
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.00
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.12
|
| Rate for Payer: Priority Health SBD |
$3.70
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
IP
|
$29.74
|
|
|
Service Code
|
NDC 0904-1313-09
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Aetna Commercial |
$25.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.33
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: Cofinity Commercial |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$26.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.28
|
| Rate for Payer: PHP Commercial |
$25.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.82
|
| Rate for Payer: Priority Health SBD |
$18.74
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
IP
|
$13.81
|
|
|
Service Code
|
NDC 37000-032-01
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Aetna Commercial |
$11.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.98
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cofinity Commercial |
$11.88
|
| Rate for Payer: Cofinity Commercial |
$9.67
|
| Rate for Payer: Healthscope Commercial |
$12.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.74
|
| Rate for Payer: PHP Commercial |
$11.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.67
|
| Rate for Payer: Priority Health SBD |
$8.70
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
IP
|
$2.88
|
|
|
Service Code
|
NDC 9900-0007-28
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
IP
|
$24.84
|
|
|
Service Code
|
NDC 149003916
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health SBD |
$15.65
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
IP
|
$233.28
|
|
|
Service Code
|
NDC 50268-127-15
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.63
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cofinity Commercial |
$163.30
|
| Rate for Payer: Cofinity Commercial |
$200.62
|
| Rate for Payer: Healthscope Commercial |
$209.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.29
|
| Rate for Payer: PHP Commercial |
$198.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.30
|
| Rate for Payer: Priority Health SBD |
$146.97
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
IP
|
$4.67
|
|
|
Service Code
|
NDC 50268-127-11
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Healthscope Commercial |
$4.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.97
|
| Rate for Payer: PHP Commercial |
$3.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.27
|
| Rate for Payer: Priority Health SBD |
$2.94
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
IP
|
$256.80
|
|
|
Service Code
|
NDC 29300-126-01
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Aetna Commercial |
$218.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.92
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cofinity Commercial |
$179.76
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Healthscope Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.28
|
| Rate for Payer: PHP Commercial |
$218.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.76
|
| Rate for Payer: Priority Health SBD |
$161.78
|
|
|
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 51720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$390.90
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.46
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$42.24
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 51700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$134.32
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.05
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$29.14
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION
|
Facility
OP
|
$284.88
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$256.39 |
| Rate for Payer: Aetna Commercial |
$242.15
|
| Rate for Payer: Aetna Commercial |
$418.28
|
| Rate for Payer: Aetna Commercial |
$233.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.86
|
| Rate for Payer: BCBS Complete |
$113.95
|
| Rate for Payer: BCBS Complete |
$109.72
|
| Rate for Payer: BCBS Complete |
$196.84
|
| Rate for Payer: BCBS Trust/PPO |
$62.24
|
| Rate for Payer: BCBS Trust/PPO |
$62.24
|
| Rate for Payer: BCBS Trust/PPO |
$62.24
|
| Rate for Payer: Cash Price |
$393.68
|
| Rate for Payer: Cash Price |
$393.68
|
| Rate for Payer: Cash Price |
$227.90
|
| Rate for Payer: Cash Price |
$219.43
|
| Rate for Payer: Cash Price |
$227.90
|
| Rate for Payer: Cash Price |
$219.43
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$344.47
|
| Rate for Payer: Cofinity Commercial |
$235.89
|
| Rate for Payer: Cofinity Commercial |
$423.21
|
| Rate for Payer: Cofinity Commercial |
$199.42
|
| Rate for Payer: Cofinity Commercial |
$245.00
|
| Rate for Payer: Healthscope Commercial |
$246.86
|
| Rate for Payer: Healthscope Commercial |
$442.89
|
| Rate for Payer: Healthscope Commercial |
$256.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$418.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.15
|
| Rate for Payer: PHP Commercial |
$233.15
|
| Rate for Payer: PHP Commercial |
$242.15
|
| Rate for Payer: PHP Commercial |
$418.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.47
|
| Rate for Payer: Priority Health SBD |
$179.47
|
| Rate for Payer: Priority Health SBD |
$310.02
|
| Rate for Payer: Priority Health SBD |
$172.80
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION
|
Facility
OP
|
$912.70
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
17012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$821.43 |
| Rate for Payer: Aetna Commercial |
$775.80
|
| Rate for Payer: Aetna Commercial |
$455.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.61
|
| Rate for Payer: BCBS Complete |
$365.08
|
| Rate for Payer: BCBS Complete |
$214.53
|
| Rate for Payer: BCBS Trust/PPO |
$62.24
|
| Rate for Payer: BCBS Trust/PPO |
$62.24
|
| Rate for Payer: Cash Price |
$429.06
|
| Rate for Payer: Cash Price |
$429.06
|
| Rate for Payer: Cash Price |
$730.16
|
| Rate for Payer: Cash Price |
$730.16
|
| Rate for Payer: Cofinity Commercial |
$784.92
|
| Rate for Payer: Cofinity Commercial |
$461.24
|
| Rate for Payer: Cofinity Commercial |
$638.89
|
| Rate for Payer: Cofinity Commercial |
$375.42
|
| Rate for Payer: Healthscope Commercial |
$482.69
|
| Rate for Payer: Healthscope Commercial |
$821.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$455.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$775.80
|
| Rate for Payer: PHP Commercial |
$455.87
|
| Rate for Payer: PHP Commercial |
$775.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.42
|
| Rate for Payer: Priority Health SBD |
$575.00
|
| Rate for Payer: Priority Health SBD |
$337.88
|
|
|
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
|
Facility
OP
|
$5,175.07
|
|
|
Service Code
|
CPT 15823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$540.93 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$957.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.02
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$540.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT
|
Facility
OP
|
$23,099.48
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
173348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$20,789.53 |
| Rate for Payer: Aetna Commercial |
$19,634.56
|
| Rate for Payer: Aetna Medicare |
$151.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,014.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.96
|
| Rate for Payer: BCBS Complete |
$83.61
|
| Rate for Payer: BCBS MAPPO |
$145.56
|
| Rate for Payer: BCBS Trust/PPO |
$430.94
|
| Rate for Payer: BCN Medicare Advantage |
$145.56
|
| Rate for Payer: Cash Price |
$18,479.58
|
| Rate for Payer: Cash Price |
$18,479.58
|
| Rate for Payer: Cofinity Commercial |
$16,169.64
|
| Rate for Payer: Cofinity Commercial |
$19,865.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.56
|
| Rate for Payer: Healthscope Commercial |
$20,789.53
|
| Rate for Payer: Mclaren Medicaid |
$79.62
|
| Rate for Payer: Mclaren Medicare |
$145.56
|
| Rate for Payer: Meridian Medicaid |
$83.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,634.56
|
| Rate for Payer: PACE Medicare |
$138.29
|
| Rate for Payer: PACE SWMI |
$145.56
|
| Rate for Payer: PHP Commercial |
$19,634.56
|
| Rate for Payer: PHP Medicare Advantage |
$145.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,169.64
|
| Rate for Payer: Priority Health Medicare |
$145.56
|
| Rate for Payer: Priority Health SBD |
$14,552.67
|
| Rate for Payer: Railroad Medicare Medicare |
$145.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.56
|
| Rate for Payer: UHC Medicare Advantage |
$149.93
|
| Rate for Payer: VA VA |
$145.56
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
IP
|
$20,729.30
|
|
|
Service Code
|
MS-DRG 553
|
| Min. Negotiated Rate |
$9,714.65 |
| Max. Negotiated Rate |
$20,729.30 |
| Rate for Payer: Aetna Medicare |
$10,634.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,782.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,782.44
|
| Rate for Payer: BCBS MAPPO |
$10,225.95
|
| Rate for Payer: BCBS Trust/PPO |
$20,729.30
|
| Rate for Payer: BCN Medicare Advantage |
$10,225.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,225.95
|
| Rate for Payer: Mclaren Medicare |
$10,225.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,737.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,759.84
|
| Rate for Payer: PACE Medicare |
$9,714.65
|
| Rate for Payer: PACE SWMI |
$10,225.95
|
| Rate for Payer: PHP Medicare Advantage |
$10,225.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,393.92
|
| Rate for Payer: Priority Health Medicare |
$10,225.95
|
| Rate for Payer: Priority Health Narrow Network |
$15,515.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10,225.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,615.78
|
| Rate for Payer: UHC Core |
$12,650.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,225.95
|
| Rate for Payer: UHC Exchange |
$13,548.79
|
| Rate for Payer: UHC Medicare Advantage |
$10,532.73
|
| Rate for Payer: VA VA |
$10,225.95
|
|
