|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,530.12
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,003.98 |
| Max. Negotiated Rate |
$8,577.11 |
| Rate for Payer: Aetna Commercial |
$8,100.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,194.58
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cofinity Advantage |
$6,671.08
|
| Rate for Payer: Cofinity Commercial |
$8,195.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,624.10
|
| Rate for Payer: Healthscope Commercial |
$8,577.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,100.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,147.59
|
| Rate for Payer: PHP Commercial |
$8,100.60
|
| Rate for Payer: Priority Health SBD |
$6,003.98
|
|
|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,530.12
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$8,577.11 |
| Rate for Payer: Aetna Commercial |
$8,100.60
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,194.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$32.18
|
| Rate for Payer: BCN Commercial |
$32.18
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cofinity Advantage |
$6,671.08
|
| Rate for Payer: Cofinity Commercial |
$8,195.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,624.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$8,577.11
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: Meridian Medicaid |
$13.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,100.60
|
| Rate for Payer: Nomi Health Commercial |
$38.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,147.59
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$8,100.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42.53
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health SBD |
$6,003.98
|
| Rate for Payer: Priority Health Tiered Network |
$34.02
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.17
|
| Rate for Payer: UHC Core |
$21.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.90
|
| Rate for Payer: UHC Exchange |
$21.17
|
| Rate for Payer: UHC Medicaid |
$6.75
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$12.90
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITH MCC
|
Facility
|
IP
|
$21,287.24
|
|
|
Service Code
|
MSDRG 725
|
| Min. Negotiated Rate |
$9,141.45 |
| Max. Negotiated Rate |
$21,287.24 |
| Rate for Payer: Aetna Medicare |
$10,007.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,028.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,028.23
|
| Rate for Payer: BCBS MAPPO |
$9,622.58
|
| Rate for Payer: BCBS Trust/PPO |
$21,287.24
|
| Rate for Payer: BCN Commercial |
$21,287.24
|
| Rate for Payer: BCN Medicare Advantage |
$9,622.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,622.58
|
| Rate for Payer: Mclaren Medicare |
$9,622.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,103.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,065.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,584.84
|
| Rate for Payer: Nomi Health Commercial |
$15,095.58
|
| Rate for Payer: PACE Medicare |
$9,141.45
|
| Rate for Payer: PACE SWMI |
$9,622.58
|
| Rate for Payer: PHP Medicare Advantage |
$9,622.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,866.13
|
| Rate for Payer: Priority Health Medicare |
$9,622.58
|
| Rate for Payer: Priority Health Tiered Network |
$15,092.90
|
| Rate for Payer: Railroad Medicare Medicare |
$9,622.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,074.26
|
| Rate for Payer: UHC Core |
$15,958.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,622.58
|
| Rate for Payer: UHC Exchange |
$13,032.52
|
| Rate for Payer: VA VA |
$9,622.58
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC
|
Facility
|
IP
|
$12,537.32
|
|
|
Service Code
|
MSDRG 726
|
| Min. Negotiated Rate |
$5,850.85 |
| Max. Negotiated Rate |
$12,537.32 |
| Rate for Payer: Aetna Medicare |
$6,405.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,698.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,698.49
|
| Rate for Payer: BCBS MAPPO |
$6,158.79
|
| Rate for Payer: BCBS Trust/PPO |
$12,537.32
|
| Rate for Payer: BCN Commercial |
$12,537.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,158.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,158.79
|
| Rate for Payer: Mclaren Medicare |
$6,158.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,466.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,082.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,774.67
|
| Rate for Payer: Nomi Health Commercial |
$9,313.80
|
| Rate for Payer: PACE Medicare |
$5,850.85
|
| Rate for Payer: PACE SWMI |
$6,158.79
|
| Rate for Payer: PHP Medicare Advantage |
$6,158.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,640.19
|
| Rate for Payer: Priority Health Medicare |
$6,158.79
|
| Rate for Payer: Priority Health Tiered Network |
$9,312.15
|
| Rate for Payer: Railroad Medicare Medicare |
$6,158.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,768.60
|
| Rate for Payer: UHC Core |
$9,845.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,158.79
|
| Rate for Payer: UHC Exchange |
$8,040.91
|
| Rate for Payer: VA VA |
$6,158.79
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$19,720.60
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.44 |
| Max. Negotiated Rate |
$17,748.54 |
| Rate for Payer: Aetna Commercial |
$16,762.51
|
| Rate for Payer: Aetna Medicare |
$169.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,818.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.20
|
| Rate for Payer: BCBS Complete |
$89.72
|
| Rate for Payer: BCBS MAPPO |
$163.36
|
| Rate for Payer: BCBS Trust/PPO |
$411.34
|
| Rate for Payer: BCN Commercial |
$411.34
|
| Rate for Payer: BCN Medicare Advantage |
$163.36
|
| Rate for Payer: Cash Price |
$15,776.48
|
| Rate for Payer: Cash Price |
$15,776.48
|
| Rate for Payer: Cofinity Advantage |
$13,804.42
|
| Rate for Payer: Cofinity Commercial |
$16,959.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,776.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.36
|
| Rate for Payer: Healthscope Commercial |
$17,748.54
|
| Rate for Payer: Mclaren Medicaid |
$85.44
|
| Rate for Payer: Mclaren Medicare |
$163.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.53
|
| Rate for Payer: Meridian Medicaid |
$171.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$179.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,762.51
|
| Rate for Payer: Nomi Health Commercial |
$490.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,790.45
|
| Rate for Payer: PACE Medicare |
$155.19
|
| Rate for Payer: PACE SWMI |
$163.36
|
| Rate for Payer: PHP Commercial |
$16,762.51
|
| Rate for Payer: PHP Medicare Advantage |
$163.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$519.09
|
| Rate for Payer: Priority Health Medicare |
$163.36
|
| Rate for Payer: Priority Health SBD |
$12,423.98
|
| Rate for Payer: Priority Health Tiered Network |
$415.27
|
| Rate for Payer: Railroad Medicare Medicare |
$163.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.55
|
| Rate for Payer: UHC Core |
$270.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.36
|
| Rate for Payer: UHC Exchange |
$270.55
|
| Rate for Payer: UHC Medicaid |
$85.44
|
| Rate for Payer: UHCCP Medicaid |
$85.44
|
| Rate for Payer: VA VA |
$163.36
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$19,720.60
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,423.98 |
| Max. Negotiated Rate |
$17,748.54 |
| Rate for Payer: Aetna Commercial |
$16,762.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,818.39
|
| Rate for Payer: Cash Price |
$15,776.48
|
| Rate for Payer: Cofinity Advantage |
$13,804.42
|
| Rate for Payer: Cofinity Commercial |
$16,959.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,776.48
|
| Rate for Payer: Healthscope Commercial |
$17,748.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,762.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,790.45
|
| Rate for Payer: PHP Commercial |
$16,762.51
|
| Rate for Payer: Priority Health SBD |
$12,423.98
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$369.55
|
|
|
Service Code
|
NDC 68084021401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.23 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$314.12
|
| Rate for Payer: Aetna Medicare |
$184.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.21
|
| Rate for Payer: BCBS Complete |
$147.82
|
| Rate for Payer: Cash Price |
$295.64
|
| Rate for Payer: Cofinity Advantage |
$258.69
|
| Rate for Payer: Cofinity Commercial |
$317.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.64
|
| Rate for Payer: Healthscope Commercial |
$332.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.16
|
| Rate for Payer: PHP Commercial |
$314.12
|
| Rate for Payer: Priority Health SBD |
$232.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.21
|
| Rate for Payer: UHC Core |
$192.54
|
| Rate for Payer: UHC Exchange |
$145.23
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$162.15
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.72 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$81.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.40
|
| Rate for Payer: UHC Core |
$84.48
|
| Rate for Payer: UHC Exchange |
$63.72
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$369.55
|
|
|
Service Code
|
NDC 68084021401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.82 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$314.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.21
|
| Rate for Payer: Cash Price |
$295.64
|
| Rate for Payer: Cofinity Advantage |
$258.69
|
| Rate for Payer: Cofinity Commercial |
$317.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.64
|
| Rate for Payer: Healthscope Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.16
|
| Rate for Payer: PHP Commercial |
$314.12
|
| Rate for Payer: Priority Health SBD |
$232.82
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 68382024701
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.91 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Advantage |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.41
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health SBD |
$196.91
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 42806071401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$3.70
|
|
|
Service Code
|
NDC 68084021411
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Advantage |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health SBD |
$2.33
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 68382024701
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.83 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna Medicare |
$156.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Advantage |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.41
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.16
|
| Rate for Payer: UHC Core |
$162.84
|
| Rate for Payer: UHC Exchange |
$122.83
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 68084021411
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Advantage |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health SBD |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$1.93
|
| Rate for Payer: UHC Exchange |
$1.45
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$81.90
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$73.71 |
| Rate for Payer: Aetna Commercial |
$69.61
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Commercial |
$91.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.23
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$86.09
|
| Rate for Payer: Cofinity Advantage |
$57.33
|
| Rate for Payer: Cofinity Advantage |
$72.43
|
| Rate for Payer: Cofinity Advantage |
$75.33
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.09
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$96.85
|
| Rate for Payer: Healthscope Commercial |
$73.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.42
|
| Rate for Payer: PHP Commercial |
$91.47
|
| Rate for Payer: PHP Commercial |
$69.61
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: Priority Health SBD |
$65.19
|
| Rate for Payer: Priority Health SBD |
$51.60
|
| Rate for Payer: Priority Health SBD |
$67.79
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$103.47
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Commercial |
$91.47
|
| Rate for Payer: Aetna Commercial |
$69.61
|
| Rate for Payer: Aetna Medicare |
$51.73
|
| Rate for Payer: Aetna Medicare |
$53.80
|
| Rate for Payer: Aetna Medicare |
$40.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.23
|
| Rate for Payer: BCBS Complete |
$32.76
|
| Rate for Payer: BCBS Complete |
$41.39
|
| Rate for Payer: BCBS Complete |
$43.04
|
| Rate for Payer: BCBS Trust/PPO |
$34.65
|
| Rate for Payer: BCBS Trust/PPO |
$34.65
|
| Rate for Payer: BCBS Trust/PPO |
$34.65
|
| Rate for Payer: BCN Commercial |
$34.65
|
| Rate for Payer: BCN Commercial |
$34.65
|
| Rate for Payer: BCN Commercial |
$34.65
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$86.09
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cash Price |
$86.09
|
| Rate for Payer: Cofinity Advantage |
$75.33
|
| Rate for Payer: Cofinity Advantage |
$72.43
|
| Rate for Payer: Cofinity Advantage |
$57.33
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Healthscope Commercial |
$73.71
|
| Rate for Payer: Healthscope Commercial |
$96.85
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.42
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$91.47
|
| Rate for Payer: PHP Commercial |
$69.61
|
| Rate for Payer: Priority Health SBD |
$65.19
|
| Rate for Payer: Priority Health SBD |
$51.60
|
| Rate for Payer: Priority Health SBD |
$67.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.80
|
| Rate for Payer: UHC Core |
$22.80
|
| Rate for Payer: UHC Core |
$22.80
|
| Rate for Payer: UHC Core |
$22.80
|
| Rate for Payer: UHC Exchange |
$22.80
|
| Rate for Payer: UHC Exchange |
$22.80
|
| Rate for Payer: UHC Exchange |
$22.80
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$433.20
|
|
|
Service Code
|
NDC 60687036801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.92 |
| Max. Negotiated Rate |
$389.88 |
| Rate for Payer: Aetna Commercial |
$368.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.58
|
| Rate for Payer: Cash Price |
$346.56
|
| Rate for Payer: Cofinity Advantage |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.56
|
| Rate for Payer: Healthscope Commercial |
$389.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.90
|
| Rate for Payer: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health SBD |
$272.92
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$433.20
|
|
|
Service Code
|
NDC 60687036801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.25 |
| Max. Negotiated Rate |
$389.88 |
| Rate for Payer: Aetna Commercial |
$368.22
|
| Rate for Payer: Aetna Medicare |
$216.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.58
|
| Rate for Payer: BCBS Complete |
$173.28
|
| Rate for Payer: Cash Price |
$346.56
|
| Rate for Payer: Cofinity Advantage |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$372.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.56
|
| Rate for Payer: Healthscope Commercial |
$389.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.90
|
| Rate for Payer: PHP Commercial |
$368.22
|
| Rate for Payer: Priority Health SBD |
$272.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.58
|
| Rate for Payer: UHC Core |
$225.70
|
| Rate for Payer: UHC Exchange |
$170.25
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 68084038811
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 60687036811
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.82
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cofinity Advantage |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.47
|
| Rate for Payer: Healthscope Commercial |
$3.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.25
|
| Rate for Payer: PHP Commercial |
$3.69
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.82
|
| Rate for Payer: UHC Core |
$2.26
|
| Rate for Payer: UHC Exchange |
$1.71
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$287.85
|
|
|
Service Code
|
NDC 00904679061
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.13 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna Medicare |
$143.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.10
|
| Rate for Payer: BCBS Complete |
$115.14
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Advantage |
$201.50
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health SBD |
$181.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.10
|
| Rate for Payer: UHC Core |
$149.97
|
| Rate for Payer: UHC Exchange |
$113.13
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 60687036811
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.82
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cofinity Advantage |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.47
|
| Rate for Payer: Healthscope Commercial |
$3.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.25
|
| Rate for Payer: PHP Commercial |
$3.69
|
| Rate for Payer: Priority Health SBD |
$2.73
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 00603243821
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Advantage |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health SBD |
$220.59
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$287.85
|
|
|
Service Code
|
NDC 00904679061
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.35 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.10
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Advantage |
$201.50
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health SBD |
$181.35
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$396.15
|
|
|
Service Code
|
NDC 68084038801
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$356.54 |
| Rate for Payer: Aetna Commercial |
$336.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.50
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cofinity Advantage |
$277.31
|
| Rate for Payer: Cofinity Commercial |
$340.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.92
|
| Rate for Payer: Healthscope Commercial |
$356.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.11
|
| Rate for Payer: PHP Commercial |
$336.73
|
| Rate for Payer: Priority Health SBD |
$249.57
|
|
