|
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 58554
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,285.54 |
| Max. Negotiated Rate |
$11,449.09 |
| Rate for Payer: Aetna Medicare |
$9,525.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,449.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,449.09
|
| Rate for Payer: BCBS Complete |
$5,261.08
|
| Rate for Payer: BCBS MAPPO |
$9,159.27
|
| Rate for Payer: BCBS Trust/PPO |
$4,191.01
|
| Rate for Payer: BCN Medicare Advantage |
$9,159.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,159.27
|
| Rate for Payer: Mclaren Medicaid |
$5,010.12
|
| Rate for Payer: Mclaren Medicare |
$9,159.27
|
| Rate for Payer: Meridian Medicaid |
$5,261.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,617.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,533.16
|
| Rate for Payer: PACE Medicare |
$8,701.31
|
| Rate for Payer: PACE SWMI |
$9,159.27
|
| Rate for Payer: PHP Medicare Advantage |
$9,159.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,010.12
|
| Rate for Payer: Priority Health Medicare |
$9,159.27
|
| Rate for Payer: Railroad Medicare Medicare |
$9,159.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,414.09
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,285.54
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$9,996.07
|
|
|
Service Code
|
CPT 31536
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$204.98 |
| Max. Negotiated Rate |
$9,996.07 |
| Rate for Payer: Aetna Medicare |
$3,465.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,165.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,165.16
|
| Rate for Payer: BCBS Complete |
$1,913.98
|
| Rate for Payer: BCBS MAPPO |
$3,332.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,954.34
|
| Rate for Payer: BCN Medicare Advantage |
$3,332.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,332.13
|
| Rate for Payer: Mclaren Medicaid |
$1,822.68
|
| Rate for Payer: Mclaren Medicare |
$3,332.13
|
| Rate for Payer: Meridian Medicaid |
$1,913.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,498.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,831.95
|
| Rate for Payer: PACE Medicare |
$3,165.52
|
| Rate for Payer: PACE SWMI |
$3,332.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,332.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,822.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,996.07
|
| Rate for Payer: Priority Health Medicare |
$3,332.13
|
| Rate for Payer: Priority Health Narrow Network |
$7,996.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3,332.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.48
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,332.13
|
| Rate for Payer: UHC Exchange |
$204.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,432.09
|
| Rate for Payer: VA VA |
$3,332.13
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$9,996.07
|
|
|
Service Code
|
CPT 31541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$256.39 |
| Max. Negotiated Rate |
$9,996.07 |
| Rate for Payer: Aetna Medicare |
$3,465.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,165.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,165.16
|
| Rate for Payer: BCBS Complete |
$1,913.98
|
| Rate for Payer: BCBS MAPPO |
$3,332.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,426.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,332.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,332.13
|
| Rate for Payer: Mclaren Medicaid |
$1,822.68
|
| Rate for Payer: Mclaren Medicare |
$3,332.13
|
| Rate for Payer: Meridian Medicaid |
$1,913.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,498.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,831.95
|
| Rate for Payer: PACE Medicare |
$3,165.52
|
| Rate for Payer: PACE SWMI |
$3,332.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,332.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,822.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,996.07
|
| Rate for Payer: Priority Health Medicare |
$3,332.13
|
| Rate for Payer: Priority Health Narrow Network |
$7,996.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3,332.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.03
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,332.13
|
| Rate for Payer: UHC Exchange |
$256.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,432.09
|
| Rate for Payer: VA VA |
$3,332.13
|
|
|
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$9,996.07
|
|
|
Service Code
|
CPT 31571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$242.63 |
| Max. Negotiated Rate |
$9,996.07 |
| Rate for Payer: Aetna Medicare |
$3,465.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,165.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,165.16
|
| Rate for Payer: BCBS Complete |
$1,913.98
|
| Rate for Payer: BCBS MAPPO |
$3,332.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,334.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,332.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,332.13
|
| Rate for Payer: Mclaren Medicaid |
$1,822.68
|
| Rate for Payer: Mclaren Medicare |
$3,332.13
|
| Rate for Payer: Meridian Medicaid |
$1,913.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,498.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,831.95
|
| Rate for Payer: PACE Medicare |
$3,165.52
|
| Rate for Payer: PACE SWMI |
$3,332.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,332.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,822.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,996.07
|
| Rate for Payer: Priority Health Medicare |
$3,332.13
|
| Rate for Payer: Priority Health Narrow Network |
$7,996.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3,332.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.89
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,332.13
|
| Rate for Payer: UHC Exchange |
$242.63
|
| Rate for Payer: UHC Medicare Advantage |
$3,432.09
|
| Rate for Payer: VA VA |
$3,332.13
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN
|
Facility
|
OP
|
$4,793.34
|
|
|
Service Code
|
CPT 31525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.84 |
| Max. Negotiated Rate |
$4,793.34 |
| Rate for Payer: Aetna Medicare |
$1,570.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,887.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,887.76
|
| Rate for Payer: BCBS Complete |
$867.46
|
| Rate for Payer: BCBS MAPPO |
$1,510.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,642.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.21
|
| Rate for Payer: Mclaren Medicaid |
$826.08
|
| Rate for Payer: Mclaren Medicare |
$1,510.21
|
| Rate for Payer: Meridian Medicaid |
$867.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,585.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,736.74
|
| Rate for Payer: PACE Medicare |
$1,434.70
|
| Rate for Payer: PACE SWMI |
$1,510.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,793.34
|
| Rate for Payer: Priority Health Medicare |
$1,510.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,834.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,510.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.52
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.21
|
| Rate for Payer: UHC Exchange |
$156.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.52
|
| Rate for Payer: VA VA |
$1,510.21
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$4,793.34
|
|
|
Service Code
|
CPT 31526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.57 |
| Max. Negotiated Rate |
$4,793.34 |
| Rate for Payer: Aetna Medicare |
$1,570.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,887.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,887.76
|
| Rate for Payer: BCBS Complete |
$867.46
|
| Rate for Payer: BCBS MAPPO |
$1,510.21
|
| Rate for Payer: BCBS Trust/PPO |
$999.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.21
|
| Rate for Payer: Mclaren Medicaid |
$826.08
|
| Rate for Payer: Mclaren Medicare |
$1,510.21
|
| Rate for Payer: Meridian Medicaid |
$867.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,585.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,736.74
|
| Rate for Payer: PACE Medicare |
$1,434.70
|
| Rate for Payer: PACE SWMI |
$1,510.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,793.34
|
| Rate for Payer: Priority Health Medicare |
$1,510.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,834.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,510.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.93
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.21
|
| Rate for Payer: UHC Exchange |
$153.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.52
|
| Rate for Payer: VA VA |
$1,510.21
|
|
|
LARYNGOSCOPY, FLEXIBLE; WITH THERAPEUTIC INJECTION(S) (EG, CHEMODENERVATION AGENT OR CORTICOSTEROID, INJECTED PERCUTANEOUS, TRANSORAL, OR VIA ENDOSCOPE CHANNEL), UNILATERAL
|
Facility
|
OP
|
$4,793.34
|
|
|
Service Code
|
CPT 31573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$4,793.34 |
| Rate for Payer: Aetna Medicare |
$1,570.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,887.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,887.76
|
| Rate for Payer: BCBS Complete |
$867.46
|
| Rate for Payer: BCBS MAPPO |
$1,510.21
|
| Rate for Payer: BCBS Trust/PPO |
$522.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.21
|
| Rate for Payer: Mclaren Medicaid |
$826.08
|
| Rate for Payer: Mclaren Medicare |
$1,510.21
|
| Rate for Payer: Meridian Medicaid |
$867.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,585.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,736.74
|
| Rate for Payer: PACE Medicare |
$1,434.70
|
| Rate for Payer: PACE SWMI |
$1,510.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,793.34
|
| Rate for Payer: Priority Health Medicare |
$1,510.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,834.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,510.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.28
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.21
|
| Rate for Payer: UHC Exchange |
$145.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.52
|
| Rate for Payer: VA VA |
$1,510.21
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$25.92
|
|
|
Service Code
|
NDC 61314-547-01
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$23.33 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.85
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.03
|
| Rate for Payer: PHP Commercial |
$22.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health SBD |
$16.33
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$50.75
|
|
|
Service Code
|
NDC 17478-625-12
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.64
|
| Rate for Payer: Healthscope Commercial |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.14
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.52
|
| Rate for Payer: Priority Health SBD |
$31.97
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$59.85
|
|
|
Service Code
|
NDC 24208-463-25
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.90
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Cofinity Commercial |
$51.47
|
| Rate for Payer: Healthscope Commercial |
$53.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.87
|
| Rate for Payer: PHP Commercial |
$50.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.90
|
| Rate for Payer: Priority Health SBD |
$37.71
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$43.61
|
|
|
Service Code
|
NDC 61314-547-03
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.47 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: Aetna Commercial |
$37.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.35
|
| Rate for Payer: Cash Price |
$34.89
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Cofinity Commercial |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$39.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.07
|
| Rate for Payer: PHP Commercial |
$37.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.53
|
| Rate for Payer: Priority Health SBD |
$27.47
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$819.28
|
|
|
Service Code
|
NDC 0013-8303-04
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$516.15 |
| Max. Negotiated Rate |
$737.35 |
| Rate for Payer: Aetna Commercial |
$696.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.53
|
| Rate for Payer: Cash Price |
$655.42
|
| Rate for Payer: Cofinity Commercial |
$573.50
|
| Rate for Payer: Cofinity Commercial |
$704.58
|
| Rate for Payer: Healthscope Commercial |
$737.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.39
|
| Rate for Payer: PHP Commercial |
$696.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.50
|
| Rate for Payer: Priority Health SBD |
$516.15
|
|
|
LATERAL RETINACULAR RELEASE, OPEN
|
Facility
|
OP
|
$8,925.64
|
|
|
Service Code
|
CPT 27425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$457.11 |
| Max. Negotiated Rate |
$8,925.64 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,925.64
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,140.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.82
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$457.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
LEFLUNOMIDE 10 MG TABLET
|
Facility
|
IP
|
$98.21
|
|
|
Service Code
|
NDC 59651-348-30
|
| Hospital Charge Code |
23872
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.87 |
| Max. Negotiated Rate |
$88.39 |
| Rate for Payer: Aetna Commercial |
$83.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.84
|
| Rate for Payer: Cash Price |
$78.57
|
| Rate for Payer: Cofinity Commercial |
$68.75
|
| Rate for Payer: Cofinity Commercial |
$84.46
|
| Rate for Payer: Healthscope Commercial |
$88.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.48
|
| Rate for Payer: PHP Commercial |
$83.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.75
|
| Rate for Payer: Priority Health SBD |
$61.87
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$5,391.39
|
|
|
Service Code
|
NDC 0088-2161-30
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,396.58 |
| Max. Negotiated Rate |
$4,852.25 |
| Rate for Payer: Aetna Commercial |
$4,582.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,504.40
|
| Rate for Payer: Cash Price |
$4,313.11
|
| Rate for Payer: Cofinity Commercial |
$3,773.97
|
| Rate for Payer: Cofinity Commercial |
$4,636.60
|
| Rate for Payer: Healthscope Commercial |
$4,852.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,582.68
|
| Rate for Payer: PHP Commercial |
$4,582.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,773.97
|
| Rate for Payer: Priority Health SBD |
$3,396.58
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$527.25
|
|
|
Service Code
|
NDC 0955-1737-30
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.17 |
| Max. Negotiated Rate |
$474.52 |
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.71
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cofinity Commercial |
$369.08
|
| Rate for Payer: Cofinity Commercial |
$453.44
|
| Rate for Payer: Healthscope Commercial |
$474.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.16
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.08
|
| Rate for Payer: Priority Health SBD |
$332.17
|
|
|
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,925.64
|
|
|
Service Code
|
CPT 27685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$463.99 |
| Max. Negotiated Rate |
$8,925.64 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,593.15
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,925.64
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,140.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.39
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$463.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 50268-476-11
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.38
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.56
|
| Rate for Payer: Priority Health SBD |
$2.31
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$182.88
|
|
|
Service Code
|
NDC 50268-476-15
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.21 |
| Max. Negotiated Rate |
$164.59 |
| Rate for Payer: Aetna Commercial |
$155.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.87
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$128.02
|
| Rate for Payer: Cofinity Commercial |
$157.28
|
| Rate for Payer: Healthscope Commercial |
$164.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.45
|
| Rate for Payer: PHP Commercial |
$155.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.02
|
| Rate for Payer: Priority Health SBD |
$115.21
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
NDC 16729-034-10
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna Commercial |
$83.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.90
|
| Rate for Payer: PHP Commercial |
$83.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.09
|
| Rate for Payer: Priority Health SBD |
$62.18
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$79.52
|
|
|
Service Code
|
NDC 0093-7620-56
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$71.57 |
| Rate for Payer: Aetna Commercial |
$67.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.69
|
| Rate for Payer: Cash Price |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$55.66
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Healthscope Commercial |
$71.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.59
|
| Rate for Payer: PHP Commercial |
$67.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.66
|
| Rate for Payer: Priority Health SBD |
$50.10
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$97.76
|
|
|
Service Code
|
NDC 60505-3255-3
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.59 |
| Max. Negotiated Rate |
$87.98 |
| Rate for Payer: Aetna Commercial |
$83.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.54
|
| Rate for Payer: Cash Price |
$78.21
|
| Rate for Payer: Cofinity Commercial |
$68.43
|
| Rate for Payer: Cofinity Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$87.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.10
|
| Rate for Payer: PHP Commercial |
$83.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.43
|
| Rate for Payer: Priority Health SBD |
$61.59
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$2,783.55
|
|
|
Service Code
|
NDC 0078-0249-15
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,753.64 |
| Max. Negotiated Rate |
$2,505.20 |
| Rate for Payer: Aetna Commercial |
$2,366.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,809.31
|
| Rate for Payer: Cash Price |
$2,226.84
|
| Rate for Payer: Cofinity Commercial |
$1,948.48
|
| Rate for Payer: Cofinity Commercial |
$2,393.85
|
| Rate for Payer: Healthscope Commercial |
$2,505.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,366.02
|
| Rate for Payer: PHP Commercial |
$2,366.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.48
|
| Rate for Payer: Priority Health SBD |
$1,753.64
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$71.16
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.83 |
| Max. Negotiated Rate |
$64.04 |
| Rate for Payer: Aetna Commercial |
$60.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.25
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cofinity Commercial |
$49.81
|
| Rate for Payer: Cofinity Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$64.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.49
|
| Rate for Payer: PHP Commercial |
$60.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.81
|
| Rate for Payer: Priority Health SBD |
$44.83
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$82.73
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Complete |
$33.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.22
|
| Rate for Payer: BCBS Trust/PPO |
$13.22
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.91
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$52.12
|
|
