|
ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$39.13
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
39477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$19.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: BCBS Complete |
$15.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Cofinity Commercial |
$27.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$35.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.26
|
| Rate for Payer: PHP Commercial |
$33.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.43
|
| Rate for Payer: Priority Health SBD |
$24.65
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$39.13
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
39477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$35.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.26
|
| Rate for Payer: PHP Commercial |
$33.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.43
|
| Rate for Payer: Priority Health SBD |
$24.65
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
IP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health SBD |
$15.91
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health SBD |
$15.91
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM
|
Facility
|
OP
|
$11,273.70
|
|
|
Service Code
|
CPT 14301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$914.67 |
| Max. Negotiated Rate |
$11,273.70 |
| Rate for Payer: Aetna Medicare |
$3,730.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,209.86
|
| Rate for Payer: BCN Commercial |
$1,209.86
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,586.95
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Nomi Health Commercial |
$7,532.60
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.70
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.96
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.67
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$2,019.45
|
| Rate for Payer: VA VA |
$3,586.95
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 14302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$228.38 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$464.08
|
| Rate for Payer: BCN Commercial |
$464.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.38
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$855.29 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,560.59
|
| Rate for Payer: BCN Commercial |
$1,560.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.29
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$694.97 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$819.87
|
| Rate for Payer: BCN Commercial |
$819.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$694.97
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$796.81 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$819.87
|
| Rate for Payer: BCN Commercial |
$819.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.81
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$652.73 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,185.75
|
| Rate for Payer: BCN Commercial |
$1,185.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.73
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$592.84 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$819.87
|
| Rate for Payer: BCN Commercial |
$819.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.84
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$688.82 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$819.87
|
| Rate for Payer: BCN Commercial |
$819.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$688.82
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$529.94 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$819.87
|
| Rate for Payer: BCN Commercial |
$819.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$529.94
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,913.44
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$16,122.10 |
| Rate for Payer: Aetna Commercial |
$15,226.42
|
| Rate for Payer: Aetna Medicare |
$42.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,643.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.21
|
| Rate for Payer: BCBS Complete |
$23.06
|
| Rate for Payer: BCBS MAPPO |
$40.97
|
| Rate for Payer: BCBS Trust/PPO |
$112.12
|
| Rate for Payer: BCN Commercial |
$112.12
|
| Rate for Payer: BCN Medicare Advantage |
$40.97
|
| Rate for Payer: Cash Price |
$14,330.75
|
| Rate for Payer: Cash Price |
$14,330.75
|
| Rate for Payer: Cofinity Commercial |
$15,405.56
|
| Rate for Payer: Cofinity Commercial |
$12,539.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,539.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,330.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.97
|
| Rate for Payer: Healthscope Commercial |
$16,122.10
|
| Rate for Payer: Mclaren Medicaid |
$21.96
|
| Rate for Payer: Mclaren Medicare |
$40.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.02
|
| Rate for Payer: Meridian Medicaid |
$23.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,226.42
|
| Rate for Payer: Nomi Health Commercial |
$122.91
|
| Rate for Payer: PACE Medicare |
$38.92
|
| Rate for Payer: PACE SWMI |
$40.97
|
| Rate for Payer: PHP Commercial |
$15,226.42
|
| Rate for Payer: PHP Medicare Advantage |
$40.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,643.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.41
|
| Rate for Payer: Priority Health Medicare |
$40.97
|
| Rate for Payer: Priority Health Narrow Network |
$93.13
|
| Rate for Payer: Priority Health SBD |
$11,285.47
|
| Rate for Payer: Railroad Medicare Medicare |
$40.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.97
|
| Rate for Payer: UHC Medicare Advantage |
$40.97
|
| Rate for Payer: UHCCP Medicaid |
$23.07
|
| Rate for Payer: VA VA |
$40.97
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17,913.44
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,285.47 |
| Max. Negotiated Rate |
$16,122.10 |
| Rate for Payer: Aetna Commercial |
$15,226.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,643.74
|
| Rate for Payer: Cash Price |
$14,330.75
|
| Rate for Payer: Cofinity Commercial |
$12,539.41
|
| Rate for Payer: Cofinity Commercial |
$15,405.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,539.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,330.75
|
| Rate for Payer: Healthscope Commercial |
$16,122.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,226.42
|
| Rate for Payer: PHP Commercial |
$15,226.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,643.74
|
| Rate for Payer: Priority Health SBD |
$11,285.47
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,661.47
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$25,795.32 |
| Rate for Payer: Aetna Commercial |
$24,362.25
|
| Rate for Payer: Aetna Medicare |
$42.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,629.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.21
|
| Rate for Payer: BCBS Complete |
$23.06
|
| Rate for Payer: BCBS MAPPO |
$40.97
|
| Rate for Payer: BCBS Trust/PPO |
$112.12
|
| Rate for Payer: BCN Commercial |
$112.12
|
| Rate for Payer: BCN Medicare Advantage |
$40.97
|
| Rate for Payer: Cash Price |
$22,929.18
|
| Rate for Payer: Cash Price |
$22,929.18
|
| Rate for Payer: Cofinity Commercial |
$24,648.86
|
| Rate for Payer: Cofinity Commercial |
$20,063.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,063.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,929.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.97
|
| Rate for Payer: Healthscope Commercial |
$25,795.32
|
| Rate for Payer: Mclaren Medicaid |
$21.96
|
| Rate for Payer: Mclaren Medicare |
$40.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.02
|
| Rate for Payer: Meridian Medicaid |
$23.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,362.25
|
| Rate for Payer: Nomi Health Commercial |
$122.91
|
| Rate for Payer: PACE Medicare |
$38.92
|
| Rate for Payer: PACE SWMI |
$40.97
|
| Rate for Payer: PHP Commercial |
$24,362.25
|
| Rate for Payer: PHP Medicare Advantage |
$40.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,629.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.41
|
| Rate for Payer: Priority Health Medicare |
$40.97
|
| Rate for Payer: Priority Health Narrow Network |
$93.13
|
| Rate for Payer: Priority Health SBD |
$18,056.73
|
| Rate for Payer: Railroad Medicare Medicare |
$40.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.97
|
| Rate for Payer: UHC Medicare Advantage |
$40.97
|
| Rate for Payer: UHCCP Medicaid |
$23.07
|
| Rate for Payer: VA VA |
$40.97
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$287.20
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$258.48 |
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna Commercial |
$241.40
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: Aetna Medicare |
$142.00
|
| Rate for Payer: Aetna Medicare |
$143.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Complete |
$114.88
|
| Rate for Payer: BCBS Trust/PPO |
$149.94
|
| Rate for Payer: BCBS Trust/PPO |
$149.94
|
| Rate for Payer: BCBS Trust/PPO |
$149.94
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cofinity Commercial |
$198.80
|
| Rate for Payer: Cofinity Commercial |
$126.01
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$244.24
|
| Rate for Payer: Cofinity Commercial |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Healthscope Commercial |
$255.60
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$241.40
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.01
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: Priority Health SBD |
$180.94
|
| Rate for Payer: Priority Health SBD |
$178.92
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$180.01
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.41 |
| Max. Negotiated Rate |
$162.01 |
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna Commercial |
$241.40
|
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cofinity Commercial |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$126.01
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$198.80
|
| Rate for Payer: Cofinity Commercial |
$244.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Healthscope Commercial |
$255.60
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: PHP Commercial |
$241.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health SBD |
$180.94
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: Priority Health SBD |
$178.92
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION 100 ML
|
Facility
|
IP
|
$287.20
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
180336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.94 |
| Max. Negotiated Rate |
$258.48 |
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cofinity Commercial |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.68
|
| Rate for Payer: Priority Health SBD |
$180.94
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION 100 ML
|
Facility
|
OP
|
$287.20
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
180336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$258.48 |
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna Medicare |
$143.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: BCBS Complete |
$114.88
|
| Rate for Payer: BCBS Trust/PPO |
$149.94
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cofinity Commercial |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.68
|
| Rate for Payer: Priority Health SBD |
$180.94
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$187.92
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
8982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$169.13 |
| Rate for Payer: Aetna Commercial |
$159.73
|
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Medicare |
$88.16
|
| Rate for Payer: Aetna Medicare |
$92.80
|
| Rate for Payer: Aetna Medicare |
$93.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.15
|
| Rate for Payer: BCBS Complete |
$74.24
|
| Rate for Payer: BCBS Complete |
$70.53
|
| Rate for Payer: BCBS Complete |
$75.17
|
| Rate for Payer: BCBS Trust/PPO |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$30.00
|
| Rate for Payer: BCN Commercial |
$30.00
|
| Rate for Payer: BCN Commercial |
$30.00
|
| Rate for Payer: BCN Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cofinity Commercial |
$129.92
|
| Rate for Payer: Cofinity Commercial |
$123.42
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$159.62
|
| Rate for Payer: Cofinity Commercial |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$161.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.34
|
| Rate for Payer: Healthscope Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Healthscope Commercial |
$169.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.73
|
| Rate for Payer: PHP Commercial |
$157.76
|
| Rate for Payer: PHP Commercial |
$159.73
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.61
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$118.39
|
| Rate for Payer: Priority Health SBD |
$116.93
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$187.92
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.39 |
| Max. Negotiated Rate |
$169.13 |
| Rate for Payer: Aetna Commercial |
$159.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.15
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cofinity Commercial |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$161.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.34
|
| Rate for Payer: Healthscope Commercial |
$169.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.73
|
| Rate for Payer: PHP Commercial |
$159.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.15
|
| Rate for Payer: Priority Health SBD |
$118.39
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$187.92
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.17 |
| Max. Negotiated Rate |
$169.13 |
| Rate for Payer: Aetna Commercial |
$159.73
|
| Rate for Payer: Aetna Medicare |
$93.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.15
|
| Rate for Payer: BCBS Complete |
$75.17
|
| Rate for Payer: BCBS Trust/PPO |
$149.94
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cofinity Commercial |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$161.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.34
|
| Rate for Payer: Healthscope Commercial |
$169.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.73
|
| Rate for Payer: PHP Commercial |
$159.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.15
|
| Rate for Payer: Priority Health SBD |
$118.39
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$176.32
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
8982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.08 |
| Max. Negotiated Rate |
$158.69 |
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Commercial |
$159.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.15
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cofinity Commercial |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$123.42
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$161.61
|
| Rate for Payer: Cofinity Commercial |
$129.92
|
| Rate for Payer: Cofinity Commercial |
$159.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.34
|
| Rate for Payer: Healthscope Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$169.13
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.73
|
| Rate for Payer: PHP Commercial |
$159.73
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: PHP Commercial |
$157.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.64
|
| Rate for Payer: Priority Health SBD |
$118.39
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$116.93
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Complete |
$0.95
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.01
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$1.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health SBD |
$1.49
|
| Rate for Payer: Priority Health SBD |
$2.76
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: Priority Health SBD |
$2.12
|
|
