|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 69315013701
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$83.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: BCBS Complete |
$66.74
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| Rate for Payer: Priority Health SBD |
$105.12
|
|
|
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 Commercial |
$201.50
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.50
|
| 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: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.10
|
| Rate for Payer: Priority Health SBD |
$181.35
|
|
|
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 Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.04
|
| 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: PHP Commercial |
$3.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.82
|
| Rate for Payer: Priority Health SBD |
$2.73
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 68084038811
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.75
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 68084038811
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.75
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$155.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$139.98 |
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.99
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$162.73
|
| Rate for Payer: Cofinity Commercial |
$132.45
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.38
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Healthscope Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: PHP Commercial |
$160.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$119.21
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$155.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$139.98 |
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Medicare |
$94.61
|
| Rate for Payer: Aetna Medicare |
$77.77
|
| Rate for Payer: Aetna Medicare |
$77.61
|
| Rate for Payer: Aetna Medicare |
$76.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.99
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS Complete |
$75.69
|
| Rate for Payer: BCBS Complete |
$62.09
|
| Rate for Payer: BCBS Complete |
$62.21
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$162.73
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$132.45
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Healthscope Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: PHP Commercial |
$160.84
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$119.21
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,578.27
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$3,220.44 |
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna Commercial |
$12,166.09
|
| Rate for Payer: Aetna Medicare |
$76.13
|
| Rate for Payer: Aetna Medicare |
$76.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,303.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.50
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$73.20
|
| Rate for Payer: BCBS MAPPO |
$73.20
|
| Rate for Payer: BCN Medicare Advantage |
$73.20
|
| Rate for Payer: BCN Medicare Advantage |
$73.20
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cofinity Commercial |
$2,504.79
|
| Rate for Payer: Cofinity Commercial |
$10,019.14
|
| Rate for Payer: Cofinity Commercial |
$12,309.22
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,019.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,504.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,450.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.20
|
| Rate for Payer: Healthscope Commercial |
$12,881.75
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Mclaren Medicaid |
$39.24
|
| Rate for Payer: Mclaren Medicaid |
$39.24
|
| Rate for Payer: Mclaren Medicare |
$73.20
|
| Rate for Payer: Mclaren Medicare |
$73.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.86
|
| Rate for Payer: Meridian Medicaid |
$41.20
|
| Rate for Payer: Meridian Medicaid |
$41.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,166.09
|
| Rate for Payer: PACE Medicare |
$69.54
|
| Rate for Payer: PACE Medicare |
$69.54
|
| Rate for Payer: PACE SWMI |
$73.20
|
| Rate for Payer: PACE SWMI |
$73.20
|
| Rate for Payer: PHP Commercial |
$12,166.09
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: PHP Medicare Advantage |
$73.20
|
| Rate for Payer: PHP Medicare Advantage |
$73.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,303.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,325.88
|
| Rate for Payer: Priority Health Medicare |
$73.20
|
| Rate for Payer: Priority Health Medicare |
$73.20
|
| Rate for Payer: Priority Health SBD |
$9,017.22
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
| Rate for Payer: Railroad Medicare Medicare |
$73.20
|
| Rate for Payer: Railroad Medicare Medicare |
$73.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.20
|
| Rate for Payer: UHC Medicare Advantage |
$73.20
|
| Rate for Payer: UHC Medicare Advantage |
$73.20
|
| Rate for Payer: UHCCP Medicaid |
$41.21
|
| Rate for Payer: UHCCP Medicaid |
$41.21
|
| Rate for Payer: VA VA |
$73.20
|
| Rate for Payer: VA VA |
$73.20
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,578.27
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,254.31 |
| Max. Negotiated Rate |
$3,220.44 |
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cofinity Commercial |
$2,504.79
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,504.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,325.88
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,993.45
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
190598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$2,694.11 |
| Rate for Payer: Aetna Commercial |
$2,544.43
|
| Rate for Payer: Aetna Commercial |
$10,177.42
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,782.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.83
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS MAPPO |
$27.86
|
| Rate for Payer: BCBS MAPPO |
$27.86
|
| Rate for Payer: BCN Medicare Advantage |
$27.86
|
| Rate for Payer: BCN Medicare Advantage |
$27.86
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cofinity Commercial |
$2,095.41
|
| Rate for Payer: Cofinity Commercial |
$8,381.40
|
| Rate for Payer: Cofinity Commercial |
$10,297.15
|
| Rate for Payer: Cofinity Commercial |
$2,574.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,381.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,095.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,578.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.86
|
| Rate for Payer: Healthscope Commercial |
$10,776.09
|
| Rate for Payer: Healthscope Commercial |
$2,694.11
|
| Rate for Payer: Mclaren Medicaid |
$14.93
|
| Rate for Payer: Mclaren Medicaid |
$14.93
|
| Rate for Payer: Mclaren Medicare |
$27.86
|
| Rate for Payer: Mclaren Medicare |
$27.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.25
|
| Rate for Payer: Meridian Medicaid |
$15.68
|
| Rate for Payer: Meridian Medicaid |
$15.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,544.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,177.42
|
| Rate for Payer: PACE Medicare |
$26.47
|
| Rate for Payer: PACE Medicare |
$26.47
|
| Rate for Payer: PACE SWMI |
$27.86
|
| Rate for Payer: PACE SWMI |
$27.86
|
| Rate for Payer: PHP Commercial |
$10,177.42
|
| Rate for Payer: PHP Commercial |
$2,544.43
|
| Rate for Payer: PHP Medicare Advantage |
$27.86
|
| Rate for Payer: PHP Medicare Advantage |
$27.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,782.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,945.74
|
| Rate for Payer: Priority Health Medicare |
$27.86
|
| Rate for Payer: Priority Health Medicare |
$27.86
|
| Rate for Payer: Priority Health SBD |
$7,543.26
|
| Rate for Payer: Priority Health SBD |
$1,885.87
|
| Rate for Payer: Railroad Medicare Medicare |
$27.86
|
| Rate for Payer: Railroad Medicare Medicare |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.86
|
| Rate for Payer: UHC Medicare Advantage |
$27.86
|
| Rate for Payer: UHC Medicare Advantage |
$27.86
|
| Rate for Payer: UHCCP Medicaid |
$15.69
|
| Rate for Payer: UHCCP Medicaid |
$15.69
|
| Rate for Payer: VA VA |
$27.86
|
| Rate for Payer: VA VA |
$27.86
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,427.53
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$2,184.78 |
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna Medicare |
$26.80
|
| Rate for Payer: Aetna Medicare |
$26.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.21
|
| Rate for Payer: BCBS Complete |
$14.50
|
| Rate for Payer: BCBS Complete |
$14.50
|
| Rate for Payer: BCBS MAPPO |
$25.77
|
| Rate for Payer: BCBS MAPPO |
$25.77
|
| Rate for Payer: BCN Medicare Advantage |
$25.77
|
| Rate for Payer: BCN Medicare Advantage |
$25.77
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cofinity Commercial |
$6,797.08
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Cofinity Commercial |
$1,699.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,699.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,797.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.77
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Mclaren Medicaid |
$13.81
|
| Rate for Payer: Mclaren Medicaid |
$13.81
|
| Rate for Payer: Mclaren Medicare |
$25.77
|
| Rate for Payer: Mclaren Medicare |
$25.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.06
|
| Rate for Payer: Meridian Medicaid |
$14.50
|
| Rate for Payer: Meridian Medicaid |
$14.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.59
|
| Rate for Payer: PACE Medicare |
$24.48
|
| Rate for Payer: PACE Medicare |
$24.48
|
| Rate for Payer: PACE SWMI |
$25.77
|
| Rate for Payer: PACE SWMI |
$25.77
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: PHP Medicare Advantage |
$25.77
|
| Rate for Payer: PHP Medicare Advantage |
$25.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,311.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.89
|
| Rate for Payer: Priority Health Medicare |
$25.77
|
| Rate for Payer: Priority Health Medicare |
$25.77
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Railroad Medicare Medicare |
$25.77
|
| Rate for Payer: Railroad Medicare Medicare |
$25.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.77
|
| Rate for Payer: UHC Medicare Advantage |
$25.77
|
| Rate for Payer: UHC Medicare Advantage |
$25.77
|
| Rate for Payer: UHCCP Medicaid |
$14.51
|
| Rate for Payer: UHCCP Medicaid |
$14.51
|
| Rate for Payer: VA VA |
$25.77
|
| Rate for Payer: VA VA |
$25.77
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$76.38
|
|
|
Service Code
|
NDC 00904601946
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna Medicare |
$38.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: BCBS Complete |
$30.55
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Commercial |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.92
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.65
|
| Rate for Payer: Priority Health SBD |
$48.12
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.61 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health SBD |
$63.96
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
OP
|
$107.73
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$91.57
|
| Rate for Payer: Aetna Medicare |
$53.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.02
|
| Rate for Payer: BCBS Complete |
$43.09
|
| Rate for Payer: Cash Price |
$86.18
|
| Rate for Payer: Cofinity Commercial |
$75.41
|
| Rate for Payer: Cofinity Commercial |
$92.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.18
|
| Rate for Payer: Healthscope Commercial |
$96.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.57
|
| Rate for Payer: PHP Commercial |
$91.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.02
|
| Rate for Payer: Priority Health SBD |
$67.87
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$76.38
|
|
|
Service Code
|
NDC 00904601946
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.12 |
| Max. Negotiated Rate |
$68.74 |
| Rate for Payer: Aetna Commercial |
$64.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cofinity Commercial |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.92
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.65
|
| Rate for Payer: Priority Health SBD |
$48.12
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 16729002310
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health SBD |
$63.96
|
|
|
BICALUTAMIDE 50 MG TABLET
|
Facility
|
IP
|
$107.73
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
15746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.87 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$91.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.02
|
| Rate for Payer: Cash Price |
$86.18
|
| Rate for Payer: Cofinity Commercial |
$75.41
|
| Rate for Payer: Cofinity Commercial |
$92.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.18
|
| Rate for Payer: Healthscope Commercial |
$96.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.57
|
| Rate for Payer: PHP Commercial |
$91.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.02
|
| Rate for Payer: Priority Health SBD |
$67.87
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
IP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250101
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,582.02 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Commercial |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,646.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,886.21
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
OP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250101
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,083.82 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna Medicare |
$7,604.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: BCBS Complete |
$6,083.82
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Commercial |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,646.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,886.21
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
OP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250103
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,083.82 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna Medicare |
$7,604.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: BCBS Complete |
$6,083.82
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Commercial |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,646.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,886.21
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET
|
Facility
|
IP
|
$15,209.56
|
|
|
Service Code
|
NDC 61958250103
|
| Hospital Charge Code |
185933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,582.02 |
| Max. Negotiated Rate |
$13,688.60 |
| Rate for Payer: Aetna Commercial |
$12,928.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,886.21
|
| Rate for Payer: Cash Price |
$12,167.65
|
| Rate for Payer: Cofinity Commercial |
$10,646.69
|
| Rate for Payer: Cofinity Commercial |
$13,080.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,646.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,167.65
|
| Rate for Payer: Healthscope Commercial |
$13,688.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,928.13
|
| Rate for Payer: PHP Commercial |
$12,928.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,886.21
|
| Rate for Payer: Priority Health SBD |
$9,582.02
|
|
|
BIOPSY, BONE, OPEN; SUPERFICIAL (EG, STERNUM, SPINOUS PROCESS, RIB, PATELLA, OLECRANON PROCESS, CALCANEUS, TARSAL, METATARSAL, CARPAL, METACARPAL, PHALANX)
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 20240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR)
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 20225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
BIOPSY, MUSCLE; DEEP
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 20205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 20206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
