|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,313.05
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.23 |
| Max. Negotiated Rate |
$12,881.74 |
| Rate for Payer: Aetna Commercial |
$12,166.09
|
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna Medicare |
$76.12
|
| Rate for Payer: Aetna Medicare |
$76.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,303.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.49
|
| Rate for Payer: BCBS Complete |
$41.19
|
| Rate for Payer: BCBS Complete |
$41.19
|
| Rate for Payer: BCBS MAPPO |
$73.19
|
| Rate for Payer: BCBS MAPPO |
$73.19
|
| Rate for Payer: BCBS Trust/PPO |
$205.36
|
| Rate for Payer: BCBS Trust/PPO |
$205.36
|
| Rate for Payer: BCN Commercial |
$205.36
|
| Rate for Payer: BCN Commercial |
$205.36
|
| Rate for Payer: BCN Medicare Advantage |
$73.19
|
| Rate for Payer: BCN Medicare Advantage |
$73.19
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| 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 Medicare Advantage |
$10,019.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,504.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,450.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.19
|
| Rate for Payer: Healthscope Commercial |
$12,881.74
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Mclaren Medicaid |
$39.23
|
| Rate for Payer: Mclaren Medicaid |
$39.23
|
| Rate for Payer: Mclaren Medicare |
$73.19
|
| Rate for Payer: Mclaren Medicare |
$73.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.85
|
| Rate for Payer: Meridian Medicaid |
$41.19
|
| Rate for Payer: Meridian Medicaid |
$41.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.17
|
| 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: Nomi Health Commercial |
$219.57
|
| Rate for Payer: Nomi Health Commercial |
$219.57
|
| Rate for Payer: PACE Medicare |
$69.53
|
| Rate for Payer: PACE Medicare |
$69.53
|
| Rate for Payer: PACE SWMI |
$73.19
|
| Rate for Payer: PACE SWMI |
$73.19
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: PHP Commercial |
$12,166.09
|
| Rate for Payer: PHP Medicare Advantage |
$73.19
|
| Rate for Payer: PHP Medicare Advantage |
$73.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,325.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,303.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.26
|
| Rate for Payer: Priority Health Medicare |
$73.19
|
| Rate for Payer: Priority Health Medicare |
$73.19
|
| Rate for Payer: Priority Health Narrow Network |
$167.41
|
| Rate for Payer: Priority Health Narrow Network |
$167.41
|
| Rate for Payer: Priority Health SBD |
$9,017.22
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
| Rate for Payer: Railroad Medicare Medicare |
$73.19
|
| Rate for Payer: Railroad Medicare Medicare |
$73.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.19
|
| Rate for Payer: UHC Medicare Advantage |
$73.19
|
| Rate for Payer: UHC Medicare Advantage |
$73.19
|
| Rate for Payer: UHCCP Medicaid |
$41.21
|
| Rate for Payer: UHCCP Medicaid |
$41.21
|
| Rate for Payer: VA VA |
$73.19
|
| Rate for Payer: VA VA |
$73.19
|
|
|
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 |
$15.40 |
| Max. Negotiated Rate |
$2,694.10 |
| Rate for Payer: Aetna Commercial |
$2,544.43
|
| Rate for Payer: Aetna Commercial |
$10,177.42
|
| Rate for Payer: Aetna Medicare |
$29.88
|
| Rate for Payer: Aetna Medicare |
$29.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,782.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.91
|
| Rate for Payer: BCBS Complete |
$16.17
|
| Rate for Payer: BCBS Complete |
$16.17
|
| Rate for Payer: BCBS MAPPO |
$28.73
|
| Rate for Payer: BCBS MAPPO |
$28.73
|
| Rate for Payer: BCBS Trust/PPO |
$71.95
|
| Rate for Payer: BCBS Trust/PPO |
$71.95
|
| Rate for Payer: BCN Commercial |
$71.95
|
| Rate for Payer: BCN Commercial |
$71.95
|
| Rate for Payer: BCN Medicare Advantage |
$28.73
|
| Rate for Payer: BCN Medicare Advantage |
$28.73
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cofinity Commercial |
$2,574.37
|
| Rate for Payer: Cofinity Commercial |
$8,381.40
|
| Rate for Payer: Cofinity Commercial |
$2,095.42
|
| Rate for Payer: Cofinity Commercial |
$10,297.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,381.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,095.42
|
| 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 |
$28.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.73
|
| Rate for Payer: Healthscope Commercial |
$2,694.10
|
| Rate for Payer: Healthscope Commercial |
$10,776.09
|
| Rate for Payer: Mclaren Medicaid |
$15.40
|
| Rate for Payer: Mclaren Medicaid |
$15.40
|
| Rate for Payer: Mclaren Medicare |
$28.73
|
| Rate for Payer: Mclaren Medicare |
$28.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.17
|
| Rate for Payer: Meridian Medicaid |
$16.17
|
| Rate for Payer: Meridian Medicaid |
$16.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.04
|
| 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: Nomi Health Commercial |
$86.19
|
| Rate for Payer: Nomi Health Commercial |
$86.19
|
| Rate for Payer: PACE Medicare |
$27.29
|
| Rate for Payer: PACE Medicare |
$27.29
|
| Rate for Payer: PACE SWMI |
$28.73
|
| Rate for Payer: PACE SWMI |
$28.73
|
| Rate for Payer: PHP Commercial |
$2,544.43
|
| Rate for Payer: PHP Commercial |
$10,177.42
|
| Rate for Payer: PHP Medicare Advantage |
$28.73
|
| Rate for Payer: PHP Medicare Advantage |
$28.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,945.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,782.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.50
|
| Rate for Payer: Priority Health Medicare |
$28.73
|
| Rate for Payer: Priority Health Medicare |
$28.73
|
| Rate for Payer: Priority Health Narrow Network |
$61.20
|
| Rate for Payer: Priority Health Narrow Network |
$61.20
|
| Rate for Payer: Priority Health SBD |
$1,885.87
|
| Rate for Payer: Priority Health SBD |
$7,543.26
|
| Rate for Payer: Railroad Medicare Medicare |
$28.73
|
| Rate for Payer: Railroad Medicare Medicare |
$28.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.73
|
| Rate for Payer: UHC Medicare Advantage |
$28.73
|
| Rate for Payer: UHC Medicare Advantage |
$28.73
|
| Rate for Payer: UHCCP Medicaid |
$16.17
|
| Rate for Payer: UHCCP Medicaid |
$16.17
|
| Rate for Payer: VA VA |
$28.73
|
| Rate for Payer: VA VA |
$28.73
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,710.11
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$8,739.10 |
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.75
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$23.00
|
| Rate for Payer: BCBS MAPPO |
$23.00
|
| Rate for Payer: BCBS Trust/PPO |
$54.17
|
| Rate for Payer: BCBS Trust/PPO |
$54.17
|
| Rate for Payer: BCN Commercial |
$54.17
|
| Rate for Payer: BCN Commercial |
$54.17
|
| Rate for Payer: BCN Medicare Advantage |
$23.00
|
| Rate for Payer: BCN Medicare Advantage |
$23.00
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cofinity Commercial |
$6,797.08
|
| Rate for Payer: Cofinity Commercial |
$1,699.27
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| 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 |
$23.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.00
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicare |
$23.00
|
| Rate for Payer: Mclaren Medicare |
$23.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.15
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.45
|
| 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: Nomi Health Commercial |
$69.00
|
| Rate for Payer: Nomi Health Commercial |
$69.00
|
| Rate for Payer: PACE Medicare |
$21.85
|
| Rate for Payer: PACE Medicare |
$21.85
|
| Rate for Payer: PACE SWMI |
$23.00
|
| Rate for Payer: PACE SWMI |
$23.00
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: PHP Medicare Advantage |
$23.00
|
| Rate for Payer: PHP Medicare Advantage |
$23.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,311.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.88
|
| Rate for Payer: Priority Health Medicare |
$23.00
|
| Rate for Payer: Priority Health Medicare |
$23.00
|
| Rate for Payer: Priority Health Narrow Network |
$54.30
|
| Rate for Payer: Priority Health Narrow Network |
$54.30
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Railroad Medicare Medicare |
$23.00
|
| Rate for Payer: Railroad Medicare Medicare |
$23.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.00
|
| Rate for Payer: UHC Medicare Advantage |
$23.00
|
| Rate for Payer: UHC Medicare Advantage |
$23.00
|
| Rate for Payer: UHCCP Medicaid |
$12.95
|
| Rate for Payer: UHCCP Medicaid |
$12.95
|
| Rate for Payer: VA VA |
$23.00
|
| Rate for Payer: VA VA |
$23.00
|
|
|
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
|
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
|
$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 |
$53.86
|
| 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
|
$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
|
|
|
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
|
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
|
|
|
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
|
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
|
|
|
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 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 |
$13,080.22
|
| Rate for Payer: Cofinity Commercial |
$10,646.69
|
| 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
|
$8,813.49
|
|
|
Service Code
|
CPT 20240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.36 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,866.27
|
| Rate for Payer: BCN Commercial |
$1,866.27
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.36
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR)
|
Facility
|
OP
|
$4,989.41
|
|
|
Service Code
|
CPT 20225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.23 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$931.52
|
| Rate for Payer: BCN Commercial |
$931.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.23
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
BIOPSY, MUSCLE; DEEP
|
Facility
|
OP
|
$8,813.49
|
|
|
Service Code
|
CPT 20205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$166.67 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,714.45
|
| Rate for Payer: BCN Commercial |
$1,714.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.67
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE
|
Facility
|
OP
|
$4,989.41
|
|
|
Service Code
|
CPT 20206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$59.58 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$571.30
|
| Rate for Payer: BCN Commercial |
$571.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.58
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 42804
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.64 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$840.61
|
| Rate for Payer: BCN Commercial |
$840.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.64
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,788.93
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 45100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.26 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,641.18
|
| Rate for Payer: BCN Commercial |
$1,641.18
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.26
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,512.75
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,681.40
|
|
|
Service Code
|
CPT 57500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$79.89 |
| Max. Negotiated Rate |
$2,681.40 |
| Rate for Payer: Aetna Medicare |
$887.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,066.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,066.41
|
| Rate for Payer: BCBS Complete |
$480.14
|
| Rate for Payer: BCBS MAPPO |
$853.13
|
| Rate for Payer: BCBS Trust/PPO |
$452.82
|
| Rate for Payer: BCN Commercial |
$452.82
|
| Rate for Payer: BCN Medicare Advantage |
$853.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$853.13
|
| Rate for Payer: Mclaren Medicaid |
$457.28
|
| Rate for Payer: Mclaren Medicare |
$853.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.79
|
| Rate for Payer: Meridian Medicaid |
$480.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$981.10
|
| Rate for Payer: Nomi Health Commercial |
$1,791.57
|
| Rate for Payer: PACE Medicare |
$810.47
|
| Rate for Payer: PACE SWMI |
$853.13
|
| Rate for Payer: PHP Medicare Advantage |
$853.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,681.40
|
| Rate for Payer: Priority Health Medicare |
$853.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$853.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.89
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$853.13
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$853.13
|
| Rate for Payer: UHCCP Medicaid |
$480.31
|
| Rate for Payer: VA VA |
$853.13
|
|
|
BIOPSY OF PALATE, UVULA
|
Facility
|
OP
|
$4,561.52
|
|
|
Service Code
|
CPT 42100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.49 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$75.49
|
| Rate for Payer: BCN Commercial |
$75.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.32
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$817.10
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
BIOPSY OF PENIS; (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,989.41
|
|
|
Service Code
|
CPT 54100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$543.70
|
| Rate for Payer: BCN Commercial |
$543.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.18
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
BIOPSY OF TONGUE; POSTERIOR ONE-THIRD
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 41105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$88.30 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$88.30
|
| Rate for Payer: BCN Commercial |
$88.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.78
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,788.93
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
BIOPSY OF VAGINAL MUCOSA; EXTENSIVE, REQUIRING SUTURE (INCLUDING CYSTS)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$154.33 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$953.12
|
| Rate for Payer: BCN Commercial |
$953.12
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.33
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
