|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$4.73
|
|
|
Service Code
|
NDC 50268012711
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$4.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.07
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$4.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.02
|
| Rate for Payer: PHP Commercial |
$4.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: Priority Health SBD |
$2.98
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$236.16
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.78 |
| Max. Negotiated Rate |
$212.54 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.50
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$203.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.93
|
| Rate for Payer: Healthscope Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.50
|
| Rate for Payer: Priority Health SBD |
$148.78
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$415.95
|
|
|
Service Code
|
NDC 52817027010
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.38 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: Aetna Medicare |
$207.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.37
|
| Rate for Payer: BCBS Complete |
$166.38
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Commercial |
$291.16
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.37
|
| Rate for Payer: Priority Health SBD |
$262.05
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$236.16
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$212.54 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna Medicare |
$118.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.50
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$203.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.93
|
| Rate for Payer: Healthscope Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.50
|
| Rate for Payer: Priority Health SBD |
$148.78
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
NDC 29300012601
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna Medicare |
$235.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health SBD |
$296.10
|
|
|
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
|
Facility
|
OP
|
$2,055.42
|
|
|
Service Code
|
CPT 51720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$2,055.42 |
| Rate for Payer: Aetna Medicare |
$680.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$402.53
|
| Rate for Payer: BCN Commercial |
$402.53
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Nomi Health Commercial |
$1,373.34
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,055.42
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,644.34
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.16
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$653.97
|
|
|
BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 51700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$31.88 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$138.31
|
| Rate for Payer: BCN Commercial |
$138.31
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.88
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$134.16
|
| Rate for Payer: VA VA |
$238.29
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$492.10
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$442.89 |
| Rate for Payer: Aetna Commercial |
$418.28
|
| Rate for Payer: Aetna Commercial |
$408.44
|
| Rate for Payer: Aetna Commercial |
$233.15
|
| Rate for Payer: Aetna Medicare |
$240.26
|
| Rate for Payer: Aetna Medicare |
$246.05
|
| Rate for Payer: Aetna Medicare |
$137.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.86
|
| Rate for Payer: BCBS Complete |
$192.21
|
| Rate for Payer: BCBS Complete |
$196.84
|
| Rate for Payer: BCBS Complete |
$109.72
|
| Rate for Payer: BCBS Trust/PPO |
$68.43
|
| Rate for Payer: BCBS Trust/PPO |
$68.43
|
| Rate for Payer: BCBS Trust/PPO |
$68.43
|
| Rate for Payer: BCN Commercial |
$68.43
|
| Rate for Payer: BCN Commercial |
$68.43
|
| Rate for Payer: BCN Commercial |
$68.43
|
| Rate for Payer: Cash Price |
$219.43
|
| Rate for Payer: Cash Price |
$219.43
|
| Rate for Payer: Cash Price |
$393.68
|
| Rate for Payer: Cash Price |
$384.42
|
| Rate for Payer: Cash Price |
$384.42
|
| Rate for Payer: Cash Price |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$336.36
|
| Rate for Payer: Cofinity Commercial |
$423.21
|
| Rate for Payer: Cofinity Commercial |
$344.47
|
| Rate for Payer: Cofinity Commercial |
$413.25
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$235.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$344.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.43
|
| Rate for Payer: Healthscope Commercial |
$442.89
|
| Rate for Payer: Healthscope Commercial |
$432.47
|
| Rate for Payer: Healthscope Commercial |
$246.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.28
|
| Rate for Payer: PHP Commercial |
$418.28
|
| Rate for Payer: PHP Commercial |
$233.15
|
| Rate for Payer: PHP Commercial |
$408.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.29
|
| Rate for Payer: Priority Health SBD |
$302.73
|
| Rate for Payer: Priority Health SBD |
$310.02
|
| Rate for Payer: Priority Health SBD |
$172.80
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$536.32
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
17012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$482.69 |
| Rate for Payer: Aetna Commercial |
$455.87
|
| Rate for Payer: Aetna Commercial |
$775.80
|
| Rate for Payer: Aetna Medicare |
$456.35
|
| Rate for Payer: Aetna Medicare |
$268.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.26
|
| Rate for Payer: BCBS Complete |
$214.53
|
| Rate for Payer: BCBS Complete |
$365.08
|
| Rate for Payer: BCBS Trust/PPO |
$68.43
|
| Rate for Payer: BCBS Trust/PPO |
$68.43
|
| Rate for Payer: BCN Commercial |
$68.43
|
| Rate for Payer: BCN Commercial |
$68.43
|
| Rate for Payer: Cash Price |
$429.06
|
| Rate for Payer: Cash Price |
$730.16
|
| Rate for Payer: Cash Price |
$429.06
|
| Rate for Payer: Cash Price |
$730.16
|
| Rate for Payer: Cofinity Commercial |
$638.89
|
| Rate for Payer: Cofinity Commercial |
$461.24
|
| Rate for Payer: Cofinity Commercial |
$784.92
|
| Rate for Payer: Cofinity Commercial |
$375.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$638.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$375.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.06
|
| Rate for Payer: Healthscope Commercial |
$482.69
|
| Rate for Payer: Healthscope Commercial |
$821.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.87
|
| Rate for Payer: PHP Commercial |
$775.80
|
| Rate for Payer: PHP Commercial |
$455.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.26
|
| Rate for Payer: Priority Health SBD |
$575.00
|
| Rate for Payer: Priority Health SBD |
$337.88
|
|
|
BLEPHAROPLASTY, UPPER EYELID;
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$413.15 |
| 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 |
$804.62
|
| Rate for Payer: BCN Commercial |
$804.62
|
| 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) |
$413.15
|
| 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
|
|
|
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$569.47 |
| 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 |
$985.93
|
| Rate for Payer: BCN Commercial |
$985.93
|
| 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) |
$569.47
|
| 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
|
|
|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.42 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,763.16
|
| Rate for Payer: BCN Commercial |
$2,763.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.42
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION
|
Facility
|
OP
|
$192.88
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$173.59 |
| Rate for Payer: Aetna Commercial |
$163.95
|
| Rate for Payer: Aetna Medicare |
$96.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.37
|
| Rate for Payer: BCBS Complete |
$77.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.35
|
| Rate for Payer: BCN Commercial |
$4.35
|
| Rate for Payer: Cash Price |
$154.30
|
| Rate for Payer: Cash Price |
$154.30
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$165.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.30
|
| Rate for Payer: Healthscope Commercial |
$173.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.95
|
| Rate for Payer: PHP Commercial |
$163.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.37
|
| Rate for Payer: Priority Health SBD |
$121.51
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$6,907.69
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$6,216.92 |
| Rate for Payer: Aetna Commercial |
$5,871.54
|
| Rate for Payer: Aetna Medicare |
$17.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,490.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.62
|
| Rate for Payer: BCBS Complete |
$9.29
|
| Rate for Payer: BCBS MAPPO |
$16.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.54
|
| Rate for Payer: BCN Commercial |
$7.54
|
| Rate for Payer: BCN Medicare Advantage |
$16.50
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cofinity Commercial |
$5,940.61
|
| Rate for Payer: Cofinity Commercial |
$4,835.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,835.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,526.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.50
|
| Rate for Payer: Healthscope Commercial |
$6,216.92
|
| Rate for Payer: Mclaren Medicaid |
$8.84
|
| Rate for Payer: Mclaren Medicare |
$16.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.32
|
| Rate for Payer: Meridian Medicaid |
$9.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,871.54
|
| Rate for Payer: Nomi Health Commercial |
$49.50
|
| Rate for Payer: PACE Medicare |
$15.68
|
| Rate for Payer: PACE SWMI |
$16.50
|
| Rate for Payer: PHP Commercial |
$5,871.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.48
|
| Rate for Payer: Priority Health Medicare |
$16.50
|
| Rate for Payer: Priority Health Narrow Network |
$37.98
|
| Rate for Payer: Priority Health SBD |
$4,351.84
|
| Rate for Payer: Railroad Medicare Medicare |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.50
|
| Rate for Payer: UHC Medicare Advantage |
$16.50
|
| Rate for Payer: UHCCP Medicaid |
$9.29
|
| Rate for Payer: VA VA |
$16.50
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$192.88
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$173.59 |
| Rate for Payer: Aetna Commercial |
$163.95
|
| Rate for Payer: Aetna Medicare |
$96.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.37
|
| Rate for Payer: BCBS Complete |
$77.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.35
|
| Rate for Payer: BCN Commercial |
$4.35
|
| Rate for Payer: Cash Price |
$154.30
|
| Rate for Payer: Cash Price |
$154.30
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$165.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.30
|
| Rate for Payer: Healthscope Commercial |
$173.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.95
|
| Rate for Payer: PHP Commercial |
$163.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.37
|
| Rate for Payer: Priority Health SBD |
$121.51
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$6,907.69
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,351.84 |
| Max. Negotiated Rate |
$6,216.92 |
| Rate for Payer: Aetna Commercial |
$5,871.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,490.00
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cofinity Commercial |
$4,835.38
|
| Rate for Payer: Cofinity Commercial |
$5,940.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,835.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,526.15
|
| Rate for Payer: Healthscope Commercial |
$6,216.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,871.54
|
| Rate for Payer: PHP Commercial |
$5,871.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,490.00
|
| Rate for Payer: Priority Health SBD |
$4,351.84
|
|
|
BORTEZOMIB 3.5 MG SUBCUTANEOUS INJECTION
|
Facility
|
OP
|
$192.88
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
151057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$173.59 |
| Rate for Payer: Aetna Commercial |
$163.95
|
| Rate for Payer: Aetna Medicare |
$96.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.37
|
| Rate for Payer: BCBS Complete |
$77.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.35
|
| Rate for Payer: BCN Commercial |
$4.35
|
| Rate for Payer: Cash Price |
$154.30
|
| Rate for Payer: Cash Price |
$154.30
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$165.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.30
|
| Rate for Payer: Healthscope Commercial |
$173.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.95
|
| Rate for Payer: PHP Commercial |
$163.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.37
|
| Rate for Payer: Priority Health SBD |
$121.51
|
|
|
BREAST REDUCTION
|
Facility
|
OP
|
$20,082.39
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,156.95 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,912.43
|
| Rate for Payer: BCN Commercial |
$3,912.43
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,156.95
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,597.34
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$54,778.00
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34,510.14 |
| Max. Negotiated Rate |
$49,300.20 |
| Rate for Payer: Aetna Commercial |
$46,561.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,605.70
|
| Rate for Payer: Cash Price |
$43,822.40
|
| Rate for Payer: Cofinity Commercial |
$38,344.60
|
| Rate for Payer: Cofinity Commercial |
$47,109.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$38,344.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,822.40
|
| Rate for Payer: Healthscope Commercial |
$49,300.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,561.30
|
| Rate for Payer: PHP Commercial |
$46,561.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,605.70
|
| Rate for Payer: Priority Health SBD |
$34,510.14
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$54,778.00
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.43 |
| Max. Negotiated Rate |
$49,300.20 |
| Rate for Payer: Aetna Commercial |
$46,561.30
|
| Rate for Payer: Aetna Medicare |
$258.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35,605.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.16
|
| Rate for Payer: BCBS Complete |
$140.10
|
| Rate for Payer: BCBS MAPPO |
$248.93
|
| Rate for Payer: BCBS Trust/PPO |
$664.98
|
| Rate for Payer: BCN Commercial |
$664.98
|
| Rate for Payer: BCN Medicare Advantage |
$248.93
|
| Rate for Payer: Cash Price |
$43,822.40
|
| Rate for Payer: Cash Price |
$43,822.40
|
| Rate for Payer: Cofinity Commercial |
$47,109.08
|
| Rate for Payer: Cofinity Commercial |
$38,344.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$38,344.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,822.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.93
|
| Rate for Payer: Healthscope Commercial |
$49,300.20
|
| Rate for Payer: Mclaren Medicaid |
$133.43
|
| Rate for Payer: Mclaren Medicare |
$248.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.38
|
| Rate for Payer: Meridian Medicaid |
$140.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,561.30
|
| Rate for Payer: Nomi Health Commercial |
$746.79
|
| Rate for Payer: PACE Medicare |
$236.48
|
| Rate for Payer: PACE SWMI |
$248.93
|
| Rate for Payer: PHP Commercial |
$46,561.30
|
| Rate for Payer: PHP Medicare Advantage |
$248.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,605.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.31
|
| Rate for Payer: Priority Health Medicare |
$248.93
|
| Rate for Payer: Priority Health Narrow Network |
$552.25
|
| Rate for Payer: Priority Health SBD |
$34,510.14
|
| Rate for Payer: Railroad Medicare Medicare |
$248.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.93
|
| Rate for Payer: UHC Medicare Advantage |
$248.93
|
| Rate for Payer: UHCCP Medicaid |
$140.15
|
| Rate for Payer: VA VA |
$248.93
|
|
|
BREXPIPRAZOLE 3 MG TABLET
|
Facility
|
OP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003913
|
| Hospital Charge Code |
174668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,086.18 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna Medicare |
$2,607.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: BCBS Complete |
$2,086.18
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
|
|
BREXPIPRAZOLE 3 MG TABLET
|
Facility
|
IP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003913
|
| Hospital Charge Code |
174668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,285.73 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$349.37
|
|
|
Service Code
|
NDC 82182077305
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$314.43 |
| Rate for Payer: Aetna Commercial |
$296.96
|
| Rate for Payer: Aetna Medicare |
$174.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.09
|
| Rate for Payer: BCBS Complete |
$139.75
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cofinity Commercial |
$244.56
|
| Rate for Payer: Cofinity Commercial |
$300.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$244.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.50
|
| Rate for Payer: Healthscope Commercial |
$314.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.96
|
| Rate for Payer: PHP Commercial |
$296.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.09
|
| Rate for Payer: Priority Health SBD |
$220.10
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$499.17
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.67 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna Medicare |
$249.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: BCBS Complete |
$199.67
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.29
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.46
|
| Rate for Payer: Priority Health SBD |
$314.48
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$499.17
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.48 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.29
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.46
|
| Rate for Payer: Priority Health SBD |
$314.48
|
|
