|
TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 26455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
TENOTOMY, FLEXOR, PALM, OPEN, EACH TENDON
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
TENOTOMY, LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS MUSCLE
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 28234
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 25290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
TENOTOMY, OPEN, TENDON FLEXOR; FOOT, SINGLE OR MULTIPLE TENDON(S) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 28230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 28232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 27606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 28011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 28010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
TENOTOMY, SHOULDER AREA; SINGLE TENDON
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44,245.82
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,468.16 |
| Max. Negotiated Rate |
$39,821.24 |
| Rate for Payer: Aetna American Axle |
$28,759.78
|
| Rate for Payer: Aetna Commercial |
$37,608.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,759.78
|
| Rate for Payer: Cash Price |
$35,396.66
|
| Rate for Payer: Cofinity Commercial |
$30,972.07
|
| Rate for Payer: Cofinity Commercial |
$38,051.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$30,972.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,396.66
|
| Rate for Payer: Healthscope Commercial |
$39,821.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,972.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33,184.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,608.95
|
| Rate for Payer: PHP Commercial |
$37,608.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,759.78
|
| Rate for Payer: Priority Health SBD |
$27,874.87
|
| Rate for Payer: UMR Bronson Commercial |
$19,468.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33,184.36
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44,245.82
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.53 |
| Max. Negotiated Rate |
$39,821.24 |
| Rate for Payer: Aetna American Axle |
$28,759.78
|
| Rate for Payer: Aetna Commercial |
$37,608.95
|
| Rate for Payer: Aetna Medicare |
$373.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,759.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$448.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$448.99
|
| Rate for Payer: BCBS Complete |
$202.15
|
| Rate for Payer: BCBS MAPPO |
$359.19
|
| Rate for Payer: BCN Medicare Advantage |
$359.19
|
| Rate for Payer: Cash Price |
$35,396.66
|
| Rate for Payer: Cash Price |
$35,396.66
|
| Rate for Payer: Cofinity Commercial |
$38,051.41
|
| Rate for Payer: Cofinity Commercial |
$30,972.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$30,972.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,396.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.19
|
| Rate for Payer: Healthscope Commercial |
$39,821.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,972.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33,184.36
|
| Rate for Payer: Mclaren Medicaid |
$192.53
|
| Rate for Payer: Mclaren Medicare |
$359.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.15
|
| Rate for Payer: Meridian Medicaid |
$202.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$413.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,608.95
|
| Rate for Payer: PACE Medicare |
$341.23
|
| Rate for Payer: PACE SWMI |
$359.19
|
| Rate for Payer: PHP Commercial |
$37,608.95
|
| Rate for Payer: PHP Medicare Advantage |
$359.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,759.78
|
| Rate for Payer: Priority Health Medicare |
$359.19
|
| Rate for Payer: Priority Health SBD |
$27,874.87
|
| Rate for Payer: Railroad Medicare Medicare |
$359.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,011.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.19
|
| Rate for Payer: UHC Exchange |
$686.45
|
| Rate for Payer: UHC Medicare Advantage |
$359.19
|
| Rate for Payer: UHCCP Medicaid |
$192.53
|
| Rate for Payer: UMR Bronson Commercial |
$16,370.95
|
| Rate for Payer: VA VA |
$359.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33,184.36
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$31.29
|
|
|
Service Code
|
NDC 51672208002
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna American Axle |
$20.34
|
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.34
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health SBD |
$19.71
|
| Rate for Payer: UMR Bronson Commercial |
$13.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$23.90
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: Aetna American Axle |
$15.54
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$11.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: BCBS Complete |
$9.56
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$16.73
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health SBD |
$15.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.93
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$23.90
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: Aetna American Axle |
$15.54
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$16.73
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health SBD |
$15.06
|
| Rate for Payer: UMR Bronson Commercial |
$10.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.93
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$31.29
|
|
|
Service Code
|
NDC 51672208002
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna American Axle |
$20.34
|
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Medicare |
$15.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.34
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health SBD |
$19.71
|
| Rate for Payer: UMR Bronson Commercial |
$11.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
NDC 96295013323
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
NDC 96295013323
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
OP
|
$90.24
|
|
|
Service Code
|
NDC 51991052633
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.39 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna American Axle |
$58.66
|
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: Aetna Medicare |
$45.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.66
|
| Rate for Payer: BCBS Complete |
$36.10
|
| Rate for Payer: Cash Price |
$72.19
|
| Rate for Payer: Cofinity Commercial |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.70
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.66
|
| Rate for Payer: Priority Health SBD |
$56.85
|
| Rate for Payer: UMR Bronson Commercial |
$33.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.68
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$90.24
|
|
|
Service Code
|
NDC 51991052633
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.71 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna American Axle |
$58.66
|
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.66
|
| Rate for Payer: Cash Price |
$72.19
|
| Rate for Payer: Cofinity Commercial |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.70
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.66
|
| Rate for Payer: Priority Health SBD |
$56.85
|
| Rate for Payer: UMR Bronson Commercial |
$39.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.68
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$67.83
|
|
|
Service Code
|
NDC 65862007930
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna American Axle |
$44.09
|
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.09
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$47.48
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Healthscope Commercial |
$61.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.66
|
| Rate for Payer: PHP Commercial |
$57.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health SBD |
$42.73
|
| Rate for Payer: UMR Bronson Commercial |
$29.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.87
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
OP
|
$92.36
|
|
|
Service Code
|
NDC 69097085902
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.17 |
| Max. Negotiated Rate |
$83.12 |
| Rate for Payer: Aetna American Axle |
$60.03
|
| Rate for Payer: Aetna Commercial |
$78.51
|
| Rate for Payer: Aetna Medicare |
$46.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.03
|
| Rate for Payer: BCBS Complete |
$36.94
|
| Rate for Payer: Cash Price |
$73.89
|
| Rate for Payer: Cofinity Commercial |
$64.65
|
| Rate for Payer: Cofinity Commercial |
$79.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.89
|
| Rate for Payer: Healthscope Commercial |
$83.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.51
|
| Rate for Payer: PHP Commercial |
$78.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.03
|
| Rate for Payer: Priority Health SBD |
$58.19
|
| Rate for Payer: UMR Bronson Commercial |
$34.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.27
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
OP
|
$67.83
|
|
|
Service Code
|
NDC 65862007930
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.10 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna American Axle |
$44.09
|
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna Medicare |
$33.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.09
|
| Rate for Payer: BCBS Complete |
$27.13
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$47.48
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Healthscope Commercial |
$61.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.66
|
| Rate for Payer: PHP Commercial |
$57.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health SBD |
$42.73
|
| Rate for Payer: UMR Bronson Commercial |
$25.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.87
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$68.39
|
|
|
Service Code
|
NDC 69097073102
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna American Axle |
$44.45
|
| Rate for Payer: Aetna Commercial |
$58.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.45
|
| Rate for Payer: Cash Price |
$54.71
|
| Rate for Payer: Cofinity Commercial |
$47.87
|
| Rate for Payer: Cofinity Commercial |
$58.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.71
|
| Rate for Payer: Healthscope Commercial |
$61.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.13
|
| Rate for Payer: PHP Commercial |
$58.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.45
|
| Rate for Payer: Priority Health SBD |
$43.09
|
| Rate for Payer: UMR Bronson Commercial |
$30.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.29
|
|
