|
BARIUM SULFATE 98 % ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$5.38
|
|
|
Service Code
|
NDC 32909076401
|
| Hospital Charge Code |
19436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: ASR ASR |
$5.21
|
| Rate for Payer: BCBS Trust/PPO |
$4.41
|
| Rate for Payer: BCN Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$5.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$5.21
|
| Rate for Payer: Healthscope Whirlpool |
$5.38
|
| Rate for Payer: Mclaren Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: Nomi Health Commercial |
$4.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.73
|
|
|
BARIUM SULFATE 98 % ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
NDC 32909076401
|
| Hospital Charge Code |
19436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$1.99
|
| Rate for Payer: ASR ASR |
$5.21
|
| Rate for Payer: BCBS Complete |
$2.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.43
|
| Rate for Payer: BCN Commercial |
$4.43
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$5.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$5.21
|
| Rate for Payer: Healthscope Whirlpool |
$5.38
|
| Rate for Payer: Mclaren Commercial |
$4.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.57
|
| Rate for Payer: Nomi Health Commercial |
$4.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.71
|
| Rate for Payer: Priority Health Narrow Network |
$3.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.73
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$28,512.13
|
|
|
Service Code
|
MSDRG 886
|
| Min. Negotiated Rate |
$15,864.25 |
| Max. Negotiated Rate |
$28,512.13 |
| Rate for Payer: Aetna Medicare |
$16,699.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,874.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,874.01
|
| Rate for Payer: BCBS MAPPO |
$16,699.21
|
| Rate for Payer: BCN Medicare Advantage |
$16,699.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,699.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,699.21
|
| Rate for Payer: Mclaren Medicare |
$16,699.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,204.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,369.13
|
| Rate for Payer: PACE Medicare |
$15,864.25
|
| Rate for Payer: PACE SWMI |
$16,699.21
|
| Rate for Payer: PHP Commercial |
$18,369.13
|
| Rate for Payer: PHP Medicare Advantage |
$16,699.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28,512.13
|
| Rate for Payer: Priority Health Medicare |
$16,699.21
|
| Rate for Payer: Priority Health Narrow Network |
$22,809.71
|
| Rate for Payer: Railroad Medicare Medicare |
$16,699.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,699.21
|
| Rate for Payer: UHC Exchange |
$25,883.78
|
| Rate for Payer: UHCCP DNSP |
$16,699.21
|
| Rate for Payer: VA VA |
$16,699.21
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 65162075110
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$137.47
|
| Rate for Payer: Aetna Medicare |
$56.52
|
| Rate for Payer: ASR ASR |
$148.17
|
| Rate for Payer: BCBS Complete |
$61.10
|
| Rate for Payer: BCBS Trust/PPO |
$125.94
|
| Rate for Payer: BCN Commercial |
$125.94
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$143.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$148.17
|
| Rate for Payer: Healthscope Whirlpool |
$152.75
|
| Rate for Payer: Mclaren Commercial |
$137.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.84
|
| Rate for Payer: Priority Health Narrow Network |
$107.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.42
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
OP
|
$128.64
|
|
|
Service Code
|
NDC 50268010915
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$128.64 |
| Rate for Payer: Aetna Commercial |
$115.78
|
| Rate for Payer: Aetna Medicare |
$47.60
|
| Rate for Payer: ASR ASR |
$124.78
|
| Rate for Payer: BCBS Complete |
$51.46
|
| Rate for Payer: BCBS Trust/PPO |
$106.06
|
| Rate for Payer: BCN Commercial |
$106.06
|
| Rate for Payer: Cash Price |
$102.91
|
| Rate for Payer: Cofinity Commercial |
$120.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.91
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Healthscope Whirlpool |
$128.64
|
| Rate for Payer: Mclaren Commercial |
$115.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.34
|
| Rate for Payer: Nomi Health Commercial |
$105.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$112.71
|
| Rate for Payer: Priority Health Narrow Network |
$90.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.20
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 50268010911
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: ASR ASR |
$2.50
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Nomi Health Commercial |
$2.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.25
|
| Rate for Payer: Priority Health Narrow Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.26
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 65162075110
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.56 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$137.47
|
| Rate for Payer: ASR ASR |
$148.17
|
| Rate for Payer: BCBS Trust/PPO |
$125.44
|
| Rate for Payer: BCN Commercial |
$125.44
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$143.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$148.17
|
| Rate for Payer: Healthscope Whirlpool |
$152.75
|
| Rate for Payer: Mclaren Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.42
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
IP
|
$128.64
|
|
|
Service Code
|
NDC 50268010915
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.48 |
| Max. Negotiated Rate |
$128.64 |
| Rate for Payer: Aetna Commercial |
$115.78
|
| Rate for Payer: ASR ASR |
$124.78
|
| Rate for Payer: BCBS Trust/PPO |
$105.64
|
| Rate for Payer: BCN Commercial |
$105.64
|
| Rate for Payer: Cash Price |
$102.91
|
| Rate for Payer: Cofinity Commercial |
$120.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.91
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Healthscope Whirlpool |
$128.64
|
| Rate for Payer: Mclaren Commercial |
$115.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.34
|
| Rate for Payer: Nomi Health Commercial |
$105.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.20
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 50268010911
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: ASR ASR |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Nomi Health Commercial |
$2.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.26
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITH MCC
|
Facility
|
IP
|
$16,077.14
|
|
|
Service Code
|
MSDRG 725
|
| Min. Negotiated Rate |
$9,672.29 |
| Max. Negotiated Rate |
$16,077.14 |
| Rate for Payer: Aetna Medicare |
$10,181.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,726.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,726.70
|
| Rate for Payer: BCBS MAPPO |
$10,181.36
|
| Rate for Payer: BCN Medicare Advantage |
$10,181.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,181.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,181.36
|
| Rate for Payer: Mclaren Medicare |
$10,181.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,690.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,708.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,199.50
|
| Rate for Payer: PACE Medicare |
$9,672.29
|
| Rate for Payer: PACE SWMI |
$10,181.36
|
| Rate for Payer: PHP Commercial |
$11,199.50
|
| Rate for Payer: PHP Medicare Advantage |
$10,181.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,077.14
|
| Rate for Payer: Priority Health Medicare |
$10,181.36
|
| Rate for Payer: Priority Health Narrow Network |
$12,861.72
|
| Rate for Payer: Railroad Medicare Medicare |
$10,181.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,181.36
|
| Rate for Payer: UHC Exchange |
$15,781.11
|
| Rate for Payer: UHCCP DNSP |
$10,181.36
|
| Rate for Payer: VA VA |
$10,181.36
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC
|
Facility
|
IP
|
$10,778.33
|
|
|
Service Code
|
MSDRG 726
|
| Min. Negotiated Rate |
$6,606.07 |
| Max. Negotiated Rate |
$10,778.33 |
| Rate for Payer: Aetna Medicare |
$6,953.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,692.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,692.20
|
| Rate for Payer: BCBS MAPPO |
$6,953.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,953.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,953.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,953.76
|
| Rate for Payer: Mclaren Medicare |
$6,953.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,301.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,996.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,649.14
|
| Rate for Payer: PACE Medicare |
$6,606.07
|
| Rate for Payer: PACE SWMI |
$6,953.76
|
| Rate for Payer: PHP Commercial |
$7,649.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,953.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,919.41
|
| Rate for Payer: Priority Health Medicare |
$6,953.76
|
| Rate for Payer: Priority Health Narrow Network |
$7,935.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,953.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,953.76
|
| Rate for Payer: UHC Exchange |
$10,778.33
|
| Rate for Payer: UHCCP DNSP |
$6,953.76
|
| Rate for Payer: VA VA |
$6,953.76
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
IP
|
$22,283.14
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
191757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,712.35 |
| Max. Negotiated Rate |
$22,283.14 |
| Rate for Payer: Aetna Commercial |
$20,054.83
|
| Rate for Payer: ASR ASR |
$21,614.64
|
| Rate for Payer: BCBS Trust/PPO |
$18,298.91
|
| Rate for Payer: BCN Commercial |
$18,298.91
|
| Rate for Payer: Cash Price |
$17,826.51
|
| Rate for Payer: Cofinity Commercial |
$20,946.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,826.51
|
| Rate for Payer: Healthscope Commercial |
$21,614.64
|
| Rate for Payer: Healthscope Whirlpool |
$22,283.14
|
| Rate for Payer: Mclaren Commercial |
$20,054.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,940.67
|
| Rate for Payer: Nomi Health Commercial |
$18,272.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,712.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19,609.16
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
OP
|
$22,283.14
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
191757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.44 |
| Max. Negotiated Rate |
$22,283.14 |
| Rate for Payer: Aetna Commercial |
$20,054.83
|
| Rate for Payer: Aetna Medicare |
$163.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.20
|
| Rate for Payer: ASR ASR |
$21,614.64
|
| Rate for Payer: BCBS Complete |
$89.72
|
| Rate for Payer: BCBS MAPPO |
$163.36
|
| Rate for Payer: BCBS Trust/PPO |
$18,372.45
|
| Rate for Payer: BCN Commercial |
$18,372.45
|
| Rate for Payer: BCN Medicare Advantage |
$163.36
|
| Rate for Payer: Cash Price |
$17,826.51
|
| Rate for Payer: Cash Price |
$17,826.51
|
| Rate for Payer: Cofinity Commercial |
$20,946.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,826.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.36
|
| Rate for Payer: Healthscope Commercial |
$21,614.64
|
| Rate for Payer: Healthscope Whirlpool |
$22,283.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.36
|
| Rate for Payer: Mclaren Commercial |
$20,054.83
|
| Rate for Payer: Mclaren Medicaid |
$163.36
|
| Rate for Payer: Mclaren Medicare |
$163.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.53
|
| Rate for Payer: Meridian Medicaid |
$89.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$179.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,940.67
|
| Rate for Payer: Nomi Health Commercial |
$18,272.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,712.35
|
| Rate for Payer: PACE Medicare |
$155.19
|
| Rate for Payer: PACE SWMI |
$163.36
|
| Rate for Payer: PHP Commercial |
$179.70
|
| Rate for Payer: PHP Medicaid |
$87.56
|
| Rate for Payer: PHP Medicare Advantage |
$163.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$170.15
|
| Rate for Payer: Priority Health Medicare |
$163.36
|
| Rate for Payer: Priority Health Narrow Network |
$136.12
|
| Rate for Payer: Railroad Medicare Medicare |
$163.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19,609.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.36
|
| Rate for Payer: UHC Exchange |
$253.21
|
| Rate for Payer: UHC Medicaid |
$85.44
|
| Rate for Payer: UHCCP DNSP |
$163.36
|
| Rate for Payer: UHCCP Medicaid |
$85.44
|
| Rate for Payer: VA VA |
$163.36
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$19,720.59
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.44 |
| Max. Negotiated Rate |
$19,720.59 |
| Rate for Payer: Aetna Commercial |
$17,748.53
|
| Rate for Payer: Aetna Medicare |
$163.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.20
|
| Rate for Payer: ASR ASR |
$19,128.98
|
| Rate for Payer: BCBS Complete |
$89.72
|
| Rate for Payer: BCBS MAPPO |
$163.36
|
| Rate for Payer: BCBS Trust/PPO |
$16,259.63
|
| Rate for Payer: BCN Commercial |
$16,259.63
|
| Rate for Payer: BCN Medicare Advantage |
$163.36
|
| Rate for Payer: Cash Price |
$15,776.47
|
| Rate for Payer: Cash Price |
$15,776.47
|
| Rate for Payer: Cofinity Commercial |
$18,537.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,776.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.36
|
| Rate for Payer: Healthscope Commercial |
$19,128.98
|
| Rate for Payer: Healthscope Whirlpool |
$19,720.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.36
|
| Rate for Payer: Mclaren Commercial |
$17,748.53
|
| Rate for Payer: Mclaren Medicaid |
$163.36
|
| Rate for Payer: Mclaren Medicare |
$163.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.53
|
| Rate for Payer: Meridian Medicaid |
$89.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$179.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,762.50
|
| Rate for Payer: Nomi Health Commercial |
$16,170.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,790.44
|
| Rate for Payer: PACE Medicare |
$155.19
|
| Rate for Payer: PACE SWMI |
$163.36
|
| Rate for Payer: PHP Commercial |
$179.70
|
| Rate for Payer: PHP Medicaid |
$87.56
|
| Rate for Payer: PHP Medicare Advantage |
$163.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$170.15
|
| Rate for Payer: Priority Health Medicare |
$163.36
|
| Rate for Payer: Priority Health Narrow Network |
$136.12
|
| Rate for Payer: Railroad Medicare Medicare |
$163.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,354.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.36
|
| Rate for Payer: UHC Exchange |
$253.21
|
| Rate for Payer: UHC Medicaid |
$85.44
|
| Rate for Payer: UHCCP DNSP |
$163.36
|
| Rate for Payer: UHCCP Medicaid |
$85.44
|
| Rate for Payer: VA VA |
$163.36
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$19,720.59
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,790.44 |
| Max. Negotiated Rate |
$19,720.59 |
| Rate for Payer: Aetna Commercial |
$17,748.53
|
| Rate for Payer: ASR ASR |
$19,128.98
|
| Rate for Payer: BCBS Trust/PPO |
$16,194.55
|
| Rate for Payer: BCN Commercial |
$16,194.55
|
| Rate for Payer: Cash Price |
$15,776.47
|
| Rate for Payer: Cofinity Commercial |
$18,537.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,776.47
|
| Rate for Payer: Healthscope Commercial |
$19,128.98
|
| Rate for Payer: Healthscope Whirlpool |
$19,720.59
|
| Rate for Payer: Mclaren Commercial |
$17,748.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,762.50
|
| Rate for Payer: Nomi Health Commercial |
$16,170.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,790.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,354.12
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
OP
|
$38.65
|
|
|
Service Code
|
NDC 283061043
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Commercial |
$34.78
|
| Rate for Payer: Aetna Medicare |
$14.30
|
| Rate for Payer: ASR ASR |
$37.49
|
| Rate for Payer: BCBS Complete |
$15.46
|
| Rate for Payer: BCBS Trust/PPO |
$31.86
|
| Rate for Payer: BCN Commercial |
$31.86
|
| Rate for Payer: Cash Price |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$36.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.92
|
| Rate for Payer: Healthscope Commercial |
$37.49
|
| Rate for Payer: Healthscope Whirlpool |
$38.65
|
| Rate for Payer: Mclaren Commercial |
$34.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.85
|
| Rate for Payer: Nomi Health Commercial |
$31.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.86
|
| Rate for Payer: Priority Health Narrow Network |
$27.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.01
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$38.65
|
|
|
Service Code
|
NDC 283061043
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Commercial |
$34.78
|
| Rate for Payer: ASR ASR |
$37.49
|
| Rate for Payer: BCBS Trust/PPO |
$31.74
|
| Rate for Payer: BCN Commercial |
$31.74
|
| Rate for Payer: Cash Price |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$36.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.92
|
| Rate for Payer: Healthscope Commercial |
$37.49
|
| Rate for Payer: Healthscope Whirlpool |
$38.65
|
| Rate for Payer: Mclaren Commercial |
$34.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.85
|
| Rate for Payer: Nomi Health Commercial |
$31.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.01
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$36.28
|
|
|
Service Code
|
NDC 283061026
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.21 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: Aetna Commercial |
$32.65
|
| Rate for Payer: ASR ASR |
$35.19
|
| Rate for Payer: BCBS Trust/PPO |
$29.80
|
| Rate for Payer: BCN Commercial |
$29.80
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$34.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.03
|
| Rate for Payer: Healthscope Commercial |
$35.19
|
| Rate for Payer: Healthscope Whirlpool |
$36.28
|
| Rate for Payer: Mclaren Commercial |
$32.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.84
|
| Rate for Payer: Nomi Health Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.93
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
OP
|
$36.28
|
|
|
Service Code
|
NDC 283061026
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: Aetna Commercial |
$32.65
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: ASR ASR |
$35.19
|
| Rate for Payer: BCBS Complete |
$14.51
|
| Rate for Payer: BCBS Trust/PPO |
$29.92
|
| Rate for Payer: BCN Commercial |
$29.92
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$34.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.03
|
| Rate for Payer: Healthscope Commercial |
$35.19
|
| Rate for Payer: Healthscope Whirlpool |
$36.28
|
| Rate for Payer: Mclaren Commercial |
$32.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.84
|
| Rate for Payer: Nomi Health Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.79
|
| Rate for Payer: Priority Health Narrow Network |
$25.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.93
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$335.35
|
|
|
Service Code
|
NDC 904715361
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.08 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna Commercial |
$301.81
|
| Rate for Payer: Aetna Medicare |
$124.08
|
| Rate for Payer: ASR ASR |
$325.29
|
| Rate for Payer: BCBS Complete |
$134.14
|
| Rate for Payer: BCBS Trust/PPO |
$276.50
|
| Rate for Payer: BCN Commercial |
$276.50
|
| Rate for Payer: Cash Price |
$268.28
|
| Rate for Payer: Cofinity Commercial |
$315.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.28
|
| Rate for Payer: Healthscope Commercial |
$325.29
|
| Rate for Payer: Healthscope Whirlpool |
$335.35
|
| Rate for Payer: Mclaren Commercial |
$301.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.05
|
| Rate for Payer: Nomi Health Commercial |
$274.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293.83
|
| Rate for Payer: Priority Health Narrow Network |
$235.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.11
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 68084021411
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: ASR ASR |
$3.59
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Healthscope Whirlpool |
$3.70
|
| Rate for Payer: Mclaren Commercial |
$3.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.24
|
| Rate for Payer: Priority Health Narrow Network |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.25
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
OP
|
$425.35
|
|
|
Service Code
|
NDC 904656460
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.38 |
| Max. Negotiated Rate |
$425.35 |
| Rate for Payer: Aetna Commercial |
$382.81
|
| Rate for Payer: Aetna Medicare |
$157.38
|
| Rate for Payer: ASR ASR |
$412.59
|
| Rate for Payer: BCBS Complete |
$170.14
|
| Rate for Payer: BCBS Trust/PPO |
$350.70
|
| Rate for Payer: BCN Commercial |
$350.70
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$399.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$412.59
|
| Rate for Payer: Healthscope Whirlpool |
$425.35
|
| Rate for Payer: Mclaren Commercial |
$382.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$372.69
|
| Rate for Payer: Priority Health Narrow Network |
$298.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.31
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$335.35
|
|
|
Service Code
|
NDC 904715361
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.51 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna Commercial |
$301.81
|
| Rate for Payer: ASR ASR |
$325.29
|
| Rate for Payer: BCBS Trust/PPO |
$275.39
|
| Rate for Payer: BCN Commercial |
$275.39
|
| Rate for Payer: Cash Price |
$268.28
|
| Rate for Payer: Cofinity Commercial |
$315.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.28
|
| Rate for Payer: Healthscope Commercial |
$325.29
|
| Rate for Payer: Healthscope Whirlpool |
$335.35
|
| Rate for Payer: Mclaren Commercial |
$301.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.05
|
| Rate for Payer: Nomi Health Commercial |
$274.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.11
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$369.55
|
|
|
Service Code
|
NDC 68084021401
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.16 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna Commercial |
$332.60
|
| Rate for Payer: ASR ASR |
$358.46
|
| Rate for Payer: BCBS Trust/PPO |
$303.47
|
| Rate for Payer: BCN Commercial |
$303.47
|
| Rate for Payer: Cash Price |
$295.64
|
| Rate for Payer: Cofinity Commercial |
$347.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.64
|
| Rate for Payer: Healthscope Commercial |
$358.46
|
| Rate for Payer: Healthscope Whirlpool |
$369.55
|
| Rate for Payer: Mclaren Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.12
|
| Rate for Payer: Nomi Health Commercial |
$303.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$325.20
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 904656460
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.01 |
| Max. Negotiated Rate |
$425.35 |
| Rate for Payer: Aetna Commercial |
$382.81
|
| Rate for Payer: ASR ASR |
$412.59
|
| Rate for Payer: BCBS Trust/PPO |
$349.30
|
| Rate for Payer: BCN Commercial |
$349.30
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$399.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$412.59
|
| Rate for Payer: Healthscope Whirlpool |
$425.35
|
| Rate for Payer: Mclaren Commercial |
$382.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.31
|
|
