|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 51079029401
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: ASR Commercial |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Healthscope Whirlpool |
$2.80
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.53
|
| Rate for Payer: Priority Health Narrow Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 65862059801
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$166.85 |
| Rate for Payer: Aetna Commercial |
$150.16
|
| Rate for Payer: Aetna Medicare |
$83.42
|
| Rate for Payer: ASR ASR |
$161.84
|
| Rate for Payer: ASR Commercial |
$161.84
|
| Rate for Payer: BCBS Complete |
$66.74
|
| Rate for Payer: BCBS Trust/PPO |
$136.63
|
| Rate for Payer: BCN Commercial |
$129.36
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$156.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$166.85
|
| Rate for Payer: Healthscope Whirlpool |
$161.84
|
| Rate for Payer: Mclaren Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Nomi Health Commercial |
$136.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.19
|
| Rate for Payer: Priority Health Narrow Network |
$116.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.83
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 65862059801
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.45 |
| Max. Negotiated Rate |
$166.85 |
| Rate for Payer: Aetna Commercial |
$150.16
|
| Rate for Payer: ASR ASR |
$161.84
|
| Rate for Payer: ASR Commercial |
$161.84
|
| Rate for Payer: BCBS Trust/PPO |
$135.97
|
| Rate for Payer: BCN Commercial |
$129.36
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$156.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$166.85
|
| Rate for Payer: Healthscope Whirlpool |
$161.84
|
| Rate for Payer: Mclaren Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Nomi Health Commercial |
$136.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.83
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 51079029401
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: ASR Commercial |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Healthscope Whirlpool |
$2.80
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$657.25
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$657.25 |
| Rate for Payer: Aetna Commercial |
$591.52
|
| Rate for Payer: Aetna Medicare |
$0.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.35
|
| Rate for Payer: ASR ASR |
$637.53
|
| Rate for Payer: ASR Commercial |
$637.53
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS MAPPO |
$0.28
|
| Rate for Payer: BCBS Trust/PPO |
$538.22
|
| Rate for Payer: BCN Commercial |
$509.57
|
| Rate for Payer: BCN Medicare Advantage |
$0.28
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cofinity Commercial |
$617.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$657.25
|
| Rate for Payer: Healthscope Whirlpool |
$637.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.28
|
| Rate for Payer: Mclaren Commercial |
$591.52
|
| Rate for Payer: Mclaren Medicaid |
$0.15
|
| Rate for Payer: Mclaren Medicare |
$0.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.66
|
| Rate for Payer: Nomi Health Commercial |
$538.95
|
| Rate for Payer: PACE Medicare |
$0.27
|
| Rate for Payer: PACE SWMI |
$0.28
|
| Rate for Payer: PHP Commercial |
$0.31
|
| Rate for Payer: PHP Medicaid |
$0.15
|
| Rate for Payer: PHP Medicare Advantage |
$0.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$575.88
|
| Rate for Payer: Priority Health Medicare |
$0.28
|
| Rate for Payer: Priority Health Narrow Network |
$460.73
|
| Rate for Payer: Railroad Medicare Medicare |
$0.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.28
|
| Rate for Payer: UHC Exchange |
$0.43
|
| Rate for Payer: UHC Medicare Advantage |
$0.28
|
| Rate for Payer: UHCCP DNSP |
$0.28
|
| Rate for Payer: UHCCP Medicaid |
$0.15
|
| Rate for Payer: VA VA |
$0.28
|
|
|
TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$657.25
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$427.21 |
| Max. Negotiated Rate |
$657.25 |
| Rate for Payer: Aetna Commercial |
$591.52
|
| Rate for Payer: ASR ASR |
$637.53
|
| Rate for Payer: ASR Commercial |
$637.53
|
| Rate for Payer: BCBS Trust/PPO |
$535.59
|
| Rate for Payer: BCN Commercial |
$509.57
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cofinity Commercial |
$617.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.80
|
| Rate for Payer: Healthscope Commercial |
$657.25
|
| Rate for Payer: Healthscope Whirlpool |
$637.53
|
| Rate for Payer: Mclaren Commercial |
$591.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.66
|
| Rate for Payer: Nomi Health Commercial |
$538.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.38
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$1,051.94
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$1,051.94 |
| Rate for Payer: Aetna Commercial |
$946.75
|
| Rate for Payer: Aetna Medicare |
$0.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.35
|
| Rate for Payer: ASR ASR |
$1,020.38
|
| Rate for Payer: ASR Commercial |
$1,020.38
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS MAPPO |
$0.28
|
| Rate for Payer: BCBS Trust/PPO |
$861.43
|
| Rate for Payer: BCN Commercial |
$815.57
|
| Rate for Payer: BCN Medicare Advantage |
$0.28
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: Cofinity Commercial |
$988.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.28
|
| Rate for Payer: Healthscope Commercial |
$1,051.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.28
|
| Rate for Payer: Mclaren Commercial |
$946.75
|
| Rate for Payer: Mclaren Medicaid |
$0.15
|
| Rate for Payer: Mclaren Medicare |
$0.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.29
|
| Rate for Payer: Meridian Medicaid |
$0.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.15
|
| Rate for Payer: Nomi Health Commercial |
$862.59
|
| Rate for Payer: PACE Medicare |
$0.27
|
| Rate for Payer: PACE SWMI |
$0.28
|
| Rate for Payer: PHP Commercial |
$0.31
|
| Rate for Payer: PHP Medicaid |
$0.15
|
| Rate for Payer: PHP Medicare Advantage |
$0.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$921.71
|
| Rate for Payer: Priority Health Medicare |
$0.28
|
| Rate for Payer: Priority Health Narrow Network |
$737.41
|
| Rate for Payer: Railroad Medicare Medicare |
$0.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.28
|
| Rate for Payer: UHC Exchange |
$0.43
|
| Rate for Payer: UHC Medicare Advantage |
$0.28
|
| Rate for Payer: UHCCP DNSP |
$0.28
|
| Rate for Payer: UHCCP Medicaid |
$0.15
|
| Rate for Payer: VA VA |
$0.28
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$1,051.94
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$683.76 |
| Max. Negotiated Rate |
$1,051.94 |
| Rate for Payer: Aetna Commercial |
$946.75
|
| Rate for Payer: ASR ASR |
$1,020.38
|
| Rate for Payer: ASR Commercial |
$1,020.38
|
| Rate for Payer: BCBS Trust/PPO |
$857.23
|
| Rate for Payer: BCN Commercial |
$815.57
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: Cofinity Commercial |
$988.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.55
|
| Rate for Payer: Healthscope Commercial |
$1,051.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.38
|
| Rate for Payer: Mclaren Commercial |
$946.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.15
|
| Rate for Payer: Nomi Health Commercial |
$862.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.71
|
|
|
TELMISARTAN 20 MG TABLET
|
Facility
|
IP
|
$85.78
|
|
|
Service Code
|
NDC 00378292093
|
| Hospital Charge Code |
29176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.76 |
| Max. Negotiated Rate |
$85.78 |
| Rate for Payer: Aetna Commercial |
$77.20
|
| Rate for Payer: ASR ASR |
$83.21
|
| Rate for Payer: ASR Commercial |
$83.21
|
| Rate for Payer: BCBS Trust/PPO |
$69.90
|
| Rate for Payer: BCN Commercial |
$66.51
|
| Rate for Payer: Cash Price |
$68.63
|
| Rate for Payer: Cofinity Commercial |
$80.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.62
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Healthscope Whirlpool |
$83.21
|
| Rate for Payer: Mclaren Commercial |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.91
|
| Rate for Payer: Nomi Health Commercial |
$70.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.49
|
|
|
TELMISARTAN 20 MG TABLET
|
Facility
|
OP
|
$85.78
|
|
|
Service Code
|
NDC 00378292093
|
| Hospital Charge Code |
29176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.31 |
| Max. Negotiated Rate |
$85.78 |
| Rate for Payer: Aetna Commercial |
$77.20
|
| Rate for Payer: Aetna Medicare |
$42.89
|
| Rate for Payer: ASR ASR |
$83.21
|
| Rate for Payer: ASR Commercial |
$83.21
|
| Rate for Payer: BCBS Complete |
$34.31
|
| Rate for Payer: BCBS Trust/PPO |
$70.25
|
| Rate for Payer: BCN Commercial |
$66.51
|
| Rate for Payer: Cash Price |
$68.63
|
| Rate for Payer: Cofinity Commercial |
$80.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.62
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Healthscope Whirlpool |
$83.21
|
| Rate for Payer: Mclaren Commercial |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.91
|
| Rate for Payer: Nomi Health Commercial |
$70.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.16
|
| Rate for Payer: Priority Health Narrow Network |
$60.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.49
|
|
|
TELMISARTAN 40 MG TABLET
|
Facility
|
OP
|
$483.52
|
|
|
Service Code
|
NDC 00597004037
|
| Hospital Charge Code |
24335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.41 |
| Max. Negotiated Rate |
$483.52 |
| Rate for Payer: Aetna Commercial |
$435.17
|
| Rate for Payer: Aetna Medicare |
$241.76
|
| Rate for Payer: ASR ASR |
$469.01
|
| Rate for Payer: ASR Commercial |
$469.01
|
| Rate for Payer: BCBS Complete |
$193.41
|
| Rate for Payer: BCBS Trust/PPO |
$395.95
|
| Rate for Payer: BCN Commercial |
$374.87
|
| Rate for Payer: Cash Price |
$386.81
|
| Rate for Payer: Cofinity Commercial |
$454.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.82
|
| Rate for Payer: Healthscope Commercial |
$483.52
|
| Rate for Payer: Healthscope Whirlpool |
$469.01
|
| Rate for Payer: Mclaren Commercial |
$435.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.99
|
| Rate for Payer: Nomi Health Commercial |
$396.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.66
|
| Rate for Payer: Priority Health Narrow Network |
$338.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$425.50
|
|
|
TELMISARTAN 40 MG TABLET
|
Facility
|
IP
|
$483.52
|
|
|
Service Code
|
NDC 00597004037
|
| Hospital Charge Code |
24335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.29 |
| Max. Negotiated Rate |
$483.52 |
| Rate for Payer: Aetna Commercial |
$435.17
|
| Rate for Payer: ASR ASR |
$469.01
|
| Rate for Payer: ASR Commercial |
$469.01
|
| Rate for Payer: BCBS Trust/PPO |
$394.02
|
| Rate for Payer: BCN Commercial |
$374.87
|
| Rate for Payer: Cash Price |
$386.81
|
| Rate for Payer: Cofinity Commercial |
$454.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.82
|
| Rate for Payer: Healthscope Commercial |
$483.52
|
| Rate for Payer: Healthscope Whirlpool |
$469.01
|
| Rate for Payer: Mclaren Commercial |
$435.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.99
|
| Rate for Payer: Nomi Health Commercial |
$396.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$425.50
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29,932.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,456.04 |
| Max. Negotiated Rate |
$29,932.37 |
| Rate for Payer: Aetna Commercial |
$26,939.13
|
| Rate for Payer: ASR ASR |
$29,034.40
|
| Rate for Payer: ASR Commercial |
$29,034.40
|
| Rate for Payer: BCBS Trust/PPO |
$24,391.89
|
| Rate for Payer: BCN Commercial |
$23,206.57
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cofinity Commercial |
$28,136.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Healthscope Commercial |
$29,932.37
|
| Rate for Payer: Healthscope Whirlpool |
$29,034.40
|
| Rate for Payer: Mclaren Commercial |
$26,939.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.51
|
| Rate for Payer: Nomi Health Commercial |
$24,544.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,456.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,340.49
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29,932.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$29,932.37 |
| Rate for Payer: Aetna Commercial |
$26,939.13
|
| Rate for Payer: Aetna Medicare |
$172.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.28
|
| Rate for Payer: ASR ASR |
$29,034.40
|
| Rate for Payer: ASR Commercial |
$29,034.40
|
| Rate for Payer: BCBS Complete |
$96.93
|
| Rate for Payer: BCBS MAPPO |
$172.22
|
| Rate for Payer: BCBS Trust/PPO |
$24,511.62
|
| Rate for Payer: BCN Commercial |
$23,206.57
|
| Rate for Payer: BCN Medicare Advantage |
$172.22
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cofinity Commercial |
$28,136.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.22
|
| Rate for Payer: Healthscope Commercial |
$29,932.37
|
| Rate for Payer: Healthscope Whirlpool |
$29,034.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$172.22
|
| Rate for Payer: Mclaren Commercial |
$26,939.13
|
| Rate for Payer: Mclaren Medicaid |
$92.31
|
| Rate for Payer: Mclaren Medicare |
$172.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.83
|
| Rate for Payer: Meridian Medicaid |
$96.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.51
|
| Rate for Payer: Nomi Health Commercial |
$24,544.54
|
| Rate for Payer: PACE Medicare |
$163.61
|
| Rate for Payer: PACE SWMI |
$172.22
|
| Rate for Payer: PHP Commercial |
$189.44
|
| Rate for Payer: PHP Medicaid |
$92.31
|
| Rate for Payer: PHP Medicare Advantage |
$172.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,456.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,226.74
|
| Rate for Payer: Priority Health Medicare |
$172.22
|
| Rate for Payer: Priority Health Narrow Network |
$20,982.59
|
| Rate for Payer: Railroad Medicare Medicare |
$172.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,340.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.22
|
| Rate for Payer: UHC Exchange |
$266.94
|
| Rate for Payer: UHC Medicare Advantage |
$172.22
|
| Rate for Payer: UHCCP DNSP |
$172.22
|
| Rate for Payer: UHCCP Medicaid |
$92.31
|
| Rate for Payer: VA VA |
$172.22
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$17.25
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$19.19
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$10.66
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: ASR ASR |
$20.68
|
| Rate for Payer: ASR ASR |
$16.73
|
| Rate for Payer: ASR ASR |
$23.32
|
| Rate for Payer: ASR Commercial |
$23.32
|
| Rate for Payer: ASR Commercial |
$20.68
|
| Rate for Payer: ASR Commercial |
$16.73
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCBS Trust/PPO |
$17.46
|
| Rate for Payer: BCBS Trust/PPO |
$19.69
|
| Rate for Payer: BCN Commercial |
$18.64
|
| Rate for Payer: BCN Commercial |
$13.37
|
| Rate for Payer: BCN Commercial |
$16.53
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Cofinity Commercial |
$20.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$21.32
|
| Rate for Payer: Healthscope Commercial |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$20.68
|
| Rate for Payer: Healthscope Whirlpool |
$16.73
|
| Rate for Payer: Healthscope Whirlpool |
$23.32
|
| Rate for Payer: Mclaren Commercial |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$19.19
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$14.14
|
| Rate for Payer: Nomi Health Commercial |
$17.48
|
| Rate for Payer: Nomi Health Commercial |
$19.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.06
|
| Rate for Payer: Priority Health Narrow Network |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$12.09
|
| Rate for Payer: Priority Health Narrow Network |
$14.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$17.25
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$19.19
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: ASR ASR |
$20.68
|
| Rate for Payer: ASR ASR |
$16.73
|
| Rate for Payer: ASR ASR |
$23.32
|
| Rate for Payer: ASR Commercial |
$23.32
|
| Rate for Payer: ASR Commercial |
$20.68
|
| Rate for Payer: ASR Commercial |
$16.73
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$17.37
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$16.53
|
| Rate for Payer: BCN Commercial |
$13.37
|
| Rate for Payer: BCN Commercial |
$18.64
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$20.04
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$24.04
|
| Rate for Payer: Healthscope Commercial |
$21.32
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Whirlpool |
$16.73
|
| Rate for Payer: Healthscope Whirlpool |
$20.68
|
| Rate for Payer: Healthscope Whirlpool |
$23.32
|
| Rate for Payer: Mclaren Commercial |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$19.19
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Nomi Health Commercial |
$19.71
|
| Rate for Payer: Nomi Health Commercial |
$17.48
|
| Rate for Payer: Nomi Health Commercial |
$14.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$101.95
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$101.95 |
| Rate for Payer: Aetna Commercial |
$91.75
|
| Rate for Payer: Aetna Commercial |
$58.59
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna Commercial |
$511.83
|
| Rate for Payer: Aetna Medicare |
$55.20
|
| Rate for Payer: Aetna Medicare |
$284.35
|
| Rate for Payer: Aetna Medicare |
$50.98
|
| Rate for Payer: Aetna Medicare |
$48.83
|
| Rate for Payer: Aetna Medicare |
$32.55
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: ASR ASR |
$551.64
|
| Rate for Payer: ASR ASR |
$98.89
|
| Rate for Payer: ASR ASR |
$63.15
|
| Rate for Payer: ASR ASR |
$107.09
|
| Rate for Payer: ASR Commercial |
$94.72
|
| Rate for Payer: ASR Commercial |
$107.09
|
| Rate for Payer: ASR Commercial |
$551.64
|
| Rate for Payer: ASR Commercial |
$63.15
|
| Rate for Payer: ASR Commercial |
$98.89
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS Complete |
$44.16
|
| Rate for Payer: BCBS Complete |
$227.48
|
| Rate for Payer: BCBS Complete |
$26.04
|
| Rate for Payer: BCBS Complete |
$40.78
|
| Rate for Payer: BCBS Trust/PPO |
$53.31
|
| Rate for Payer: BCBS Trust/PPO |
$83.49
|
| Rate for Payer: BCBS Trust/PPO |
$90.41
|
| Rate for Payer: BCBS Trust/PPO |
$465.71
|
| Rate for Payer: BCBS Trust/PPO |
$79.97
|
| Rate for Payer: BCN Commercial |
$75.71
|
| Rate for Payer: BCN Commercial |
$50.47
|
| Rate for Payer: BCN Commercial |
$85.59
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: BCN Commercial |
$440.91
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cash Price |
$88.32
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cash Price |
$454.96
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Cofinity Commercial |
$534.58
|
| Rate for Payer: Cofinity Commercial |
$103.78
|
| Rate for Payer: Cofinity Commercial |
$95.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Healthscope Commercial |
$568.70
|
| Rate for Payer: Healthscope Commercial |
$65.10
|
| Rate for Payer: Healthscope Commercial |
$97.65
|
| Rate for Payer: Healthscope Commercial |
$101.95
|
| Rate for Payer: Healthscope Commercial |
$110.40
|
| Rate for Payer: Healthscope Whirlpool |
$63.15
|
| Rate for Payer: Healthscope Whirlpool |
$551.64
|
| Rate for Payer: Healthscope Whirlpool |
$107.09
|
| Rate for Payer: Healthscope Whirlpool |
$98.89
|
| Rate for Payer: Healthscope Whirlpool |
$94.72
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: Mclaren Commercial |
$511.83
|
| Rate for Payer: Mclaren Commercial |
$99.36
|
| Rate for Payer: Mclaren Commercial |
$58.59
|
| Rate for Payer: Mclaren Commercial |
$91.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$53.38
|
| Rate for Payer: Nomi Health Commercial |
$466.33
|
| Rate for Payer: Nomi Health Commercial |
$83.60
|
| Rate for Payer: Nomi Health Commercial |
$90.53
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$498.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.56
|
| Rate for Payer: Priority Health Narrow Network |
$68.45
|
| Rate for Payer: Priority Health Narrow Network |
$45.64
|
| Rate for Payer: Priority Health Narrow Network |
$77.39
|
| Rate for Payer: Priority Health Narrow Network |
$71.47
|
| Rate for Payer: Priority Health Narrow Network |
$398.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.46
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$110.40
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna Commercial |
$58.59
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Commercial |
$511.83
|
| Rate for Payer: Aetna Commercial |
$91.75
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: ASR ASR |
$63.15
|
| Rate for Payer: ASR ASR |
$551.64
|
| Rate for Payer: ASR ASR |
$107.09
|
| Rate for Payer: ASR ASR |
$98.89
|
| Rate for Payer: ASR Commercial |
$551.64
|
| Rate for Payer: ASR Commercial |
$94.72
|
| Rate for Payer: ASR Commercial |
$63.15
|
| Rate for Payer: ASR Commercial |
$107.09
|
| Rate for Payer: ASR Commercial |
$98.89
|
| Rate for Payer: BCBS Trust/PPO |
$79.57
|
| Rate for Payer: BCBS Trust/PPO |
$83.08
|
| Rate for Payer: BCBS Trust/PPO |
$89.96
|
| Rate for Payer: BCBS Trust/PPO |
$53.05
|
| Rate for Payer: BCBS Trust/PPO |
$463.43
|
| Rate for Payer: BCN Commercial |
$85.59
|
| Rate for Payer: BCN Commercial |
$75.71
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: BCN Commercial |
$440.91
|
| Rate for Payer: BCN Commercial |
$50.47
|
| Rate for Payer: Cash Price |
$88.32
|
| Rate for Payer: Cash Price |
$454.96
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$103.78
|
| Rate for Payer: Cofinity Commercial |
$534.58
|
| Rate for Payer: Cofinity Commercial |
$95.83
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.32
|
| Rate for Payer: Healthscope Commercial |
$568.70
|
| Rate for Payer: Healthscope Commercial |
$65.10
|
| Rate for Payer: Healthscope Commercial |
$110.40
|
| Rate for Payer: Healthscope Commercial |
$101.95
|
| Rate for Payer: Healthscope Commercial |
$97.65
|
| Rate for Payer: Healthscope Whirlpool |
$94.72
|
| Rate for Payer: Healthscope Whirlpool |
$98.89
|
| Rate for Payer: Healthscope Whirlpool |
$551.64
|
| Rate for Payer: Healthscope Whirlpool |
$107.09
|
| Rate for Payer: Healthscope Whirlpool |
$63.15
|
| Rate for Payer: Mclaren Commercial |
$99.36
|
| Rate for Payer: Mclaren Commercial |
$511.83
|
| Rate for Payer: Mclaren Commercial |
$91.75
|
| Rate for Payer: Mclaren Commercial |
$58.59
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.39
|
| Rate for Payer: Nomi Health Commercial |
$466.33
|
| Rate for Payer: Nomi Health Commercial |
$83.60
|
| Rate for Payer: Nomi Health Commercial |
$90.53
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Nomi Health Commercial |
$53.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.29
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,678.14
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.85 |
| Max. Negotiated Rate |
$1,678.14 |
| Rate for Payer: Aetna Commercial |
$1,510.33
|
| Rate for Payer: Aetna Medicare |
$593.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$741.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$741.25
|
| Rate for Payer: ASR ASR |
$1,627.80
|
| Rate for Payer: ASR Commercial |
$1,627.80
|
| Rate for Payer: BCBS Complete |
$333.74
|
| Rate for Payer: BCBS MAPPO |
$593.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,374.23
|
| Rate for Payer: BCN Commercial |
$1,301.06
|
| Rate for Payer: BCN Medicare Advantage |
$593.00
|
| Rate for Payer: Cash Price |
$1,342.52
|
| Rate for Payer: Cash Price |
$1,342.52
|
| Rate for Payer: Cofinity Commercial |
$1,577.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.00
|
| Rate for Payer: Healthscope Commercial |
$1,678.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,627.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$593.00
|
| Rate for Payer: Mclaren Commercial |
$1,510.33
|
| Rate for Payer: Mclaren Medicaid |
$317.85
|
| Rate for Payer: Mclaren Medicare |
$593.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$622.65
|
| Rate for Payer: Meridian Medicaid |
$333.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.42
|
| Rate for Payer: Nomi Health Commercial |
$1,376.07
|
| Rate for Payer: PACE Medicare |
$563.35
|
| Rate for Payer: PACE SWMI |
$593.00
|
| Rate for Payer: PHP Commercial |
$652.30
|
| Rate for Payer: PHP Medicaid |
$317.85
|
| Rate for Payer: PHP Medicare Advantage |
$593.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,470.39
|
| Rate for Payer: Priority Health Medicare |
$593.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,176.38
|
| Rate for Payer: Railroad Medicare Medicare |
$593.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,476.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$593.00
|
| Rate for Payer: UHC Exchange |
$919.15
|
| Rate for Payer: UHC Medicare Advantage |
$593.00
|
| Rate for Payer: UHCCP DNSP |
$593.00
|
| Rate for Payer: UHCCP Medicaid |
$317.85
|
| Rate for Payer: VA VA |
$593.00
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,678.14
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,090.79 |
| Max. Negotiated Rate |
$1,678.14 |
| Rate for Payer: Aetna Commercial |
$1,510.33
|
| Rate for Payer: ASR ASR |
$1,627.80
|
| Rate for Payer: ASR Commercial |
$1,627.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.52
|
| Rate for Payer: BCN Commercial |
$1,301.06
|
| Rate for Payer: Cash Price |
$1,342.52
|
| Rate for Payer: Cofinity Commercial |
$1,577.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.51
|
| Rate for Payer: Healthscope Commercial |
$1,678.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,627.80
|
| Rate for Payer: Mclaren Commercial |
$1,510.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.42
|
| Rate for Payer: Nomi Health Commercial |
$1,376.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,476.76
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
OP
|
$38.25
|
|
|
Service Code
|
NDC 00065074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$19.12
|
| Rate for Payer: ASR ASR |
$37.10
|
| Rate for Payer: ASR Commercial |
$37.10
|
| Rate for Payer: BCBS Complete |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$31.32
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$35.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$37.10
|
| Rate for Payer: Mclaren Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.51
|
| Rate for Payer: Nomi Health Commercial |
$31.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.51
|
| Rate for Payer: Priority Health Narrow Network |
$26.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.66
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
IP
|
$38.25
|
|
|
Service Code
|
NDC 00065074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: ASR ASR |
$37.10
|
| Rate for Payer: ASR Commercial |
$37.10
|
| Rate for Payer: BCBS Trust/PPO |
$31.17
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$35.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$37.10
|
| Rate for Payer: Mclaren Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.51
|
| Rate for Payer: Nomi Health Commercial |
$31.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.66
|
|
|
THERMAGE
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 00167
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
|
|
THERMAGE ABDOMEN - ENTIRE
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 00150
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
|
|
THERMAGE ABDOMEN - LOWER
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 00149
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Medicare |
$1,020.00
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
|
