|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,694.95
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$291.90 |
| Max. Negotiated Rate |
$1,870.30 |
| Rate for Payer: Aetna Commercial |
$1,440.71
|
| Rate for Payer: Aetna Medicare |
$580.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.65
|
| Rate for Payer: BCBS Complete |
$306.52
|
| Rate for Payer: BCBS MAPPO |
$558.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.55
|
| Rate for Payer: BCN Commercial |
$1,476.55
|
| Rate for Payer: BCN Medicare Advantage |
$558.12
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cofinity Advantage |
$1,186.46
|
| Rate for Payer: Cofinity Commercial |
$1,457.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,355.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.12
|
| Rate for Payer: Healthscope Commercial |
$1,525.45
|
| Rate for Payer: Mclaren Medicaid |
$291.90
|
| Rate for Payer: Mclaren Medicare |
$558.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.03
|
| Rate for Payer: Meridian Medicaid |
$586.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$641.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$613.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,440.71
|
| Rate for Payer: Nomi Health Commercial |
$1,674.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.21
|
| Rate for Payer: PACE Medicare |
$530.21
|
| Rate for Payer: PACE SWMI |
$558.12
|
| Rate for Payer: PHP Commercial |
$1,440.71
|
| Rate for Payer: PHP Medicare Advantage |
$558.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,870.30
|
| Rate for Payer: Priority Health Medicare |
$558.12
|
| Rate for Payer: Priority Health SBD |
$1,067.82
|
| Rate for Payer: Priority Health Tiered Network |
$1,496.24
|
| Rate for Payer: Railroad Medicare Medicare |
$558.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.09
|
| Rate for Payer: UHC Core |
$971.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$558.12
|
| Rate for Payer: UHC Exchange |
$971.09
|
| Rate for Payer: UHC Medicaid |
$291.90
|
| Rate for Payer: UHCCP Medicaid |
$291.90
|
| Rate for Payer: VA VA |
$558.12
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
IP
|
$43.07
|
|
|
Service Code
|
NDC 00065074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.13 |
| Max. Negotiated Rate |
$38.76 |
| Rate for Payer: Aetna Commercial |
$36.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.00
|
| Rate for Payer: Cash Price |
$34.46
|
| Rate for Payer: Cofinity Advantage |
$30.15
|
| Rate for Payer: Cofinity Commercial |
$37.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.46
|
| Rate for Payer: Healthscope Commercial |
$38.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.30
|
| Rate for Payer: PHP Commercial |
$36.61
|
| Rate for Payer: Priority Health SBD |
$27.13
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
OP
|
$43.07
|
|
|
Service Code
|
NDC 00065074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$38.76 |
| Rate for Payer: Aetna Commercial |
$36.61
|
| Rate for Payer: Aetna Medicare |
$21.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.00
|
| Rate for Payer: BCBS Complete |
$17.23
|
| Rate for Payer: Cash Price |
$34.46
|
| Rate for Payer: Cofinity Advantage |
$30.15
|
| Rate for Payer: Cofinity Commercial |
$37.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.46
|
| Rate for Payer: Healthscope Commercial |
$38.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.30
|
| Rate for Payer: PHP Commercial |
$36.61
|
| Rate for Payer: Priority Health SBD |
$27.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.00
|
| Rate for Payer: UHC Core |
$22.44
|
| Rate for Payer: UHC Exchange |
$16.93
|
|
|
TETRACYCLINE 250 MG CAPSULE
|
Facility
|
IP
|
$255.36
|
|
|
Service Code
|
NDC 51991090601
|
| Hospital Charge Code |
7796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.88 |
| Max. Negotiated Rate |
$229.82 |
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.98
|
| Rate for Payer: Cash Price |
$204.29
|
| Rate for Payer: Cofinity Advantage |
$178.75
|
| Rate for Payer: Cofinity Commercial |
$219.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.29
|
| Rate for Payer: Healthscope Commercial |
$229.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.52
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health SBD |
$160.88
|
|
|
TETRACYCLINE 250 MG CAPSULE
|
Facility
|
IP
|
$459.80
|
|
|
Service Code
|
NDC 23155001701
|
| Hospital Charge Code |
7796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.67 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Aetna Commercial |
$390.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.87
|
| Rate for Payer: Cash Price |
$367.84
|
| Rate for Payer: Cofinity Advantage |
$321.86
|
| Rate for Payer: Cofinity Commercial |
$395.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.84
|
| Rate for Payer: Healthscope Commercial |
$413.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.85
|
| Rate for Payer: PHP Commercial |
$390.83
|
| Rate for Payer: Priority Health SBD |
$289.67
|
|
|
TETRACYCLINE 250 MG CAPSULE
|
Facility
|
OP
|
$459.80
|
|
|
Service Code
|
NDC 23155001701
|
| Hospital Charge Code |
7796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Aetna Commercial |
$390.83
|
| Rate for Payer: Aetna Medicare |
$229.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.87
|
| Rate for Payer: BCBS Complete |
$183.92
|
| Rate for Payer: Cash Price |
$367.84
|
| Rate for Payer: Cofinity Advantage |
$321.86
|
| Rate for Payer: Cofinity Commercial |
$395.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.84
|
| Rate for Payer: Healthscope Commercial |
$413.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.85
|
| Rate for Payer: PHP Commercial |
$390.83
|
| Rate for Payer: Priority Health SBD |
$289.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.87
|
| Rate for Payer: UHC Core |
$239.56
|
| Rate for Payer: UHC Exchange |
$180.70
|
|
|
TETRACYCLINE 250 MG CAPSULE
|
Facility
|
OP
|
$255.36
|
|
|
Service Code
|
NDC 51991090601
|
| Hospital Charge Code |
7796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$229.82 |
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: Aetna Medicare |
$127.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.98
|
| Rate for Payer: BCBS Complete |
$102.14
|
| Rate for Payer: Cash Price |
$204.29
|
| Rate for Payer: Cofinity Advantage |
$178.75
|
| Rate for Payer: Cofinity Commercial |
$219.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.29
|
| Rate for Payer: Healthscope Commercial |
$229.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.52
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health SBD |
$160.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.98
|
| Rate for Payer: UHC Core |
$133.04
|
| Rate for Payer: UHC Exchange |
$100.36
|
|
|
TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$11,926.08
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
199104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,513.43 |
| Max. Negotiated Rate |
$10,733.47 |
| Rate for Payer: Aetna Commercial |
$10,137.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,751.95
|
| Rate for Payer: Cash Price |
$9,540.86
|
| Rate for Payer: Cofinity Advantage |
$8,348.26
|
| Rate for Payer: Cofinity Commercial |
$10,256.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,540.86
|
| Rate for Payer: Healthscope Commercial |
$10,733.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,137.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,944.56
|
| Rate for Payer: PHP Commercial |
$10,137.17
|
| Rate for Payer: Priority Health SBD |
$7,513.43
|
|
|
TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$11,926.08
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
199104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$10,733.47 |
| Rate for Payer: Aetna Commercial |
$10,137.17
|
| Rate for Payer: Aetna Medicare |
$18.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,751.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.98
|
| Rate for Payer: BCBS Complete |
$9.65
|
| Rate for Payer: BCBS MAPPO |
$17.58
|
| Rate for Payer: BCBS Trust/PPO |
$44.69
|
| Rate for Payer: BCN Commercial |
$44.69
|
| Rate for Payer: BCN Medicare Advantage |
$17.58
|
| Rate for Payer: Cash Price |
$9,540.86
|
| Rate for Payer: Cash Price |
$9,540.86
|
| Rate for Payer: Cofinity Advantage |
$8,348.26
|
| Rate for Payer: Cofinity Commercial |
$10,256.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,540.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.58
|
| Rate for Payer: Healthscope Commercial |
$10,733.47
|
| Rate for Payer: Mclaren Medicaid |
$9.19
|
| Rate for Payer: Mclaren Medicare |
$17.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.46
|
| Rate for Payer: Meridian Medicaid |
$18.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,137.17
|
| Rate for Payer: Nomi Health Commercial |
$52.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,944.56
|
| Rate for Payer: PACE Medicare |
$16.70
|
| Rate for Payer: PACE SWMI |
$17.58
|
| Rate for Payer: PHP Commercial |
$10,137.17
|
| Rate for Payer: PHP Medicare Advantage |
$17.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56.80
|
| Rate for Payer: Priority Health Medicare |
$17.58
|
| Rate for Payer: Priority Health SBD |
$7,513.43
|
| Rate for Payer: Priority Health Tiered Network |
$45.44
|
| Rate for Payer: Railroad Medicare Medicare |
$17.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.40
|
| Rate for Payer: UHC Core |
$29.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.58
|
| Rate for Payer: UHC Exchange |
$29.40
|
| Rate for Payer: UHC Medicaid |
$9.19
|
| Rate for Payer: UHCCP Medicaid |
$9.19
|
| Rate for Payer: VA VA |
$17.58
|
|
|
THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$436.32
|
|
|
Service Code
|
NDC 62332002531
|
| Hospital Charge Code |
12098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.47 |
| Max. Negotiated Rate |
$392.69 |
| Rate for Payer: Aetna Commercial |
$370.87
|
| Rate for Payer: Aetna Medicare |
$218.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.61
|
| Rate for Payer: BCBS Complete |
$174.53
|
| Rate for Payer: Cash Price |
$349.06
|
| Rate for Payer: Cofinity Advantage |
$305.42
|
| Rate for Payer: Cofinity Commercial |
$375.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.06
|
| Rate for Payer: Healthscope Commercial |
$392.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.24
|
| Rate for Payer: PHP Commercial |
$370.87
|
| Rate for Payer: Priority Health SBD |
$274.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.61
|
| Rate for Payer: UHC Core |
$227.32
|
| Rate for Payer: UHC Exchange |
$171.47
|
|
|
THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$436.32
|
|
|
Service Code
|
NDC 62332002531
|
| Hospital Charge Code |
12098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.88 |
| Max. Negotiated Rate |
$392.69 |
| Rate for Payer: Aetna Commercial |
$370.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.61
|
| Rate for Payer: Cash Price |
$349.06
|
| Rate for Payer: Cofinity Advantage |
$305.42
|
| Rate for Payer: Cofinity Commercial |
$375.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.06
|
| Rate for Payer: Healthscope Commercial |
$392.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.24
|
| Rate for Payer: PHP Commercial |
$370.87
|
| Rate for Payer: Priority Health SBD |
$274.88
|
|
|
THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$597.12
|
|
|
Service Code
|
NDC 68462038001
|
| Hospital Charge Code |
108325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.19 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Advantage |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.84
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health SBD |
$376.19
|
|
|
THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$463.68
|
|
|
Service Code
|
NDC 42858070101
|
| Hospital Charge Code |
108325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.23 |
| Max. Negotiated Rate |
$417.31 |
| Rate for Payer: Aetna Commercial |
$394.13
|
| Rate for Payer: Aetna Medicare |
$231.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.39
|
| Rate for Payer: BCBS Complete |
$185.47
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cofinity Advantage |
$324.58
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.94
|
| Rate for Payer: Healthscope Commercial |
$417.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$347.76
|
| Rate for Payer: PHP Commercial |
$394.13
|
| Rate for Payer: Priority Health SBD |
$292.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.39
|
| Rate for Payer: UHC Core |
$241.58
|
| Rate for Payer: UHC Exchange |
$182.23
|
|
|
THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$463.68
|
|
|
Service Code
|
NDC 42858070101
|
| Hospital Charge Code |
108325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.12 |
| Max. Negotiated Rate |
$417.31 |
| Rate for Payer: Aetna Commercial |
$394.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.39
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cofinity Advantage |
$324.58
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.94
|
| Rate for Payer: Healthscope Commercial |
$417.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$347.76
|
| Rate for Payer: PHP Commercial |
$394.13
|
| Rate for Payer: Priority Health SBD |
$292.12
|
|
|
THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$597.12
|
|
|
Service Code
|
NDC 68462038001
|
| Hospital Charge Code |
108325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.67 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna Medicare |
$298.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Advantage |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.84
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health SBD |
$376.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.13
|
| Rate for Payer: UHC Core |
$311.10
|
| Rate for Payer: UHC Exchange |
$234.67
|
|
|
THERMAGE
|
Professional
|
Both
|
$1,051.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$420.40 |
| Max. Negotiated Rate |
$788.25 |
| Rate for Payer: Aetna Medicare |
$525.50
|
| Rate for Payer: BCBS Complete |
$420.40
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.25
|
|
|
THERMAGE ABDOMEN - ENTIRE
|
Professional
|
Both
|
$3,257.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,302.80 |
| Max. Negotiated Rate |
$2,442.75 |
| Rate for Payer: Aetna Medicare |
$1,628.50
|
| Rate for Payer: BCBS Complete |
$1,302.80
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,117.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
|
|
THERMAGE ABDOMEN - LOWER
|
Professional
|
Both
|
$2,101.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: Aetna Medicare |
$1,050.50
|
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
|
|
THERMAGE ARMS - 1 ARM
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
|
|
THERMAGE ARMS - BILATERAL
|
Professional
|
Both
|
$2,206.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$882.40 |
| Max. Negotiated Rate |
$1,654.50 |
| Rate for Payer: Aetna Medicare |
$1,103.00
|
| Rate for Payer: BCBS Complete |
$882.40
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,654.50
|
|
|
THERMAGE EYES
|
Professional
|
Both
|
$998.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$399.20 |
| Max. Negotiated Rate |
$748.50 |
| Rate for Payer: Aetna Medicare |
$499.00
|
| Rate for Payer: BCBS Complete |
$399.20
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$748.50
|
|
|
THERMAGE FACE
|
Professional
|
Both
|
$2,101.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: Aetna Medicare |
$1,050.50
|
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
|
|
THERMAGE FACE & EYES
|
Professional
|
Both
|
$2,837.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,134.80 |
| Max. Negotiated Rate |
$2,127.75 |
| Rate for Payer: Aetna Medicare |
$1,418.50
|
| Rate for Payer: BCBS Complete |
$1,134.80
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,844.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.75
|
|
|
THERMAGE FACE & NECK
|
Professional
|
Both
|
$2,942.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,176.80 |
| Max. Negotiated Rate |
$2,206.50 |
| Rate for Payer: Aetna Medicare |
$1,471.00
|
| Rate for Payer: BCBS Complete |
$1,176.80
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,206.50
|
|
|
THERMAGE FACE, NECK, & EYES
|
Professional
|
Both
|
$3,677.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,470.80 |
| Max. Negotiated Rate |
$2,757.75 |
| Rate for Payer: Aetna Medicare |
$1,838.50
|
| Rate for Payer: BCBS Complete |
$1,470.80
|
| Rate for Payer: Cash Price |
$2,941.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,390.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,757.75
|
|
