|
TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 24605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$874.70
|
| Rate for Payer: BCN Commercial |
$874.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE AND/OR LOCKING SCREWS
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 24516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,700.25 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$5,700.25
|
| Rate for Payer: BCN Commercial |
$5,700.25
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$6,690.48
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 59812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.66
|
| Rate for Payer: BCN Commercial |
$1,869.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 59820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,714.53
|
| Rate for Payer: BCN Commercial |
$1,714.53
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
|
Facility
|
OP
|
$2,381.49
|
|
|
Service Code
|
CPT 12020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$478.99
|
| Rate for Payer: BCN Commercial |
$478.99
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 27759
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,782.01 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$5,782.01
|
| Rate for Payer: BCN Commercial |
$5,782.01
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$6,690.48
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
TRIAMCINOLONE ACETONIDE 0.147 MG/GRAM TOPICAL AEROSOL
|
Facility
|
OP
|
$1,735.12
|
|
|
Service Code
|
NDC 10631009362
|
| Hospital Charge Code |
19770
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$681.90 |
| Max. Negotiated Rate |
$1,561.61 |
| Rate for Payer: Aetna Commercial |
$1,474.85
|
| Rate for Payer: Aetna Medicare |
$867.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.83
|
| Rate for Payer: BCBS Complete |
$694.05
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cofinity Advantage |
$1,214.58
|
| Rate for Payer: Cofinity Commercial |
$1,492.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.10
|
| Rate for Payer: Healthscope Commercial |
$1,561.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,388.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,301.34
|
| Rate for Payer: PHP Commercial |
$1,474.85
|
| Rate for Payer: Priority Health SBD |
$1,093.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,127.83
|
| Rate for Payer: UHC Core |
$904.00
|
| Rate for Payer: UHC Exchange |
$681.90
|
|
|
TRIAMCINOLONE ACETONIDE 0.147 MG/GRAM TOPICAL AEROSOL
|
Facility
|
IP
|
$1,735.12
|
|
|
Service Code
|
NDC 10631009362
|
| Hospital Charge Code |
19770
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,093.13 |
| Max. Negotiated Rate |
$1,561.61 |
| Rate for Payer: Aetna Commercial |
$1,474.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.83
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cofinity Advantage |
$1,214.58
|
| Rate for Payer: Cofinity Commercial |
$1,492.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.10
|
| Rate for Payer: Healthscope Commercial |
$1,561.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,301.34
|
| Rate for Payer: PHP Commercial |
$1,474.85
|
| Rate for Payer: Priority Health SBD |
$1,093.13
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$58.80
|
|
|
Service Code
|
NDC 52817081154
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$52.92 |
| Rate for Payer: Aetna Commercial |
$49.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.22
|
| Rate for Payer: Cash Price |
$47.04
|
| Rate for Payer: Cofinity Advantage |
$41.16
|
| Rate for Payer: Cofinity Commercial |
$50.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.04
|
| Rate for Payer: Healthscope Commercial |
$52.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.10
|
| Rate for Payer: PHP Commercial |
$49.98
|
| Rate for Payer: Priority Health SBD |
$37.04
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$17.76
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$15.98 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.54
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cofinity Advantage |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.21
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.32
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: Priority Health SBD |
$11.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.54
|
| Rate for Payer: UHC Core |
$9.25
|
| Rate for Payer: UHC Exchange |
$6.98
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$73.10
|
|
|
Service Code
|
NDC 67877025145
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.05 |
| Max. Negotiated Rate |
$65.79 |
| Rate for Payer: Aetna Commercial |
$62.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.52
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cofinity Advantage |
$51.17
|
| Rate for Payer: Cofinity Commercial |
$62.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.48
|
| Rate for Payer: Healthscope Commercial |
$65.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.83
|
| Rate for Payer: PHP Commercial |
$62.13
|
| Rate for Payer: Priority Health SBD |
$46.05
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$17.76
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$15.98 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.54
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cofinity Advantage |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.21
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.32
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: Priority Health SBD |
$11.19
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$73.10
|
|
|
Service Code
|
NDC 67877025145
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$65.79 |
| Rate for Payer: Aetna Commercial |
$62.13
|
| Rate for Payer: Aetna Medicare |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.52
|
| Rate for Payer: BCBS Complete |
$29.24
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cofinity Advantage |
$51.17
|
| Rate for Payer: Cofinity Commercial |
$62.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.48
|
| Rate for Payer: Healthscope Commercial |
$65.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.83
|
| Rate for Payer: PHP Commercial |
$62.13
|
| Rate for Payer: Priority Health SBD |
$46.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.52
|
| Rate for Payer: UHC Core |
$38.09
|
| Rate for Payer: UHC Exchange |
$28.73
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$57.21
|
|
|
Service Code
|
NDC 21922006230
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$51.49 |
| Rate for Payer: Aetna Commercial |
$48.63
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: BCBS Complete |
$22.88
|
| Rate for Payer: Cash Price |
$45.77
|
| Rate for Payer: Cofinity Advantage |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.77
|
| Rate for Payer: Healthscope Commercial |
$51.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.91
|
| Rate for Payer: PHP Commercial |
$48.63
|
| Rate for Payer: Priority Health SBD |
$36.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.19
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Exchange |
$22.48
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$58.80
|
|
|
Service Code
|
NDC 52817081154
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.11 |
| Max. Negotiated Rate |
$52.92 |
| Rate for Payer: Aetna Commercial |
$49.98
|
| Rate for Payer: Aetna Medicare |
$29.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.22
|
| Rate for Payer: BCBS Complete |
$23.52
|
| Rate for Payer: Cash Price |
$47.04
|
| Rate for Payer: Cofinity Advantage |
$41.16
|
| Rate for Payer: Cofinity Commercial |
$50.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.04
|
| Rate for Payer: Healthscope Commercial |
$52.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.10
|
| Rate for Payer: PHP Commercial |
$49.98
|
| Rate for Payer: Priority Health SBD |
$37.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.22
|
| Rate for Payer: UHC Core |
$30.63
|
| Rate for Payer: UHC Exchange |
$23.11
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$57.21
|
|
|
Service Code
|
NDC 21922006230
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$51.49 |
| Rate for Payer: Aetna Commercial |
$48.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: Cash Price |
$45.77
|
| Rate for Payer: Cofinity Advantage |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.77
|
| Rate for Payer: Healthscope Commercial |
$51.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.91
|
| Rate for Payer: PHP Commercial |
$48.63
|
| Rate for Payer: Priority Health SBD |
$36.04
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$18.16
|
|
|
Service Code
|
NDC 51672128401
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna Commercial |
$15.44
|
| Rate for Payer: Aetna Medicare |
$9.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.80
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cofinity Advantage |
$12.71
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.62
|
| Rate for Payer: PHP Commercial |
$15.44
|
| Rate for Payer: Priority Health SBD |
$11.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.80
|
| Rate for Payer: UHC Core |
$9.46
|
| Rate for Payer: UHC Exchange |
$7.14
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$81.04
|
|
|
Service Code
|
NDC 16714027603
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$72.94 |
| Rate for Payer: Aetna Commercial |
$68.88
|
| Rate for Payer: Aetna Medicare |
$40.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.68
|
| Rate for Payer: BCBS Complete |
$32.42
|
| Rate for Payer: Cash Price |
$64.83
|
| Rate for Payer: Cofinity Advantage |
$56.73
|
| Rate for Payer: Cofinity Commercial |
$69.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.83
|
| Rate for Payer: Healthscope Commercial |
$72.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.78
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: Priority Health SBD |
$51.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.68
|
| Rate for Payer: UHC Core |
$42.22
|
| Rate for Payer: UHC Exchange |
$31.85
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$11.28
|
|
|
Service Code
|
NDC 00168000615
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Medicare |
$5.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.33
|
| Rate for Payer: BCBS Complete |
$4.51
|
| Rate for Payer: Cash Price |
$9.02
|
| Rate for Payer: Cofinity Advantage |
$7.90
|
| Rate for Payer: Cofinity Commercial |
$9.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.02
|
| Rate for Payer: Healthscope Commercial |
$10.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.46
|
| Rate for Payer: PHP Commercial |
$9.59
|
| Rate for Payer: Priority Health SBD |
$7.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.33
|
| Rate for Payer: UHC Core |
$5.88
|
| Rate for Payer: UHC Exchange |
$4.43
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$11.28
|
|
|
Service Code
|
NDC 00168000615
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.33
|
| Rate for Payer: Cash Price |
$9.02
|
| Rate for Payer: Cofinity Advantage |
$7.90
|
| Rate for Payer: Cofinity Commercial |
$9.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.02
|
| Rate for Payer: Healthscope Commercial |
$10.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.46
|
| Rate for Payer: PHP Commercial |
$9.59
|
| Rate for Payer: Priority Health SBD |
$7.11
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$81.04
|
|
|
Service Code
|
NDC 16714027603
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.06 |
| Max. Negotiated Rate |
$72.94 |
| Rate for Payer: Aetna Commercial |
$68.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.68
|
| Rate for Payer: Cash Price |
$64.83
|
| Rate for Payer: Cofinity Advantage |
$56.73
|
| Rate for Payer: Cofinity Commercial |
$69.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.83
|
| Rate for Payer: Healthscope Commercial |
$72.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.78
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: Priority Health SBD |
$51.06
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$18.16
|
|
|
Service Code
|
NDC 51672128401
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna Commercial |
$15.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.80
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cofinity Advantage |
$12.71
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.62
|
| Rate for Payer: PHP Commercial |
$15.44
|
| Rate for Payer: Priority Health SBD |
$11.44
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$18.84
|
|
|
Service Code
|
NDC 45802005535
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cofinity Advantage |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.13
|
| Rate for Payer: PHP Commercial |
$16.01
|
| Rate for Payer: Priority Health SBD |
$11.87
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$18.84
|
|
|
Service Code
|
NDC 45802005535
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cofinity Advantage |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.13
|
| Rate for Payer: PHP Commercial |
$16.01
|
| Rate for Payer: Priority Health SBD |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.25
|
| Rate for Payer: UHC Core |
$9.82
|
| Rate for Payer: UHC Exchange |
$7.40
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$25.61
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Aetna Commercial |
$21.77
|
| Rate for Payer: Aetna Commercial |
$249.61
|
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.76
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$20.49
|
| Rate for Payer: Cash Price |
$234.93
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cofinity Advantage |
$11.40
|
| Rate for Payer: Cofinity Advantage |
$17.93
|
| Rate for Payer: Cofinity Advantage |
$23.43
|
| Rate for Payer: Cofinity Advantage |
$205.56
|
| Rate for Payer: Cofinity Advantage |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$22.02
|
| Rate for Payer: Cofinity Commercial |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$252.55
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Healthscope Commercial |
$30.12
|
| Rate for Payer: Healthscope Commercial |
$264.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.21
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: PHP Commercial |
$28.45
|
| Rate for Payer: PHP Commercial |
$249.61
|
| Rate for Payer: PHP Commercial |
$21.77
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: Priority Health SBD |
$16.13
|
| Rate for Payer: Priority Health SBD |
$24.39
|
| Rate for Payer: Priority Health SBD |
$21.09
|
| Rate for Payer: Priority Health SBD |
$10.26
|
| Rate for Payer: Priority Health SBD |
$185.01
|
|
