|
DENOSUMAB-BMWO 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,924.39
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
211791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,992.37 |
| Max. Negotiated Rate |
$7,131.95 |
| Rate for Payer: Aetna Commercial |
$6,735.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,150.85
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cofinity Advantage |
$5,547.07
|
| Rate for Payer: Cofinity Commercial |
$6,814.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,339.51
|
| Rate for Payer: Healthscope Commercial |
$7,131.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,735.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,943.29
|
| Rate for Payer: PHP Commercial |
$6,735.73
|
| Rate for Payer: Priority Health SBD |
$4,992.37
|
|
|
DENOSUMAB-BMWO 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,825.03
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
211788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$4,342.53 |
| Rate for Payer: Aetna Commercial |
$4,101.28
|
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.76
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: BCBS MAPPO |
$26.21
|
| Rate for Payer: BCBS Trust/PPO |
$67.22
|
| Rate for Payer: BCN Commercial |
$67.22
|
| Rate for Payer: BCN Medicare Advantage |
$26.21
|
| Rate for Payer: Cash Price |
$3,860.02
|
| Rate for Payer: Cash Price |
$3,860.02
|
| Rate for Payer: Cofinity Advantage |
$3,377.52
|
| Rate for Payer: Cofinity Commercial |
$4,149.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,860.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$4,342.53
|
| Rate for Payer: Mclaren Medicaid |
$13.71
|
| Rate for Payer: Mclaren Medicare |
$26.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.52
|
| Rate for Payer: Meridian Medicaid |
$27.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,101.28
|
| Rate for Payer: Nomi Health Commercial |
$78.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,618.77
|
| Rate for Payer: PACE Medicare |
$24.90
|
| Rate for Payer: PACE SWMI |
$26.21
|
| Rate for Payer: PHP Commercial |
$4,101.28
|
| Rate for Payer: PHP Medicare Advantage |
$26.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.72
|
| Rate for Payer: Priority Health Medicare |
$26.21
|
| Rate for Payer: Priority Health SBD |
$3,039.77
|
| Rate for Payer: Priority Health Tiered Network |
$70.98
|
| Rate for Payer: Railroad Medicare Medicare |
$26.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.41
|
| Rate for Payer: UHC Core |
$46.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.21
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$13.71
|
| Rate for Payer: UHCCP Medicaid |
$13.71
|
| Rate for Payer: VA VA |
$26.21
|
|
|
DENOSUMAB-NXXP 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,048.36
|
|
|
Service Code
|
NDC 78206019501
|
| Hospital Charge Code |
213298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,770.01 |
| Max. Negotiated Rate |
$6,343.52 |
| Rate for Payer: Aetna Commercial |
$5,991.11
|
| Rate for Payer: Aetna Medicare |
$3,524.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,581.43
|
| Rate for Payer: BCBS Complete |
$2,819.34
|
| Rate for Payer: Cash Price |
$5,638.69
|
| Rate for Payer: Cofinity Advantage |
$4,933.85
|
| Rate for Payer: Cofinity Commercial |
$6,061.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,638.69
|
| Rate for Payer: Healthscope Commercial |
$6,343.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,638.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,991.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,286.27
|
| Rate for Payer: PHP Commercial |
$5,991.11
|
| Rate for Payer: Priority Health SBD |
$4,440.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,581.43
|
| Rate for Payer: UHC Core |
$3,672.20
|
| Rate for Payer: UHC Exchange |
$2,770.01
|
|
|
DENOSUMAB-NXXP 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,048.36
|
|
|
Service Code
|
NDC 78206019501
|
| Hospital Charge Code |
213298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,440.47 |
| Max. Negotiated Rate |
$6,343.52 |
| Rate for Payer: Aetna Commercial |
$5,991.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,581.43
|
| Rate for Payer: Cash Price |
$5,638.69
|
| Rate for Payer: Cofinity Advantage |
$4,933.85
|
| Rate for Payer: Cofinity Commercial |
$6,061.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,638.69
|
| Rate for Payer: Healthscope Commercial |
$6,343.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,991.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,286.27
|
| Rate for Payer: PHP Commercial |
$5,991.11
|
| Rate for Payer: Priority Health SBD |
$4,440.47
|
|
|
DENOSUMAB-NXXP 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$2,511.59
|
|
|
Service Code
|
NDC 78206019301
|
| Hospital Charge Code |
213299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,582.30 |
| Max. Negotiated Rate |
$2,260.43 |
| Rate for Payer: Aetna Commercial |
$2,134.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,632.53
|
| Rate for Payer: Cash Price |
$2,009.27
|
| Rate for Payer: Cofinity Advantage |
$1,758.11
|
| Rate for Payer: Cofinity Commercial |
$2,159.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,009.27
|
| Rate for Payer: Healthscope Commercial |
$2,260.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,134.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,883.69
|
| Rate for Payer: PHP Commercial |
$2,134.85
|
| Rate for Payer: Priority Health SBD |
$1,582.30
|
|
|
DENOSUMAB-NXXP 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$2,511.59
|
|
|
Service Code
|
NDC 78206019301
|
| Hospital Charge Code |
213299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$987.05 |
| Max. Negotiated Rate |
$2,260.43 |
| Rate for Payer: Aetna Commercial |
$2,134.85
|
| Rate for Payer: Aetna Medicare |
$1,255.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,632.53
|
| Rate for Payer: BCBS Complete |
$1,004.64
|
| Rate for Payer: Cash Price |
$2,009.27
|
| Rate for Payer: Cofinity Advantage |
$1,758.11
|
| Rate for Payer: Cofinity Commercial |
$2,159.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,009.27
|
| Rate for Payer: Healthscope Commercial |
$2,260.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,009.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,134.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,883.69
|
| Rate for Payer: PHP Commercial |
$2,134.85
|
| Rate for Payer: Priority Health SBD |
$1,582.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,632.53
|
| Rate for Payer: UHC Core |
$1,308.54
|
| Rate for Payer: UHC Exchange |
$987.05
|
|
|
DENTAL AND ORAL DISEASES WITH CC
|
Facility
|
IP
|
$17,984.37
|
|
|
Service Code
|
MSDRG 158
|
| Min. Negotiated Rate |
$7,229.63 |
| Max. Negotiated Rate |
$17,984.37 |
| Rate for Payer: Aetna Medicare |
$7,914.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,512.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,512.67
|
| Rate for Payer: BCBS MAPPO |
$7,610.14
|
| Rate for Payer: BCBS Trust/PPO |
$17,984.37
|
| Rate for Payer: BCN Commercial |
$17,984.37
|
| Rate for Payer: BCN Medicare Advantage |
$7,610.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,610.14
|
| Rate for Payer: Mclaren Medicare |
$7,610.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,990.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,751.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,371.15
|
| Rate for Payer: Nomi Health Commercial |
$11,736.42
|
| Rate for Payer: PACE Medicare |
$7,229.63
|
| Rate for Payer: PACE SWMI |
$7,610.14
|
| Rate for Payer: PHP Medicare Advantage |
$7,610.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,667.92
|
| Rate for Payer: Priority Health Medicare |
$7,610.14
|
| Rate for Payer: Priority Health Tiered Network |
$11,734.34
|
| Rate for Payer: Railroad Medicare Medicare |
$7,610.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,829.74
|
| Rate for Payer: UHC Core |
$12,406.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,610.14
|
| Rate for Payer: UHC Exchange |
$10,132.44
|
| Rate for Payer: VA VA |
$7,610.14
|
|
|
DENTAL AND ORAL DISEASES WITH MCC
|
Facility
|
IP
|
$48,140.89
|
|
|
Service Code
|
MSDRG 157
|
| Min. Negotiated Rate |
$13,154.48 |
| Max. Negotiated Rate |
$48,140.89 |
| Rate for Payer: Aetna Medicare |
$14,400.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,308.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,308.53
|
| Rate for Payer: BCBS MAPPO |
$13,846.82
|
| Rate for Payer: BCBS Trust/PPO |
$48,140.89
|
| Rate for Payer: BCN Commercial |
$48,140.89
|
| Rate for Payer: BCN Medicare Advantage |
$13,846.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,846.82
|
| Rate for Payer: Mclaren Medicare |
$13,846.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,539.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,923.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,231.50
|
| Rate for Payer: Nomi Health Commercial |
$22,146.72
|
| Rate for Payer: PACE Medicare |
$13,154.48
|
| Rate for Payer: PACE SWMI |
$13,846.82
|
| Rate for Payer: PHP Medicare Advantage |
$13,846.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,678.49
|
| Rate for Payer: Priority Health Medicare |
$13,846.82
|
| Rate for Payer: Priority Health Tiered Network |
$22,142.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13,846.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,983.84
|
| Rate for Payer: UHC Core |
$23,412.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,846.82
|
| Rate for Payer: UHC Exchange |
$19,120.00
|
| Rate for Payer: VA VA |
$13,846.82
|
|
|
DENTAL AND ORAL DISEASES WITHOUT CC/MCC
|
Facility
|
IP
|
$12,865.04
|
|
|
Service Code
|
MSDRG 159
|
| Min. Negotiated Rate |
$5,751.74 |
| Max. Negotiated Rate |
$12,865.04 |
| Rate for Payer: UHC Core |
$9,661.81
|
| Rate for Payer: Aetna Medicare |
$6,296.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,568.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,568.07
|
| Rate for Payer: BCBS MAPPO |
$6,054.46
|
| Rate for Payer: BCBS Trust/PPO |
$12,865.04
|
| Rate for Payer: BCN Commercial |
$12,865.04
|
| Rate for Payer: BCN Medicare Advantage |
$6,054.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,054.46
|
| Rate for Payer: Mclaren Medicare |
$6,054.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,357.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,962.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,659.91
|
| Rate for Payer: Nomi Health Commercial |
$9,139.65
|
| Rate for Payer: PACE Medicare |
$5,751.74
|
| Rate for Payer: PACE SWMI |
$6,054.46
|
| Rate for Payer: PHP Medicare Advantage |
$6,054.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,422.54
|
| Rate for Payer: Priority Health Medicare |
$6,054.46
|
| Rate for Payer: Priority Health Tiered Network |
$9,138.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6,054.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,548.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,054.46
|
| Rate for Payer: UHC Exchange |
$7,890.56
|
| Rate for Payer: VA VA |
$6,054.46
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$15,201.05
|
|
|
Service Code
|
APR-DRG 1144
|
| Min. Negotiated Rate |
$14,477.19 |
| Max. Negotiated Rate |
$15,201.05 |
| Rate for Payer: BCBS Complete |
$15,201.05
|
| Rate for Payer: Mclaren Medicaid |
$14,477.19
|
| Rate for Payer: Meridian Medicaid |
$15,201.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,477.19
|
| Rate for Payer: UHC Medicaid |
$14,477.19
|
| Rate for Payer: UHCCP Medicaid |
$14,477.19
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$3,391.07
|
|
|
Service Code
|
APR-DRG 1142
|
| Min. Negotiated Rate |
$3,229.59 |
| Max. Negotiated Rate |
$3,391.07 |
| Rate for Payer: BCBS Complete |
$3,391.07
|
| Rate for Payer: Mclaren Medicaid |
$3,229.59
|
| Rate for Payer: Meridian Medicaid |
$3,391.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,229.59
|
| Rate for Payer: UHC Medicaid |
$3,229.59
|
| Rate for Payer: UHCCP Medicaid |
$3,229.59
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$3,305.65
|
|
|
Service Code
|
APR-DRG 1141
|
| Min. Negotiated Rate |
$3,148.24 |
| Max. Negotiated Rate |
$3,305.65 |
| Rate for Payer: BCBS Complete |
$3,305.65
|
| Rate for Payer: Mclaren Medicaid |
$3,148.24
|
| Rate for Payer: Meridian Medicaid |
$3,305.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,148.24
|
| Rate for Payer: UHC Medicaid |
$3,148.24
|
| Rate for Payer: UHCCP Medicaid |
$3,148.24
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$6,234.64
|
|
|
Service Code
|
APR-DRG 1143
|
| Min. Negotiated Rate |
$5,937.75 |
| Max. Negotiated Rate |
$6,234.64 |
| Rate for Payer: BCBS Complete |
$6,234.64
|
| Rate for Payer: Mclaren Medicaid |
$5,937.75
|
| Rate for Payer: Meridian Medicaid |
$6,234.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,937.75
|
| Rate for Payer: UHC Medicaid |
$5,937.75
|
| Rate for Payer: UHCCP Medicaid |
$5,937.75
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$3,299.91
|
|
|
Service Code
|
APR-DRG 7512
|
| Min. Negotiated Rate |
$3,142.78 |
| Max. Negotiated Rate |
$3,299.91 |
| Rate for Payer: BCBS Complete |
$3,299.91
|
| Rate for Payer: Mclaren Medicaid |
$3,142.78
|
| Rate for Payer: Meridian Medicaid |
$3,299.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,142.78
|
| Rate for Payer: UHC Medicaid |
$3,142.78
|
| Rate for Payer: UHCCP Medicaid |
$3,142.78
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$10,500.56
|
|
|
Service Code
|
APR-DRG 7514
|
| Min. Negotiated Rate |
$10,000.54 |
| Max. Negotiated Rate |
$10,500.56 |
| Rate for Payer: BCBS Complete |
$10,500.56
|
| Rate for Payer: Mclaren Medicaid |
$10,000.54
|
| Rate for Payer: Meridian Medicaid |
$10,500.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,000.54
|
| Rate for Payer: UHC Medicaid |
$10,000.54
|
| Rate for Payer: UHCCP Medicaid |
$10,000.54
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$5,064.53
|
|
|
Service Code
|
APR-DRG 7513
|
| Min. Negotiated Rate |
$4,823.36 |
| Max. Negotiated Rate |
$5,064.53 |
| Rate for Payer: BCBS Complete |
$5,064.53
|
| Rate for Payer: Mclaren Medicaid |
$4,823.36
|
| Rate for Payer: Meridian Medicaid |
$5,064.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,823.36
|
| Rate for Payer: UHC Medicaid |
$4,823.36
|
| Rate for Payer: UHCCP Medicaid |
$4,823.36
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$2,872.23
|
|
|
Service Code
|
APR-DRG 7511
|
| Min. Negotiated Rate |
$2,735.46 |
| Max. Negotiated Rate |
$2,872.23 |
| Rate for Payer: BCBS Complete |
$2,872.23
|
| Rate for Payer: Mclaren Medicaid |
$2,735.46
|
| Rate for Payer: Meridian Medicaid |
$2,872.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,735.46
|
| Rate for Payer: UHC Medicaid |
$2,735.46
|
| Rate for Payer: UHCCP Medicaid |
$2,735.46
|
|
|
DEPRESSIVE NEUROSES
|
Facility
|
IP
|
$15,336.67
|
|
|
Service Code
|
MSDRG 881
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$15,336.67 |
| Rate for Payer: Aetna Medicare |
$8,164.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,813.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,813.12
|
| Rate for Payer: BCBS MAPPO |
$7,850.50
|
| Rate for Payer: BCBS Trust/PPO |
$9,779.86
|
| Rate for Payer: BCN Commercial |
$9,779.86
|
| Rate for Payer: BCN Medicare Advantage |
$7,850.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,850.50
|
| Rate for Payer: Mclaren Medicare |
$7,850.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,243.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,028.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,635.55
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$7,457.98
|
| Rate for Payer: PACE SWMI |
$7,850.50
|
| Rate for Payer: PHP Medicare Advantage |
$7,850.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,169.32
|
| Rate for Payer: Priority Health Medicare |
$7,850.50
|
| Rate for Payer: Priority Health Tiered Network |
$12,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$7,850.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,336.67
|
| Rate for Payer: UHC Core |
$12,831.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,850.50
|
| Rate for Payer: UHC Exchange |
$10,478.80
|
| Rate for Payer: VA VA |
$7,850.50
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
IP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.28 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.00
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Advantage |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.62
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health SBD |
$54.28
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
OP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: Aetna Medicare |
$43.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.00
|
| Rate for Payer: BCBS Complete |
$34.46
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Advantage |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.62
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health SBD |
$54.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.00
|
| Rate for Payer: UHC Core |
$44.89
|
| Rate for Payer: UHC Exchange |
$33.86
|
|
|
DERMAPLANNING
|
Professional
|
Both
|
$42.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
NDC 69918010101
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.84 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.20
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Advantage |
$327.60
|
| Rate for Payer: Cofinity Commercial |
$402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.40
|
| Rate for Payer: Healthscope Commercial |
$421.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.00
|
| Rate for Payer: PHP Commercial |
$397.80
|
| Rate for Payer: Priority Health SBD |
$294.84
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
NDC 69918010101
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.92 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Medicare |
$234.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.20
|
| Rate for Payer: BCBS Complete |
$187.20
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Advantage |
$327.60
|
| Rate for Payer: Cofinity Commercial |
$402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.40
|
| Rate for Payer: Healthscope Commercial |
$421.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.00
|
| Rate for Payer: PHP Commercial |
$397.80
|
| Rate for Payer: Priority Health SBD |
$294.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.20
|
| Rate for Payer: UHC Core |
$243.83
|
| Rate for Payer: UHC Exchange |
$183.92
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)
|
Facility
|
IP
|
$423.69
|
|
|
Service Code
|
NDC 47335078891
|
| Hospital Charge Code |
21135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.92 |
| Max. Negotiated Rate |
$381.32 |
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.40
|
| Rate for Payer: Cash Price |
$338.95
|
| Rate for Payer: Cofinity Advantage |
$296.58
|
| Rate for Payer: Cofinity Commercial |
$364.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.95
|
| Rate for Payer: Healthscope Commercial |
$381.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.77
|
| Rate for Payer: PHP Commercial |
$360.14
|
| Rate for Payer: Priority Health SBD |
$266.92
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)
|
Facility
|
OP
|
$423.69
|
|
|
Service Code
|
NDC 47335078891
|
| Hospital Charge Code |
21135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.51 |
| Max. Negotiated Rate |
$381.32 |
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: Aetna Medicare |
$211.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.40
|
| Rate for Payer: BCBS Complete |
$169.48
|
| Rate for Payer: Cash Price |
$338.95
|
| Rate for Payer: Cofinity Advantage |
$296.58
|
| Rate for Payer: Cofinity Commercial |
$364.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.95
|
| Rate for Payer: Healthscope Commercial |
$381.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.77
|
| Rate for Payer: PHP Commercial |
$360.14
|
| Rate for Payer: Priority Health SBD |
$266.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.40
|
| Rate for Payer: UHC Core |
$220.74
|
| Rate for Payer: UHC Exchange |
$166.51
|
|
