|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$88.91
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$80.02 |
| Rate for Payer: Aetna Commercial |
$75.57
|
| Rate for Payer: Aetna Commercial |
$518.55
|
| Rate for Payer: Aetna Commercial |
$227.71
|
| Rate for Payer: Aetna Commercial |
$51.86
|
| Rate for Payer: Aetna Commercial |
$184.69
|
| Rate for Payer: Aetna Medicare |
$108.64
|
| Rate for Payer: Aetna Medicare |
$133.94
|
| Rate for Payer: Aetna Medicare |
$305.03
|
| Rate for Payer: Aetna Medicare |
$44.45
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.23
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: BCBS Complete |
$244.02
|
| Rate for Payer: BCBS Complete |
$86.91
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cofinity Advantage |
$62.24
|
| Rate for Payer: Cofinity Advantage |
$42.71
|
| Rate for Payer: Cofinity Advantage |
$187.52
|
| Rate for Payer: Cofinity Advantage |
$152.10
|
| Rate for Payer: Cofinity Advantage |
$427.04
|
| Rate for Payer: Cofinity Commercial |
$524.65
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$52.47
|
| Rate for Payer: Cofinity Commercial |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.31
|
| Rate for Payer: Healthscope Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$80.02
|
| Rate for Payer: Healthscope Commercial |
$54.91
|
| Rate for Payer: Healthscope Commercial |
$549.05
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$488.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$457.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.76
|
| Rate for Payer: PHP Commercial |
$518.55
|
| Rate for Payer: PHP Commercial |
$227.71
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$75.57
|
| Rate for Payer: PHP Commercial |
$51.86
|
| Rate for Payer: Priority Health SBD |
$384.34
|
| Rate for Payer: Priority Health SBD |
$38.44
|
| Rate for Payer: Priority Health SBD |
$56.01
|
| Rate for Payer: Priority Health SBD |
$168.77
|
| Rate for Payer: Priority Health SBD |
$136.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$217.28
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.89 |
| Max. Negotiated Rate |
$195.55 |
| Rate for Payer: Aetna Commercial |
$184.69
|
| Rate for Payer: Aetna Commercial |
$75.57
|
| Rate for Payer: Aetna Commercial |
$51.86
|
| Rate for Payer: Aetna Commercial |
$518.55
|
| Rate for Payer: Aetna Commercial |
$227.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.23
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cofinity Advantage |
$42.71
|
| Rate for Payer: Cofinity Advantage |
$152.10
|
| Rate for Payer: Cofinity Advantage |
$427.04
|
| Rate for Payer: Cofinity Advantage |
$62.24
|
| Rate for Payer: Cofinity Advantage |
$187.52
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$524.65
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$52.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.13
|
| Rate for Payer: Healthscope Commercial |
$54.91
|
| Rate for Payer: Healthscope Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$549.05
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Healthscope Commercial |
$80.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$457.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.68
|
| Rate for Payer: PHP Commercial |
$51.86
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$518.55
|
| Rate for Payer: PHP Commercial |
$227.71
|
| Rate for Payer: PHP Commercial |
$75.57
|
| Rate for Payer: Priority Health SBD |
$56.01
|
| Rate for Payer: Priority Health SBD |
$384.34
|
| Rate for Payer: Priority Health SBD |
$136.89
|
| Rate for Payer: Priority Health SBD |
$168.77
|
| Rate for Payer: Priority Health SBD |
$38.44
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.33
|
| Rate for Payer: BCN Commercial |
$2,126.33
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.22
|
| Rate for Payer: BCN Commercial |
$1,769.22
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 56515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,150.82
|
| Rate for Payer: BCN Commercial |
$2,150.82
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,507.05
|
|
|
Service Code
|
NDC 00008121030
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$949.44 |
| Max. Negotiated Rate |
$1,356.35 |
| Rate for Payer: Aetna Commercial |
$1,280.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.58
|
| Rate for Payer: Cash Price |
$1,205.64
|
| Rate for Payer: Cofinity Advantage |
$1,054.93
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.29
|
| Rate for Payer: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health SBD |
$949.44
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,507.05
|
|
|
Service Code
|
NDC 00008121030
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$592.27 |
| Max. Negotiated Rate |
$1,356.35 |
| Rate for Payer: Aetna Commercial |
$1,280.99
|
| Rate for Payer: Aetna Medicare |
$753.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.58
|
| Rate for Payer: BCBS Complete |
$602.82
|
| Rate for Payer: Cash Price |
$1,205.64
|
| Rate for Payer: Cofinity Advantage |
$1,054.93
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,205.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.29
|
| Rate for Payer: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health SBD |
$949.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.58
|
| Rate for Payer: UHC Core |
$785.17
|
| Rate for Payer: UHC Exchange |
$592.27
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$73.30
|
|
|
Service Code
|
NDC 51991000633
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$65.97 |
| Rate for Payer: Aetna Commercial |
$62.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.65
|
| Rate for Payer: Cash Price |
$58.64
|
| Rate for Payer: Cofinity Advantage |
$51.31
|
| Rate for Payer: Cofinity Commercial |
$63.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.64
|
| Rate for Payer: Healthscope Commercial |
$65.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.98
|
| Rate for Payer: PHP Commercial |
$62.30
|
| Rate for Payer: Priority Health SBD |
$46.18
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$73.30
|
|
|
Service Code
|
NDC 51991000633
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$65.97 |
| Rate for Payer: Aetna Commercial |
$62.30
|
| Rate for Payer: Aetna Medicare |
$36.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.65
|
| Rate for Payer: BCBS Complete |
$29.32
|
| Rate for Payer: Cash Price |
$58.64
|
| Rate for Payer: Cofinity Advantage |
$51.31
|
| Rate for Payer: Cofinity Commercial |
$63.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.64
|
| Rate for Payer: Healthscope Commercial |
$65.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.98
|
| Rate for Payer: PHP Commercial |
$62.30
|
| Rate for Payer: Priority Health SBD |
$46.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.65
|
| Rate for Payer: UHC Core |
$38.19
|
| Rate for Payer: UHC Exchange |
$28.81
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$101.09
|
|
|
Service Code
|
NDC 51991031133
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.73 |
| Max. Negotiated Rate |
$90.98 |
| Rate for Payer: Aetna Commercial |
$85.93
|
| Rate for Payer: Aetna Medicare |
$50.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.71
|
| Rate for Payer: BCBS Complete |
$40.44
|
| Rate for Payer: Cash Price |
$80.87
|
| Rate for Payer: Cofinity Advantage |
$70.76
|
| Rate for Payer: Cofinity Commercial |
$86.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.87
|
| Rate for Payer: Healthscope Commercial |
$90.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.82
|
| Rate for Payer: PHP Commercial |
$85.93
|
| Rate for Payer: Priority Health SBD |
$63.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.71
|
| Rate for Payer: UHC Core |
$52.67
|
| Rate for Payer: UHC Exchange |
$39.73
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$7.87
|
|
|
Service Code
|
NDC 60687060711
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.12
|
| Rate for Payer: BCBS Complete |
$3.15
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Advantage |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$6.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$7.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.90
|
| Rate for Payer: PHP Commercial |
$6.69
|
| Rate for Payer: Priority Health SBD |
$4.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$4.10
|
| Rate for Payer: UHC Exchange |
$3.09
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$240.63
|
|
|
Service Code
|
NDC 51991031190
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$216.57 |
| Rate for Payer: Aetna Commercial |
$204.54
|
| Rate for Payer: Aetna Medicare |
$120.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.41
|
| Rate for Payer: BCBS Complete |
$96.25
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cofinity Advantage |
$168.44
|
| Rate for Payer: Cofinity Commercial |
$206.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.50
|
| Rate for Payer: Healthscope Commercial |
$216.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.47
|
| Rate for Payer: PHP Commercial |
$204.54
|
| Rate for Payer: Priority Health SBD |
$151.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.41
|
| Rate for Payer: UHC Core |
$125.37
|
| Rate for Payer: UHC Exchange |
$94.57
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$235.88
|
|
|
Service Code
|
NDC 60687060721
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$212.29 |
| Rate for Payer: Aetna Commercial |
$200.50
|
| Rate for Payer: Aetna Medicare |
$117.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.32
|
| Rate for Payer: BCBS Complete |
$94.35
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cofinity Advantage |
$165.12
|
| Rate for Payer: Cofinity Commercial |
$202.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.70
|
| Rate for Payer: Healthscope Commercial |
$212.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.91
|
| Rate for Payer: PHP Commercial |
$200.50
|
| Rate for Payer: Priority Health SBD |
$148.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.32
|
| Rate for Payer: UHC Core |
$122.89
|
| Rate for Payer: UHC Exchange |
$92.70
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$235.88
|
|
|
Service Code
|
NDC 60687060721
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.60 |
| Max. Negotiated Rate |
$212.29 |
| Rate for Payer: Aetna Commercial |
$200.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.32
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cofinity Advantage |
$165.12
|
| Rate for Payer: Cofinity Commercial |
$202.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.70
|
| Rate for Payer: Healthscope Commercial |
$212.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.91
|
| Rate for Payer: PHP Commercial |
$200.50
|
| Rate for Payer: Priority Health SBD |
$148.60
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,507.05
|
|
|
Service Code
|
NDC 00008121130
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$592.27 |
| Max. Negotiated Rate |
$1,356.35 |
| Rate for Payer: Aetna Commercial |
$1,280.99
|
| Rate for Payer: Aetna Medicare |
$753.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.58
|
| Rate for Payer: BCBS Complete |
$602.82
|
| Rate for Payer: Cash Price |
$1,205.64
|
| Rate for Payer: Cofinity Advantage |
$1,054.93
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,205.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.29
|
| Rate for Payer: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health SBD |
$949.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.58
|
| Rate for Payer: UHC Core |
$785.17
|
| Rate for Payer: UHC Exchange |
$592.27
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7.87
|
|
|
Service Code
|
NDC 60687060711
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.12
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Advantage |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$6.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$7.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.90
|
| Rate for Payer: PHP Commercial |
$6.69
|
| Rate for Payer: Priority Health SBD |
$4.96
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$101.09
|
|
|
Service Code
|
NDC 51991031133
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$90.98 |
| Rate for Payer: Aetna Commercial |
$85.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.71
|
| Rate for Payer: Cash Price |
$80.87
|
| Rate for Payer: Cofinity Advantage |
$70.76
|
| Rate for Payer: Cofinity Commercial |
$86.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.87
|
| Rate for Payer: Healthscope Commercial |
$90.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.82
|
| Rate for Payer: PHP Commercial |
$85.93
|
| Rate for Payer: Priority Health SBD |
$63.69
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$240.63
|
|
|
Service Code
|
NDC 51991031190
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.60 |
| Max. Negotiated Rate |
$216.57 |
| Rate for Payer: Aetna Commercial |
$204.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.41
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cofinity Advantage |
$168.44
|
| Rate for Payer: Cofinity Commercial |
$206.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.50
|
| Rate for Payer: Healthscope Commercial |
$216.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.47
|
| Rate for Payer: PHP Commercial |
$204.54
|
| Rate for Payer: Priority Health SBD |
$151.60
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,507.05
|
|
|
Service Code
|
NDC 00008121130
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$949.44 |
| Max. Negotiated Rate |
$1,356.35 |
| Rate for Payer: Aetna Commercial |
$1,280.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.58
|
| Rate for Payer: Cash Price |
$1,205.64
|
| Rate for Payer: Cofinity Advantage |
$1,054.93
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.29
|
| Rate for Payer: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health SBD |
$949.44
|
|
|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$235.48
|
|
|
Service Code
|
NDC 82667060005
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.54 |
| Max. Negotiated Rate |
$211.93 |
| Rate for Payer: Aetna Commercial |
$200.16
|
| Rate for Payer: Aetna Medicare |
$117.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: BCBS Complete |
$94.19
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Advantage |
$164.84
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.61
|
| Rate for Payer: PHP Commercial |
$200.16
|
| Rate for Payer: Priority Health SBD |
$148.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.06
|
| Rate for Payer: UHC Core |
$122.69
|
| Rate for Payer: UHC Exchange |
$92.54
|
|
|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$235.48
|
|
|
Service Code
|
NDC 82667060005
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.35 |
| Max. Negotiated Rate |
$211.93 |
| Rate for Payer: Aetna Commercial |
$200.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Advantage |
$164.84
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.61
|
| Rate for Payer: PHP Commercial |
$200.16
|
| Rate for Payer: Priority Health SBD |
$148.35
|
|
|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$235.48
|
|
|
Service Code
|
NDC 00078092525
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.54 |
| Max. Negotiated Rate |
$211.93 |
| Rate for Payer: Aetna Commercial |
$200.16
|
| Rate for Payer: Aetna Medicare |
$117.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: BCBS Complete |
$94.19
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Advantage |
$164.84
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.61
|
| Rate for Payer: PHP Commercial |
$200.16
|
| Rate for Payer: Priority Health SBD |
$148.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.06
|
| Rate for Payer: UHC Core |
$122.69
|
| Rate for Payer: UHC Exchange |
$92.54
|
|
|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$235.48
|
|
|
Service Code
|
NDC 00078092525
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.35 |
| Max. Negotiated Rate |
$211.93 |
| Rate for Payer: Aetna Commercial |
$200.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Advantage |
$164.84
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.61
|
| Rate for Payer: PHP Commercial |
$200.16
|
| Rate for Payer: Priority Health SBD |
$148.35
|
|
|
DEXAMETHASONE 0.5 MG TABLET
|
Facility
|
IP
|
$242.05
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
2322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.49 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Advantage |
$169.44
|
| Rate for Payer: Cofinity Advantage |
$164.50
|
| Rate for Payer: Cofinity Advantage |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.54
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health SBD |
$23.69
|
| Rate for Payer: Priority Health SBD |
$148.05
|
| Rate for Payer: Priority Health SBD |
$152.49
|
|
|
DEXAMETHASONE 0.5 MG TABLET
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
2322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Aetna Medicare |
$121.03
|
| Rate for Payer: Aetna Medicare |
$18.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: BCBS Complete |
$15.04
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS Complete |
$96.82
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Advantage |
$169.44
|
| Rate for Payer: Cofinity Advantage |
$164.50
|
| Rate for Payer: Cofinity Advantage |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.20
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: Priority Health SBD |
$148.05
|
| Rate for Payer: Priority Health SBD |
$23.69
|
| Rate for Payer: Priority Health SBD |
$152.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
|
