|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$554.26
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$498.83 |
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Commercial |
$844.83
|
| Rate for Payer: Aetna Commercial |
$335.44
|
| Rate for Payer: Aetna Commercial |
$316.00
|
| Rate for Payer: Aetna Commercial |
$6,685.14
|
| Rate for Payer: Aetna Commercial |
$5,644.60
|
| Rate for Payer: Aetna Medicare |
$3,320.36
|
| Rate for Payer: Aetna Medicare |
$250.12
|
| Rate for Payer: Aetna Medicare |
$185.88
|
| Rate for Payer: Aetna Medicare |
$277.13
|
| Rate for Payer: Aetna Medicare |
$197.32
|
| Rate for Payer: Aetna Medicare |
$496.96
|
| Rate for Payer: Aetna Medicare |
$3,932.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,316.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,112.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.05
|
| Rate for Payer: BCBS Complete |
$157.85
|
| Rate for Payer: BCBS Complete |
$148.71
|
| Rate for Payer: BCBS Complete |
$2,656.28
|
| Rate for Payer: BCBS Complete |
$3,145.95
|
| Rate for Payer: BCBS Complete |
$397.57
|
| Rate for Payer: BCBS Complete |
$200.10
|
| Rate for Payer: BCBS Complete |
$221.70
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$6,291.90
|
| Rate for Payer: Cash Price |
$6,291.90
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Commercial |
$260.24
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$276.24
|
| Rate for Payer: Cofinity Commercial |
$339.38
|
| Rate for Payer: Cofinity Commercial |
$350.17
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Cofinity Commercial |
$387.98
|
| Rate for Payer: Cofinity Commercial |
$854.77
|
| Rate for Payer: Cofinity Commercial |
$695.74
|
| Rate for Payer: Cofinity Commercial |
$4,648.50
|
| Rate for Payer: Cofinity Commercial |
$5,711.01
|
| Rate for Payer: Cofinity Commercial |
$6,763.79
|
| Rate for Payer: Cofinity Commercial |
$5,505.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,648.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,505.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$695.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,291.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,312.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.70
|
| Rate for Payer: Healthscope Commercial |
$5,976.64
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Healthscope Commercial |
$894.53
|
| Rate for Payer: Healthscope Commercial |
$355.17
|
| Rate for Payer: Healthscope Commercial |
$7,078.38
|
| Rate for Payer: Healthscope Commercial |
$334.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,644.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,685.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.20
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: PHP Commercial |
$335.44
|
| Rate for Payer: PHP Commercial |
$6,685.14
|
| Rate for Payer: PHP Commercial |
$844.83
|
| Rate for Payer: PHP Commercial |
$5,644.60
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: PHP Commercial |
$316.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,316.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,112.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.65
|
| Rate for Payer: Priority Health SBD |
$4,183.65
|
| Rate for Payer: Priority Health SBD |
$4,954.87
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: Priority Health SBD |
$315.15
|
| Rate for Payer: Priority Health SBD |
$234.22
|
| Rate for Payer: Priority Health SBD |
$248.62
|
| Rate for Payer: Priority Health SBD |
$626.17
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$554.26
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$349.18 |
| Max. Negotiated Rate |
$498.83 |
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$316.00
|
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Commercial |
$335.44
|
| Rate for Payer: Aetna Commercial |
$844.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cofinity Commercial |
$387.98
|
| Rate for Payer: Cofinity Commercial |
$260.24
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$276.24
|
| Rate for Payer: Cofinity Commercial |
$339.38
|
| Rate for Payer: Cofinity Commercial |
$350.17
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Cofinity Commercial |
$854.77
|
| Rate for Payer: Cofinity Commercial |
$695.74
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$695.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.70
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Healthscope Commercial |
$355.17
|
| Rate for Payer: Healthscope Commercial |
$334.59
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Healthscope Commercial |
$894.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.00
|
| Rate for Payer: PHP Commercial |
$316.00
|
| Rate for Payer: PHP Commercial |
$335.44
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: PHP Commercial |
$844.83
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.16
|
| Rate for Payer: Priority Health SBD |
$315.15
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: Priority Health SBD |
$626.17
|
| Rate for Payer: Priority Health SBD |
$234.22
|
| Rate for Payer: Priority Health SBD |
$248.62
|
|
|
DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER
|
Facility
|
OP
|
$1,021.42
|
|
|
Service Code
|
CPT 36593
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.31 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$214.11
|
| Rate for Payer: BCN Commercial |
$214.11
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Nomi Health Commercial |
$682.46
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.42
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$817.14
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.31
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
IP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.91 |
| Max. Negotiated Rate |
$135.58 |
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$135.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health SBD |
$94.91
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
OP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$135.58 |
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Medicare |
$75.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCN Commercial |
$19.13
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$135.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health SBD |
$94.91
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$53.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$48.19 |
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Medicare |
$75.32
|
| Rate for Payer: Aetna Medicare |
$18.49
|
| Rate for Payer: Aetna Medicare |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: BCBS Complete |
$14.79
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Complete |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCN Commercial |
$19.13
|
| Rate for Payer: BCN Commercial |
$19.13
|
| Rate for Payer: BCN Commercial |
$19.13
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.83
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$135.58
|
| Rate for Payer: Healthscope Commercial |
$48.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.51
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$45.51
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: Priority Health SBD |
$33.73
|
| Rate for Payer: Priority Health SBD |
$23.30
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.91 |
| Max. Negotiated Rate |
$135.58 |
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.83
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$48.19
|
| Rate for Payer: Healthscope Commercial |
$135.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.51
|
| Rate for Payer: PHP Commercial |
$45.51
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.04
|
| Rate for Payer: Priority Health SBD |
$33.73
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: Priority Health SBD |
$23.30
|
|
|
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,755.46
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,995.94 |
| Max. Negotiated Rate |
$4,279.91 |
| Rate for Payer: Aetna Commercial |
$4,042.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,091.05
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cofinity Commercial |
$3,328.82
|
| Rate for Payer: Cofinity Commercial |
$4,089.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,328.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,804.37
|
| Rate for Payer: Healthscope Commercial |
$4,279.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,042.14
|
| Rate for Payer: PHP Commercial |
$4,042.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,091.05
|
| Rate for Payer: Priority Health SBD |
$2,995.94
|
|
|
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,755.46
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$4,279.91 |
| Rate for Payer: Aetna Commercial |
$4,042.14
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,091.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$11.84
|
| Rate for Payer: BCN Commercial |
$11.84
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cofinity Commercial |
$4,089.70
|
| Rate for Payer: Cofinity Commercial |
$3,328.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,328.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,804.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$4,279.91
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,042.14
|
| Rate for Payer: Nomi Health Commercial |
$12.84
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$4,042.14
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,091.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.01
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow Network |
$9.61
|
| Rate for Payer: Priority Health SBD |
$2,995.94
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.41
|
| Rate for Payer: VA VA |
$4.28
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$1,523.97
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$960.10 |
| Max. Negotiated Rate |
$1,371.57 |
| Rate for Payer: Aetna Commercial |
$1,295.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.58
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cofinity Commercial |
$1,066.78
|
| Rate for Payer: Cofinity Commercial |
$1,310.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,066.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,219.18
|
| Rate for Payer: Healthscope Commercial |
$1,371.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.37
|
| Rate for Payer: PHP Commercial |
$1,295.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.58
|
| Rate for Payer: Priority Health SBD |
$960.10
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$1,523.97
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$1,371.57 |
| Rate for Payer: Aetna Commercial |
$1,295.37
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$11.84
|
| Rate for Payer: BCN Commercial |
$11.84
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cofinity Commercial |
$1,310.61
|
| Rate for Payer: Cofinity Commercial |
$1,066.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,066.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,219.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$1,371.57
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.37
|
| Rate for Payer: Nomi Health Commercial |
$12.84
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$1,295.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.01
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow Network |
$9.61
|
| Rate for Payer: Priority Health SBD |
$960.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.41
|
| Rate for Payer: VA VA |
$4.28
|
|
|
DEIONIZED WATER
|
Facility
|
OP
|
$889.48
|
|
|
Service Code
|
NDC 09900000039
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$355.79 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna Medicare |
$444.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: BCBS Complete |
$355.79
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Commercial |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$622.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.58
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.06
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.16
|
| Rate for Payer: Priority Health SBD |
$560.37
|
|
|
DEIONIZED WATER
|
Facility
|
IP
|
$889.48
|
|
|
Service Code
|
NDC 09900000039
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$560.37 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Commercial |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$622.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.58
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.06
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.16
|
| Rate for Payer: Priority Health SBD |
$560.37
|
|
|
DELAYED CREATION OF EXIT SITE FROM EMBEDDED SUBCUTANEOUS SEGMENT OF INTRAPERITONEAL CANNULA OR CATHETER
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 49436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$199.31 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$634.26
|
| Rate for Payer: BCN Commercial |
$634.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.31
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$1,046.41
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR LIPS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$358.96 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$804.62
|
| Rate for Payer: BCN Commercial |
$804.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.96
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,924.39
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$7,131.95 |
| Rate for Payer: Aetna Commercial |
$6,735.73
|
| Rate for Payer: Aetna Medicare |
$28.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,150.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.58
|
| Rate for Payer: BCBS Complete |
$15.57
|
| Rate for Payer: BCBS MAPPO |
$27.66
|
| Rate for Payer: BCBS Trust/PPO |
$76.13
|
| Rate for Payer: BCN Commercial |
$76.13
|
| Rate for Payer: BCN Medicare Advantage |
$27.66
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cofinity Commercial |
$6,814.98
|
| Rate for Payer: Cofinity Commercial |
$5,547.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,547.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,339.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$7,131.95
|
| Rate for Payer: Mclaren Medicaid |
$14.83
|
| Rate for Payer: Mclaren Medicare |
$27.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.04
|
| Rate for Payer: Meridian Medicaid |
$15.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,735.73
|
| Rate for Payer: Nomi Health Commercial |
$82.98
|
| Rate for Payer: PACE Medicare |
$26.28
|
| Rate for Payer: PACE SWMI |
$27.66
|
| Rate for Payer: PHP Commercial |
$6,735.73
|
| Rate for Payer: PHP Medicare Advantage |
$27.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,150.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.58
|
| Rate for Payer: Priority Health Medicare |
$27.66
|
| Rate for Payer: Priority Health Narrow Network |
$62.06
|
| Rate for Payer: Priority Health SBD |
$4,992.37
|
| Rate for Payer: Railroad Medicare Medicare |
$27.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.66
|
| Rate for Payer: UHC Medicare Advantage |
$27.66
|
| Rate for Payer: UHCCP Medicaid |
$15.57
|
| Rate for Payer: VA VA |
$27.66
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,924.39
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
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 Commercial |
$5,547.07
|
| Rate for Payer: Cofinity Commercial |
$6,814.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,547.07
|
| 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: PHP Commercial |
$6,735.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,150.85
|
| Rate for Payer: Priority Health SBD |
$4,992.37
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,315.49
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$4,783.94 |
| Rate for Payer: Aetna Commercial |
$4,518.17
|
| Rate for Payer: Aetna Medicare |
$28.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,455.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.58
|
| Rate for Payer: BCBS Complete |
$15.57
|
| Rate for Payer: BCBS MAPPO |
$27.66
|
| Rate for Payer: BCBS Trust/PPO |
$76.13
|
| Rate for Payer: BCN Commercial |
$76.13
|
| Rate for Payer: BCN Medicare Advantage |
$27.66
|
| Rate for Payer: Cash Price |
$4,252.39
|
| Rate for Payer: Cash Price |
$4,252.39
|
| Rate for Payer: Cofinity Commercial |
$4,571.32
|
| Rate for Payer: Cofinity Commercial |
$3,720.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,720.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,252.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$4,783.94
|
| Rate for Payer: Mclaren Medicaid |
$14.83
|
| Rate for Payer: Mclaren Medicare |
$27.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.04
|
| Rate for Payer: Meridian Medicaid |
$15.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,518.17
|
| Rate for Payer: Nomi Health Commercial |
$82.98
|
| Rate for Payer: PACE Medicare |
$26.28
|
| Rate for Payer: PACE SWMI |
$27.66
|
| Rate for Payer: PHP Commercial |
$4,518.17
|
| Rate for Payer: PHP Medicare Advantage |
$27.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,455.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.58
|
| Rate for Payer: Priority Health Medicare |
$27.66
|
| Rate for Payer: Priority Health Narrow Network |
$62.06
|
| Rate for Payer: Priority Health SBD |
$3,348.76
|
| Rate for Payer: Railroad Medicare Medicare |
$27.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.66
|
| Rate for Payer: UHC Medicare Advantage |
$27.66
|
| Rate for Payer: UHCCP Medicaid |
$15.57
|
| Rate for Payer: VA VA |
$27.66
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,315.49
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,348.76 |
| Max. Negotiated Rate |
$4,783.94 |
| Rate for Payer: Aetna Commercial |
$4,518.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,455.07
|
| Rate for Payer: Cash Price |
$4,252.39
|
| Rate for Payer: Cofinity Commercial |
$3,720.84
|
| Rate for Payer: Cofinity Commercial |
$4,571.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,720.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,252.39
|
| Rate for Payer: Healthscope Commercial |
$4,783.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,518.17
|
| Rate for Payer: PHP Commercial |
$4,518.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,455.07
|
| Rate for Payer: Priority Health SBD |
$3,348.76
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
OP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.46 |
| 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 Commercial |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.31
|
| 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: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$54.28
|
|
|
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 Commercial |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.31
|
| 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: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$54.28
|
|
|
DERMAPLANNING
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 00175
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$478.08
|
|
|
Service Code
|
NDC 69918010101
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.19 |
| Max. Negotiated Rate |
$430.27 |
| Rate for Payer: Aetna Commercial |
$406.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.75
|
| Rate for Payer: Cash Price |
$382.46
|
| Rate for Payer: Cofinity Commercial |
$334.66
|
| Rate for Payer: Cofinity Commercial |
$411.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$334.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.46
|
| Rate for Payer: Healthscope Commercial |
$430.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$406.37
|
| Rate for Payer: PHP Commercial |
$406.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.75
|
| Rate for Payer: Priority Health SBD |
$301.19
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$7.24
|
|
|
Service Code
|
NDC 68084060611
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$6.52 |
| Rate for Payer: Aetna Commercial |
$6.15
|
| Rate for Payer: Aetna Medicare |
$3.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.71
|
| Rate for Payer: BCBS Complete |
$2.90
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Cofinity Commercial |
$5.07
|
| Rate for Payer: Cofinity Commercial |
$6.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.79
|
| Rate for Payer: Healthscope Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.15
|
| Rate for Payer: PHP Commercial |
$6.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.71
|
| Rate for Payer: Priority Health SBD |
$4.56
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$7.24
|
|
|
Service Code
|
NDC 68084060611
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$6.52 |
| Rate for Payer: Aetna Commercial |
$6.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.71
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Cofinity Commercial |
$5.07
|
| Rate for Payer: Cofinity Commercial |
$6.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.79
|
| Rate for Payer: Healthscope Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.15
|
| Rate for Payer: PHP Commercial |
$6.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.71
|
| Rate for Payer: Priority Health SBD |
$4.56
|
|
