|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
OP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.26 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Medicare |
$75.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Commercial |
$105.45
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| 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
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.26 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Medicare |
$26.77
|
| Rate for Payer: Aetna Medicare |
$75.33
|
| Rate for Payer: Aetna Medicare |
$18.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: BCBS Complete |
$14.79
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Complete |
$21.42
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Commercial |
$105.45
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$37.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| 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 |
$45.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$45.51
|
| 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 |
$23.30
|
| Rate for Payer: Priority Health SBD |
$94.91
|
|
|
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 |
$135.59 |
| 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 |
$105.45
|
| 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 |
$105.45
|
| 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 |
$135.59
|
| 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 |
$2.39 |
| Max. Negotiated Rate |
$4,279.91 |
| Rate for Payer: Aetna Commercial |
$4,042.14
|
| Rate for Payer: Aetna Medicare |
$4.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,091.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.56
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$4.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.45
|
| 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 |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$4,279.91
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: Meridian Medicaid |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,042.14
|
| Rate for Payer: PACE Medicare |
$4.23
|
| Rate for Payer: PACE SWMI |
$4.45
|
| Rate for Payer: PHP Commercial |
$4,042.14
|
| Rate for Payer: PHP Medicare Advantage |
$4.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,091.05
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: Priority Health SBD |
$2,995.94
|
| Rate for Payer: Railroad Medicare Medicare |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.45
|
| Rate for Payer: UHC Medicare Advantage |
$4.45
|
| Rate for Payer: UHCCP Medicaid |
$2.51
|
| Rate for Payer: VA VA |
$4.45
|
|
|
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 |
$2.39 |
| Max. Negotiated Rate |
$1,371.57 |
| Rate for Payer: Aetna Commercial |
$1,295.37
|
| Rate for Payer: Aetna Medicare |
$4.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.56
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$4.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.45
|
| 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 |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$1,371.57
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: Meridian Medicaid |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.37
|
| Rate for Payer: PACE Medicare |
$4.23
|
| Rate for Payer: PACE SWMI |
$4.45
|
| Rate for Payer: PHP Commercial |
$1,295.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.58
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: Priority Health SBD |
$960.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.45
|
| Rate for Payer: UHC Medicare Advantage |
$4.45
|
| Rate for Payer: UHCCP Medicaid |
$2.51
|
| Rate for Payer: VA VA |
$4.45
|
|
|
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
|
|
|
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
|
|
|
DELAYED CREATION OF EXIT SITE FROM EMBEDDED SUBCUTANEOUS SEGMENT OF INTRAPERITONEAL CANNULA OR CATHETER
|
Facility
|
OP
|
$5,207.85
|
|
|
Service Code
|
CPT 49436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$1,041.61
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR LIPS
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
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 |
$15.75 |
| Max. Negotiated Rate |
$7,131.95 |
| Rate for Payer: Aetna Commercial |
$6,735.73
|
| Rate for Payer: Aetna Medicare |
$30.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,150.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| 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 |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$7,131.95
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Mclaren Medicare |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,735.73
|
| Rate for Payer: PACE Medicare |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$6,735.73
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,150.85
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health SBD |
$4,992.37
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$16.54
|
| Rate for Payer: VA VA |
$29.38
|
|
|
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
|
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
|
|
|
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 |
$15.75 |
| Max. Negotiated Rate |
$4,783.94 |
| Rate for Payer: Aetna Commercial |
$4,518.17
|
| Rate for Payer: Aetna Medicare |
$30.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,455.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$4,252.39
|
| 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: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$4,783.94
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Mclaren Medicare |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,518.17
|
| Rate for Payer: PACE Medicare |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$4,518.17
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,455.07
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health SBD |
$3,348.76
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$16.54
|
| Rate for Payer: VA VA |
$29.38
|
|
|
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
|
|
|
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
|
|
|
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
|
$217.01
|
|
|
Service Code
|
NDC 68084060621
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.72 |
| Max. Negotiated Rate |
$195.31 |
| Rate for Payer: Aetna Commercial |
$184.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.06
|
| Rate for Payer: Cash Price |
$173.61
|
| Rate for Payer: Cofinity Commercial |
$151.91
|
| Rate for Payer: Cofinity Commercial |
$186.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.61
|
| Rate for Payer: Healthscope Commercial |
$195.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.46
|
| Rate for Payer: PHP Commercial |
$184.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.06
|
| Rate for Payer: Priority Health SBD |
$136.72
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$217.01
|
|
|
Service Code
|
NDC 68084060621
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$195.31 |
| Rate for Payer: Aetna Commercial |
$184.46
|
| Rate for Payer: Aetna Medicare |
$108.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.06
|
| Rate for Payer: BCBS Complete |
$86.80
|
| Rate for Payer: Cash Price |
$173.61
|
| Rate for Payer: Cofinity Commercial |
$151.91
|
| Rate for Payer: Cofinity Commercial |
$186.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.61
|
| Rate for Payer: Healthscope Commercial |
$195.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.46
|
| Rate for Payer: PHP Commercial |
$184.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.06
|
| Rate for Payer: Priority Health SBD |
$136.72
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$478.08
|
|
|
Service Code
|
NDC 69918010101
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.23 |
| Max. Negotiated Rate |
$430.27 |
| Rate for Payer: Aetna Commercial |
$406.37
|
| Rate for Payer: Aetna Medicare |
$239.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.75
|
| Rate for Payer: BCBS Complete |
$191.23
|
| 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
|
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
|
|
|
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 Commercial |
$296.58
|
| Rate for Payer: Cofinity Commercial |
$364.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.58
|
| 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: PHP Commercial |
$360.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: Priority Health SBD |
$266.92
|
|
