|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)
|
Facility
|
OP
|
$423.69
|
|
|
Service Code
|
NDC 47335078891
|
| Hospital Charge Code |
21135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.48 |
| Max. Negotiated Rate |
$381.32 |
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: Aetna Medicare |
$211.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.40
|
| Rate for Payer: BCBS Complete |
$169.48
|
| Rate for Payer: Cash Price |
$338.95
|
| Rate for Payer: Cofinity 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
|
|
|
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 |
$227.71
|
| Rate for Payer: Aetna Commercial |
$518.55
|
| Rate for Payer: Aetna Commercial |
$51.86
|
| Rate for Payer: Aetna Commercial |
$75.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Cofinity Commercial |
$152.10
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$52.47
|
| Rate for Payer: Cofinity Commercial |
$42.71
|
| Rate for Payer: Cofinity Commercial |
$427.04
|
| Rate for Payer: Cofinity Commercial |
$524.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$427.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.05
|
| 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 |
$48.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.13
|
| Rate for Payer: Healthscope Commercial |
$549.05
|
| Rate for Payer: Healthscope Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Healthscope Commercial |
$54.91
|
| Rate for Payer: Healthscope Commercial |
$80.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$51.86
|
| Rate for Payer: PHP Commercial |
$75.57
|
| Rate for Payer: PHP Commercial |
$518.55
|
| Rate for Payer: PHP Commercial |
$227.71
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.66
|
| Rate for Payer: Priority Health SBD |
$38.44
|
| Rate for Payer: Priority Health SBD |
$168.77
|
| Rate for Payer: Priority Health SBD |
$384.34
|
| Rate for Payer: Priority Health SBD |
$136.89
|
| Rate for Payer: Priority Health SBD |
$56.01
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$610.06
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$549.05 |
| Rate for Payer: Aetna Commercial |
$518.55
|
| Rate for Payer: Aetna Commercial |
$227.71
|
| 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 Medicare |
$3.66
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| 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) |
$39.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$214.31
|
| 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 |
$71.13
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cofinity Commercial |
$52.47
|
| Rate for Payer: Cofinity Commercial |
$152.10
|
| Rate for Payer: Cofinity Commercial |
$42.71
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$524.65
|
| Rate for Payer: Cofinity Commercial |
$427.04
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$427.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$549.05
|
| Rate for Payer: Healthscope Commercial |
$80.02
|
| Rate for Payer: Healthscope Commercial |
$54.91
|
| Rate for Payer: Healthscope Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Mclaren Medicare |
$3.52
|
| Rate for Payer: Mclaren Medicare |
$3.52
|
| Rate for Payer: Mclaren Medicare |
$3.52
|
| Rate for Payer: Mclaren Medicare |
$3.52
|
| Rate for Payer: Mclaren Medicare |
$3.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.70
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| 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 |
$518.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.57
|
| Rate for Payer: PACE Medicare |
$3.34
|
| Rate for Payer: PACE Medicare |
$3.34
|
| Rate for Payer: PACE Medicare |
$3.34
|
| Rate for Payer: PACE Medicare |
$3.34
|
| Rate for Payer: PACE Medicare |
$3.34
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PHP Commercial |
$518.55
|
| Rate for Payer: PHP Commercial |
$51.86
|
| Rate for Payer: PHP Commercial |
$75.57
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$227.71
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.23
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health SBD |
$384.34
|
| Rate for Payer: Priority Health SBD |
$38.44
|
| Rate for Payer: Priority Health SBD |
$136.89
|
| Rate for Payer: Priority Health SBD |
$168.77
|
| Rate for Payer: Priority Health SBD |
$56.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: VA VA |
$3.52
|
| Rate for Payer: VA VA |
$3.52
|
| Rate for Payer: VA VA |
$3.52
|
| Rate for Payer: VA VA |
$3.52
|
| Rate for Payer: VA VA |
$3.52
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 17110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 17270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO OR CHEMICAL)
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 42160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,780.71
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,505.80
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 46910
|
|
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
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,505.80
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,505.80
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 54065
|
|
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
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 54057
|
|
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
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 54060
|
|
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
|
|
|
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 56515
|
|
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
|
|
|
DESTRUCTION OF LESION(S), VULVA; SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 56501
|
|
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
|
|
|
DESTRUCTION OF RECTAL TUMOR (EG, ELECTRODESICCATION, ELECTROSURGERY, LASER ABLATION, LASER RESECTION, CRYOSURGERY) TRANSANAL APPROACH
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 45190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,505.80
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
DESTRUCTION OF VAGINAL LESION(S); SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 57061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$82.37
|
|
|
Service Code
|
NDC 51991000633
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.89 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Commercial |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.54
|
| Rate for Payer: Priority Health SBD |
$51.89
|
|
|
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 |
$602.82 |
| 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 Commercial |
$1,054.93
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,054.93
|
| 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: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.58
|
| Rate for Payer: Priority Health SBD |
$949.44
|
|
|
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 Commercial |
$1,054.93
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,054.93
|
| 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: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.58
|
| Rate for Payer: Priority Health SBD |
$949.44
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$82.37
|
|
|
Service Code
|
NDC 51991000633
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.95 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna Medicare |
$41.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: BCBS Complete |
$32.95
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Commercial |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.54
|
| Rate for Payer: Priority Health SBD |
$51.89
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
NDC 60687060721
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Aetna Commercial |
$243.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.55
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$200.90
|
| Rate for Payer: Cofinity Commercial |
$246.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.60
|
| Rate for Payer: Healthscope Commercial |
$258.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.95
|
| Rate for Payer: PHP Commercial |
$243.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.55
|
| Rate for Payer: Priority Health SBD |
$180.81
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$406.98
|
|
|
Service Code
|
NDC 51991031190
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$366.28 |
| Rate for Payer: Aetna Commercial |
$345.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.54
|
| Rate for Payer: Cash Price |
$325.58
|
| Rate for Payer: Cofinity Commercial |
$284.89
|
| Rate for Payer: Cofinity Commercial |
$350.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$284.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.58
|
| Rate for Payer: Healthscope Commercial |
$366.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.93
|
| Rate for Payer: PHP Commercial |
$345.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.54
|
| Rate for Payer: Priority Health SBD |
$256.40
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$9.57
|
|
|
Service Code
|
NDC 60687060711
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.22
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$6.70
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$8.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health SBD |
$6.03
|
|
|
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 |
$602.82 |
| 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 Commercial |
$1,054.93
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,054.93
|
| 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: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.58
|
| Rate for Payer: Priority Health SBD |
$949.44
|
|
