|
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
|
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
|
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 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
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$267.89
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$241.10 |
| Rate for Payer: Aetna Commercial |
$227.71
|
| Rate for Payer: Aetna Commercial |
$184.69
|
| Rate for Payer: Aetna Commercial |
$51.86
|
| Rate for Payer: Aetna Commercial |
$75.57
|
| Rate for Payer: Aetna Commercial |
$518.55
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| 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) |
$396.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.30
|
| Rate for Payer: BCN Commercial |
$15.30
|
| Rate for Payer: BCN Commercial |
$15.30
|
| Rate for Payer: BCN Commercial |
$15.30
|
| Rate for Payer: BCN Commercial |
$15.30
|
| Rate for Payer: BCN Commercial |
$15.30
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$71.13
|
| 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 |
$48.81
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cofinity Commercial |
$52.47
|
| Rate for Payer: Cofinity Commercial |
$524.65
|
| Rate for Payer: Cofinity Commercial |
$427.04
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$152.10
|
| Rate for Payer: Cofinity Commercial |
$42.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$427.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Healthscope Commercial |
$549.05
|
| Rate for Payer: Healthscope Commercial |
$54.91
|
| Rate for Payer: Healthscope Commercial |
$80.02
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| 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 |
$51.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.71
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.85
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$227.71
|
| Rate for Payer: PHP Commercial |
$75.57
|
| Rate for Payer: PHP Commercial |
$518.55
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$51.86
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| 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 Cigna Priority Health |
$141.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| Rate for Payer: Priority Health Narrow Network |
$12.48
|
| 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: Priority Health SBD |
$384.34
|
| Rate for Payer: Priority Health SBD |
$38.44
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$2.79
|
| Rate for Payer: UHCCP Medicaid |
$2.79
|
| Rate for Payer: UHCCP Medicaid |
$2.79
|
| Rate for Payer: UHCCP Medicaid |
$2.79
|
| Rate for Payer: UHCCP Medicaid |
$2.79
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: VA VA |
$4.95
|
|
|
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
|
|
|
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
|
$940.00
|
|
|
Service Code
|
CPT 17110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$59.92
|
| Rate for Payer: BCN Commercial |
$59.92
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.83
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
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
|
$940.00
|
|
|
Service Code
|
CPT 17270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.86 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$62.86
|
| Rate for Payer: BCN Commercial |
$62.86
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$408.83
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.98
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO OR CHEMICAL)
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 42160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$124.54
|
| Rate for Payer: BCN Commercial |
$124.54
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.65
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,788.93
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,660.06
|
| Rate for Payer: BCN Commercial |
$1,660.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.22
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,512.75
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 46910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$138.72 |
| 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 |
$138.72
|
| Rate for Payer: BCN Commercial |
$138.72
|
| 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) |
$143.35
|
| 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
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.93 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$899.20
|
| Rate for Payer: BCN Commercial |
$899.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.93
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,512.75
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$146.36 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,381.26
|
| Rate for Payer: BCN Commercial |
$1,381.26
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.36
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,512.75
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 54065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$180.02 |
| 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) |
$180.02
|
| 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
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 54057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$102.77 |
| 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) |
$102.77
|
| 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
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 54060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$138.88 |
| 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 |
$1,075.89
|
| Rate for Payer: BCN Commercial |
$1,075.89
|
| 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) |
$138.88
|
| 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
|
|
|
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 56515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$225.58 |
| 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 |
$1,679.18
|
| Rate for Payer: BCN Commercial |
$1,679.18
|
| 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) |
$225.58
|
| 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
|
|
|
DESTRUCTION OF LESION(S), VULVA; SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 56501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$140.22 |
| 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 |
$1,110.94
|
| Rate for Payer: BCN Commercial |
$1,110.94
|
| 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) |
$140.22
|
| 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
|
|
|
DESTRUCTION OF RECTAL TUMOR (EG, ELECTRODESICCATION, ELECTROSURGERY, LASER ABLATION, LASER RESECTION, CRYOSURGERY) TRANSANAL APPROACH
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 45190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$736.41 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,161.81
|
| Rate for Payer: BCN Commercial |
$1,161.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$736.41
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,512.75
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
DESTRUCTION OF VAGINAL LESION(S); SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$47.70
|
| Rate for Payer: BCN Commercial |
$47.70
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.09
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
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 |
$1,356.34 |
| 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 |
$1,054.94
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,054.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.34
|
| 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 |
$41.18
|
| 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 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 |
$1,356.34 |
| 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 |
$1,054.94
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,054.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.34
|
| 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
|
$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
|
|
