|
DERMAPLANNING
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 00175
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$500.16
|
|
|
Service Code
|
NDC 45963034202
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.10 |
| Max. Negotiated Rate |
$450.14 |
| Rate for Payer: Aetna Commercial |
$425.14
|
| Rate for Payer: BCBS Trust/PPO |
$408.28
|
| Rate for Payer: BCN Commercial |
$386.52
|
| Rate for Payer: Cash Price |
$400.13
|
| Rate for Payer: Cofinity Commercial |
$430.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.13
|
| Rate for Payer: Healthscope Commercial |
$450.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.14
|
| Rate for Payer: Nomi Health Commercial |
$410.13
|
| Rate for Payer: PHP Commercial |
$425.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.10
|
| Rate for Payer: Priority Health HMO/PPO |
$435.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.14
|
| Rate for Payer: UHC Core |
$417.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.12
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
OP
|
$500.16
|
|
|
Service Code
|
NDC 45963034202
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.79 |
| Max. Negotiated Rate |
$450.14 |
| Rate for Payer: Aetna Commercial |
$425.14
|
| Rate for Payer: Aetna Medicare |
$130.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.30
|
| Rate for Payer: BCBS Complete |
$200.06
|
| Rate for Payer: BCBS MAPPO |
$125.04
|
| Rate for Payer: BCBS Trust/PPO |
$411.18
|
| Rate for Payer: BCN Commercial |
$388.87
|
| Rate for Payer: BCN Medicare Advantage |
$125.04
|
| Rate for Payer: Cash Price |
$400.13
|
| Rate for Payer: Cofinity Commercial |
$430.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.04
|
| Rate for Payer: Healthscope Commercial |
$450.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.14
|
| Rate for Payer: Nomi Health Commercial |
$410.13
|
| Rate for Payer: PACE Senior Care Partners |
$118.79
|
| Rate for Payer: PACE SWMI |
$125.04
|
| Rate for Payer: PHP Commercial |
$425.14
|
| Rate for Payer: PHP Medicare Advantage |
$125.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.10
|
| Rate for Payer: Priority Health HMO/PPO |
$435.14
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.11
|
| Rate for Payer: Railroad Medicare Medicare |
$125.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.14
|
| Rate for Payer: UHC Core |
$417.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.04
|
| Rate for Payer: UHC Exchange |
$125.04
|
| Rate for Payer: UHC Medicare Advantage |
$125.04
|
| Rate for Payer: VA VA |
$125.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.12
|
|
|
DESMOPRESSIN 0.2 MG TABLET
|
Facility
|
IP
|
$9.15
|
|
|
Service Code
|
NDC 68084060411
|
| Hospital Charge Code |
16053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$7.47
|
| Rate for Payer: BCN Commercial |
$7.07
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$7.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.32
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.78
|
| Rate for Payer: Nomi Health Commercial |
$7.50
|
| Rate for Payer: PHP Commercial |
$7.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.95
|
| Rate for Payer: Priority Health HMO/PPO |
$7.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.05
|
| Rate for Payer: UHC Core |
$7.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.86
|
|
|
DESMOPRESSIN 0.2 MG TABLET
|
Facility
|
IP
|
$274.32
|
|
|
Service Code
|
NDC 68084060421
|
| Hospital Charge Code |
16053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.31 |
| Max. Negotiated Rate |
$246.89 |
| Rate for Payer: Aetna Commercial |
$233.17
|
| Rate for Payer: BCBS Trust/PPO |
$223.93
|
| Rate for Payer: BCN Commercial |
$211.99
|
| Rate for Payer: Cash Price |
$219.46
|
| Rate for Payer: Cofinity Commercial |
$235.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.46
|
| Rate for Payer: Healthscope Commercial |
$246.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.17
|
| Rate for Payer: Nomi Health Commercial |
$224.94
|
| Rate for Payer: PHP Commercial |
$233.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.31
|
| Rate for Payer: Priority Health HMO/PPO |
$238.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.40
|
| Rate for Payer: UHC Core |
$229.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.74
|
|
|
DESMOPRESSIN 0.2 MG TABLET
|
Facility
|
OP
|
$274.32
|
|
|
Service Code
|
NDC 68084060421
|
| Hospital Charge Code |
16053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.15 |
| Max. Negotiated Rate |
$246.89 |
| Rate for Payer: Aetna Commercial |
$233.17
|
| Rate for Payer: Aetna Medicare |
$71.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.72
|
| Rate for Payer: BCBS Complete |
$109.73
|
| Rate for Payer: BCBS MAPPO |
$68.58
|
| Rate for Payer: BCBS Trust/PPO |
$225.52
|
| Rate for Payer: BCN Commercial |
$213.28
|
| Rate for Payer: BCN Medicare Advantage |
$68.58
|
| Rate for Payer: Cash Price |
$219.46
|
| Rate for Payer: Cofinity Commercial |
$235.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$246.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.17
|
| Rate for Payer: Nomi Health Commercial |
$224.94
|
| Rate for Payer: PACE Senior Care Partners |
$65.15
|
| Rate for Payer: PACE SWMI |
$68.58
|
| Rate for Payer: PHP Commercial |
$233.17
|
| Rate for Payer: PHP Medicare Advantage |
$68.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.31
|
| Rate for Payer: Priority Health HMO/PPO |
$238.66
|
| Rate for Payer: Priority Health Medicare |
$69.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.79
|
| Rate for Payer: Railroad Medicare Medicare |
$68.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.40
|
| Rate for Payer: UHC Core |
$229.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.58
|
| Rate for Payer: UHC Exchange |
$68.58
|
| Rate for Payer: UHC Medicare Advantage |
$68.58
|
| Rate for Payer: VA VA |
$68.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.74
|
|
|
DESMOPRESSIN 0.2 MG TABLET
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 68084060411
|
| Hospital Charge Code |
16053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.86
|
| Rate for Payer: BCBS Complete |
$3.66
|
| Rate for Payer: BCBS MAPPO |
$2.29
|
| Rate for Payer: BCBS Trust/PPO |
$7.52
|
| Rate for Payer: BCN Commercial |
$7.11
|
| Rate for Payer: BCN Medicare Advantage |
$2.29
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$7.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.78
|
| Rate for Payer: Nomi Health Commercial |
$7.50
|
| Rate for Payer: PACE Senior Care Partners |
$2.17
|
| Rate for Payer: PACE SWMI |
$2.29
|
| Rate for Payer: PHP Commercial |
$7.78
|
| Rate for Payer: PHP Medicare Advantage |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.95
|
| Rate for Payer: Priority Health HMO/PPO |
$7.96
|
| Rate for Payer: Priority Health Medicare |
$2.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.05
|
| Rate for Payer: UHC Core |
$7.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.29
|
| Rate for Payer: UHC Exchange |
$2.29
|
| Rate for Payer: UHC Medicare Advantage |
$2.29
|
| Rate for Payer: VA VA |
$2.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.86
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$600.09
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$540.08 |
| Rate for Payer: Aetna Commercial |
$510.08
|
| Rate for Payer: Aetna Commercial |
$167.03
|
| Rate for Payer: Aetna Commercial |
$587.46
|
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Aetna Commercial |
$184.69
|
| Rate for Payer: Aetna Medicare |
$56.49
|
| Rate for Payer: Aetna Medicare |
$51.09
|
| Rate for Payer: Aetna Medicare |
$156.02
|
| Rate for Payer: Aetna Medicare |
$54.88
|
| Rate for Payer: Aetna Medicare |
$179.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.98
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$150.02
|
| Rate for Payer: BCBS MAPPO |
$52.77
|
| Rate for Payer: BCBS MAPPO |
$49.13
|
| Rate for Payer: BCBS MAPPO |
$54.32
|
| Rate for Payer: BCBS MAPPO |
$172.78
|
| Rate for Payer: BCBS Trust/PPO |
$568.18
|
| Rate for Payer: BCBS Trust/PPO |
$493.33
|
| Rate for Payer: BCBS Trust/PPO |
$178.63
|
| Rate for Payer: BCBS Trust/PPO |
$173.52
|
| Rate for Payer: BCBS Trust/PPO |
$161.55
|
| Rate for Payer: BCN Commercial |
$168.94
|
| Rate for Payer: BCN Commercial |
$164.11
|
| Rate for Payer: BCN Commercial |
$466.57
|
| Rate for Payer: BCN Commercial |
$537.35
|
| Rate for Payer: BCN Commercial |
$152.79
|
| Rate for Payer: BCN Medicare Advantage |
$172.78
|
| Rate for Payer: BCN Medicare Advantage |
$49.13
|
| Rate for Payer: BCN Medicare Advantage |
$54.32
|
| Rate for Payer: BCN Medicare Advantage |
$150.02
|
| Rate for Payer: BCN Medicare Advantage |
$52.77
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$157.21
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$168.86
|
| Rate for Payer: Cash Price |
$480.07
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$480.07
|
| Rate for Payer: Cash Price |
$168.86
|
| Rate for Payer: Cash Price |
$157.21
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cofinity Commercial |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$181.52
|
| Rate for Payer: Cofinity Commercial |
$516.08
|
| Rate for Payer: Cofinity Commercial |
$594.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.32
|
| Rate for Payer: Healthscope Commercial |
$622.02
|
| Rate for Payer: Healthscope Commercial |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Healthscope Commercial |
$540.08
|
| Rate for Payer: Healthscope Commercial |
$189.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.38
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.52
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.69
|
| Rate for Payer: Nomi Health Commercial |
$161.14
|
| Rate for Payer: Nomi Health Commercial |
$566.73
|
| Rate for Payer: Nomi Health Commercial |
$178.17
|
| Rate for Payer: Nomi Health Commercial |
$173.08
|
| Rate for Payer: Nomi Health Commercial |
$492.07
|
| Rate for Payer: PACE Senior Care Partners |
$51.60
|
| Rate for Payer: PACE Senior Care Partners |
$50.13
|
| Rate for Payer: PACE Senior Care Partners |
$164.14
|
| Rate for Payer: PACE Senior Care Partners |
$46.67
|
| Rate for Payer: PACE Senior Care Partners |
$142.52
|
| Rate for Payer: PACE SWMI |
$49.13
|
| Rate for Payer: PACE SWMI |
$172.78
|
| Rate for Payer: PACE SWMI |
$150.02
|
| Rate for Payer: PACE SWMI |
$54.32
|
| Rate for Payer: PACE SWMI |
$52.77
|
| Rate for Payer: PHP Commercial |
$587.46
|
| Rate for Payer: PHP Commercial |
$167.03
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$510.08
|
| Rate for Payer: PHP Commercial |
$179.41
|
| Rate for Payer: PHP Medicare Advantage |
$49.13
|
| Rate for Payer: PHP Medicare Advantage |
$52.77
|
| Rate for Payer: PHP Medicare Advantage |
$172.78
|
| Rate for Payer: PHP Medicare Advantage |
$54.32
|
| Rate for Payer: PHP Medicare Advantage |
$150.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO |
$522.08
|
| Rate for Payer: Priority Health HMO/PPO |
$170.96
|
| Rate for Payer: Priority Health HMO/PPO |
$183.63
|
| Rate for Payer: Priority Health HMO/PPO |
$189.03
|
| Rate for Payer: Priority Health HMO/PPO |
$601.28
|
| Rate for Payer: Priority Health Medicare |
$151.52
|
| Rate for Payer: Priority Health Medicare |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$174.51
|
| Rate for Payer: Priority Health Medicare |
$49.62
|
| Rate for Payer: Priority Health Medicare |
$54.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$402.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.06
|
| Rate for Payer: Railroad Medicare Medicare |
$49.13
|
| Rate for Payer: Railroad Medicare Medicare |
$150.02
|
| Rate for Payer: Railroad Medicare Medicare |
$54.32
|
| Rate for Payer: Railroad Medicare Medicare |
$172.78
|
| Rate for Payer: Railroad Medicare Medicare |
$52.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.74
|
| Rate for Payer: UHC Core |
$181.43
|
| Rate for Payer: UHC Core |
$176.24
|
| Rate for Payer: UHC Core |
$164.09
|
| Rate for Payer: UHC Core |
$501.08
|
| Rate for Payer: UHC Core |
$577.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.13
|
| Rate for Payer: UHC Exchange |
$172.78
|
| Rate for Payer: UHC Exchange |
$49.13
|
| Rate for Payer: UHC Exchange |
$54.32
|
| Rate for Payer: UHC Exchange |
$150.02
|
| Rate for Payer: UHC Exchange |
$52.77
|
| Rate for Payer: UHC Medicare Advantage |
$150.02
|
| Rate for Payer: UHC Medicare Advantage |
$54.32
|
| Rate for Payer: UHC Medicare Advantage |
$52.77
|
| Rate for Payer: UHC Medicare Advantage |
$49.13
|
| Rate for Payer: UHC Medicare Advantage |
$172.78
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: VA VA |
$172.78
|
| Rate for Payer: VA VA |
$49.13
|
| Rate for Payer: VA VA |
$54.32
|
| Rate for Payer: VA VA |
$52.77
|
| Rate for Payer: VA VA |
$150.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.30
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$691.13
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$449.23 |
| Max. Negotiated Rate |
$622.02 |
| Rate for Payer: Aetna Commercial |
$587.46
|
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Aetna Commercial |
$184.69
|
| Rate for Payer: Aetna Commercial |
$510.08
|
| Rate for Payer: Aetna Commercial |
$167.03
|
| Rate for Payer: BCBS Trust/PPO |
$489.85
|
| Rate for Payer: BCBS Trust/PPO |
$564.17
|
| Rate for Payer: BCBS Trust/PPO |
$177.37
|
| Rate for Payer: BCBS Trust/PPO |
$172.30
|
| Rate for Payer: BCBS Trust/PPO |
$160.41
|
| Rate for Payer: BCN Commercial |
$463.75
|
| Rate for Payer: BCN Commercial |
$167.91
|
| Rate for Payer: BCN Commercial |
$151.86
|
| Rate for Payer: BCN Commercial |
$163.11
|
| Rate for Payer: BCN Commercial |
$534.11
|
| Rate for Payer: Cash Price |
$157.21
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$168.86
|
| Rate for Payer: Cash Price |
$480.07
|
| Rate for Payer: Cofinity Commercial |
$594.37
|
| Rate for Payer: Cofinity Commercial |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$516.08
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$181.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.90
|
| Rate for Payer: Healthscope Commercial |
$189.96
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Healthscope Commercial |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$540.08
|
| Rate for Payer: Healthscope Commercial |
$622.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.08
|
| Rate for Payer: Nomi Health Commercial |
$161.14
|
| Rate for Payer: Nomi Health Commercial |
$173.08
|
| Rate for Payer: Nomi Health Commercial |
$178.17
|
| Rate for Payer: Nomi Health Commercial |
$492.07
|
| Rate for Payer: Nomi Health Commercial |
$566.73
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$179.41
|
| Rate for Payer: PHP Commercial |
$167.03
|
| Rate for Payer: PHP Commercial |
$510.08
|
| Rate for Payer: PHP Commercial |
$587.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.73
|
| Rate for Payer: Priority Health HMO/PPO |
$170.96
|
| Rate for Payer: Priority Health HMO/PPO |
$601.28
|
| Rate for Payer: Priority Health HMO/PPO |
$189.03
|
| Rate for Payer: Priority Health HMO/PPO |
$522.08
|
| Rate for Payer: Priority Health HMO/PPO |
$183.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$402.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.08
|
| Rate for Payer: UHC Core |
$164.09
|
| Rate for Payer: UHC Core |
$176.24
|
| Rate for Payer: UHC Core |
$501.08
|
| Rate for Payer: UHC Core |
$577.09
|
| Rate for Payer: UHC Core |
$181.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.07
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, GENICULAR NERVE BRANCHES INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$1,452.56
|
|
|
Service Code
|
CPT 64624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,383.30 |
| Max. Negotiated Rate |
$1,452.56 |
| Rate for Payer: BCBS Complete |
$1,452.56
|
| Rate for Payer: Mclaren Medicaid |
$1,383.30
|
| Rate for Payer: Meridian Medicaid |
$1,452.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.30
|
| Rate for Payer: UHCCP Medicaid |
$1,383.30
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE
|
Facility
|
OP
|
$662.24
|
|
|
Service Code
|
CPT 64620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$630.67 |
| Max. Negotiated Rate |
$662.24 |
| Rate for Payer: BCBS Complete |
$662.24
|
| Rate for Payer: Mclaren Medicaid |
$630.67
|
| Rate for Payer: Meridian Medicaid |
$662.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.67
|
| Rate for Payer: UHCCP Medicaid |
$630.67
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
|
Facility
|
OP
|
$662.24
|
|
|
Service Code
|
CPT 64640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$630.67 |
| Max. Negotiated Rate |
$662.24 |
| Rate for Payer: BCBS Complete |
$662.24
|
| Rate for Payer: Mclaren Medicaid |
$630.67
|
| Rate for Payer: Meridian Medicaid |
$662.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.67
|
| Rate for Payer: UHCCP Medicaid |
$630.67
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
|
Facility
|
OP
|
$1,452.56
|
|
|
Service Code
|
CPT 64635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,383.30 |
| Max. Negotiated Rate |
$1,452.56 |
| Rate for Payer: BCBS Complete |
$1,452.56
|
| Rate for Payer: Mclaren Medicaid |
$1,383.30
|
| Rate for Payer: Meridian Medicaid |
$1,452.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.30
|
| Rate for Payer: UHCCP Medicaid |
$1,383.30
|
|
|
DESTRUCTION OF INTERNAL HEMORRHOID(S) BY THERMAL ENERGY (EG, INFRARED COAGULATION, CAUTERY, RADIOFREQUENCY)
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 46930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$2,039.92
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.66 |
| Max. Negotiated Rate |
$2,039.92 |
| Rate for Payer: BCBS Complete |
$2,039.92
|
| Rate for Payer: Mclaren Medicaid |
$1,942.66
|
| Rate for Payer: Meridian Medicaid |
$2,039.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.66
|
| Rate for Payer: UHCCP Medicaid |
$1,942.66
|
|
|
DESVENLAFAXINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$352.32
|
|
|
Service Code
|
NDC 63304019130
|
| Hospital Charge Code |
166026
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.01 |
| Max. Negotiated Rate |
$317.09 |
| Rate for Payer: Aetna Commercial |
$299.47
|
| Rate for Payer: BCBS Trust/PPO |
$287.60
|
| Rate for Payer: BCN Commercial |
$272.27
|
| Rate for Payer: Cash Price |
$281.86
|
| Rate for Payer: Cofinity Commercial |
$303.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.86
|
| Rate for Payer: Healthscope Commercial |
$317.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.47
|
| Rate for Payer: Nomi Health Commercial |
$288.90
|
| Rate for Payer: PHP Commercial |
$299.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.01
|
| Rate for Payer: Priority Health HMO/PPO |
$306.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.04
|
| Rate for Payer: UHC Core |
$294.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.24
|
|
|
DESVENLAFAXINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$352.32
|
|
|
Service Code
|
NDC 63304019130
|
| Hospital Charge Code |
166026
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.68 |
| Max. Negotiated Rate |
$317.09 |
| Rate for Payer: Aetna Commercial |
$299.47
|
| Rate for Payer: Aetna Medicare |
$91.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.10
|
| Rate for Payer: BCBS Complete |
$140.93
|
| Rate for Payer: BCBS MAPPO |
$88.08
|
| Rate for Payer: BCBS Trust/PPO |
$289.64
|
| Rate for Payer: BCN Commercial |
$273.93
|
| Rate for Payer: BCN Medicare Advantage |
$88.08
|
| Rate for Payer: Cash Price |
$281.86
|
| Rate for Payer: Cofinity Commercial |
$303.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.08
|
| Rate for Payer: Healthscope Commercial |
$317.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.47
|
| Rate for Payer: Nomi Health Commercial |
$288.90
|
| Rate for Payer: PACE Senior Care Partners |
$83.68
|
| Rate for Payer: PACE SWMI |
$88.08
|
| Rate for Payer: PHP Commercial |
$299.47
|
| Rate for Payer: PHP Medicare Advantage |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.01
|
| Rate for Payer: Priority Health HMO/PPO |
$306.52
|
| Rate for Payer: Priority Health Medicare |
$88.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.05
|
| Rate for Payer: Railroad Medicare Medicare |
$88.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.04
|
| Rate for Payer: UHC Core |
$294.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.08
|
| Rate for Payer: UHC Exchange |
$88.08
|
| Rate for Payer: UHC Medicare Advantage |
$88.08
|
| Rate for Payer: VA VA |
$88.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.24
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
NDC 60687060721
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Aetna Commercial |
$243.95
|
| Rate for Payer: Aetna Medicare |
$74.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.69
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS MAPPO |
$71.75
|
| Rate for Payer: BCBS Trust/PPO |
$235.94
|
| Rate for Payer: BCN Commercial |
$223.14
|
| Rate for Payer: BCN Medicare Advantage |
$71.75
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$246.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.75
|
| Rate for Payer: Healthscope Commercial |
$258.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.95
|
| Rate for Payer: Nomi Health Commercial |
$235.34
|
| Rate for Payer: PACE Senior Care Partners |
$68.16
|
| Rate for Payer: PACE SWMI |
$71.75
|
| Rate for Payer: PHP Commercial |
$243.95
|
| Rate for Payer: PHP Medicare Advantage |
$71.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.55
|
| Rate for Payer: Priority Health HMO/PPO |
$249.69
|
| Rate for Payer: Priority Health Medicare |
$72.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.29
|
| Rate for Payer: Railroad Medicare Medicare |
$71.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.56
|
| Rate for Payer: UHC Core |
$239.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.75
|
| Rate for Payer: UHC Exchange |
$71.75
|
| Rate for Payer: UHC Medicare Advantage |
$71.75
|
| Rate for Payer: VA VA |
$71.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.25
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$87.56
|
|
|
Service Code
|
NDC 70436001204
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.91 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna Commercial |
$74.43
|
| Rate for Payer: BCBS Trust/PPO |
$71.48
|
| Rate for Payer: BCN Commercial |
$67.67
|
| Rate for Payer: Cash Price |
$70.05
|
| Rate for Payer: Cofinity Commercial |
$75.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.05
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.43
|
| Rate for Payer: Nomi Health Commercial |
$71.80
|
| Rate for Payer: PHP Commercial |
$74.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.91
|
| Rate for Payer: Priority Health HMO/PPO |
$76.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.05
|
| Rate for Payer: UHC Core |
$73.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.67
|
|
|
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 |
$357.92 |
| Max. Negotiated Rate |
$1,356.34 |
| Rate for Payer: Aetna Commercial |
$1,280.99
|
| Rate for Payer: Aetna Medicare |
$391.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$470.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$470.95
|
| Rate for Payer: BCBS Complete |
$602.82
|
| Rate for Payer: BCBS MAPPO |
$376.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.95
|
| Rate for Payer: BCN Commercial |
$1,171.73
|
| Rate for Payer: BCN Medicare Advantage |
$376.76
|
| Rate for Payer: Cash Price |
$1,205.64
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.76
|
| Rate for Payer: Healthscope Commercial |
$1,356.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,130.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$433.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.99
|
| Rate for Payer: Nomi Health Commercial |
$1,235.78
|
| Rate for Payer: PACE Senior Care Partners |
$357.92
|
| Rate for Payer: PACE SWMI |
$376.76
|
| Rate for Payer: PHP Commercial |
$1,280.99
|
| Rate for Payer: PHP Medicare Advantage |
$376.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.58
|
| Rate for Payer: Priority Health HMO/PPO |
$1,311.13
|
| Rate for Payer: Priority Health Medicare |
$380.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,009.72
|
| Rate for Payer: Railroad Medicare Medicare |
$376.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,326.20
|
| Rate for Payer: UHC Core |
$1,258.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$376.76
|
| Rate for Payer: UHC Exchange |
$376.76
|
| Rate for Payer: UHC Medicare Advantage |
$376.76
|
| Rate for Payer: VA VA |
$376.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,130.29
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$9.57
|
|
|
Service Code
|
NDC 60687060711
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna Medicare |
$2.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.99
|
| Rate for Payer: BCBS Complete |
$3.83
|
| Rate for Payer: BCBS MAPPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$7.87
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: BCN Medicare Advantage |
$2.39
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$8.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$7.85
|
| Rate for Payer: PACE Senior Care Partners |
$2.27
|
| Rate for Payer: PACE SWMI |
$2.39
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: PHP Medicare Advantage |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health HMO/PPO |
$8.33
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.41
|
| Rate for Payer: Railroad Medicare Medicare |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.42
|
| Rate for Payer: UHC Core |
$7.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.39
|
| Rate for Payer: UHC Exchange |
$2.39
|
| Rate for Payer: UHC Medicare Advantage |
$2.39
|
| Rate for Payer: VA VA |
$2.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.18
|
|
|
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 |
$6.22 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: BCBS Trust/PPO |
$7.81
|
| Rate for Payer: BCN Commercial |
$7.40
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$8.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$7.85
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health HMO/PPO |
$8.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.42
|
| Rate for Payer: UHC Core |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.18
|
|
|
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 |
$186.55 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Aetna Commercial |
$243.95
|
| Rate for Payer: BCBS Trust/PPO |
$234.28
|
| Rate for Payer: BCN Commercial |
$221.79
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$246.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.60
|
| Rate for Payer: Healthscope Commercial |
$258.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.95
|
| Rate for Payer: Nomi Health Commercial |
$235.34
|
| Rate for Payer: PHP Commercial |
$243.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.55
|
| Rate for Payer: Priority Health HMO/PPO |
$249.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.56
|
| Rate for Payer: UHC Core |
$239.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.25
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,507.05
|
|
|
Service Code
|
NDC 00008121130
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$979.58 |
| Max. Negotiated Rate |
$1,356.34 |
| Rate for Payer: Aetna Commercial |
$1,280.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.20
|
| Rate for Payer: BCN Commercial |
$1,164.65
|
| Rate for Payer: Cash Price |
$1,205.64
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,130.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.99
|
| Rate for Payer: Nomi Health Commercial |
$1,235.78
|
| Rate for Payer: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.58
|
| Rate for Payer: Priority Health HMO/PPO |
$1,311.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,009.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,326.20
|
| Rate for Payer: UHC Core |
$1,258.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,130.29
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$87.56
|
|
|
Service Code
|
NDC 70436001204
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna Commercial |
$74.43
|
| Rate for Payer: Aetna Medicare |
$22.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.36
|
| Rate for Payer: BCBS Complete |
$35.02
|
| Rate for Payer: BCBS MAPPO |
$21.89
|
| Rate for Payer: BCBS Trust/PPO |
$71.98
|
| Rate for Payer: BCN Commercial |
$68.08
|
| Rate for Payer: BCN Medicare Advantage |
$21.89
|
| Rate for Payer: Cash Price |
$70.05
|
| Rate for Payer: Cofinity Commercial |
$75.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.89
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.43
|
| Rate for Payer: Nomi Health Commercial |
$71.80
|
| Rate for Payer: PACE Senior Care Partners |
$20.80
|
| Rate for Payer: PACE SWMI |
$21.89
|
| Rate for Payer: PHP Commercial |
$74.43
|
| Rate for Payer: PHP Medicare Advantage |
$21.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.91
|
| Rate for Payer: Priority Health HMO/PPO |
$76.18
|
| Rate for Payer: Priority Health Medicare |
$22.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.67
|
| Rate for Payer: Railroad Medicare Medicare |
$21.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.05
|
| Rate for Payer: UHC Core |
$73.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.89
|
| Rate for Payer: UHC Exchange |
$21.89
|
| Rate for Payer: UHC Medicare Advantage |
$21.89
|
| Rate for Payer: VA VA |
$21.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.67
|
|
