|
DESTRUCTION BY NEUROLYTIC AGENT, GENICULAR NERVE BRANCHES INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$1,482.54
|
|
|
Service Code
|
CPT 64624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,411.85 |
| Max. Negotiated Rate |
$1,482.54 |
| Rate for Payer: BCBS Complete |
$1,482.54
|
| Rate for Payer: Mclaren Medicaid |
$1,411.85
|
| Rate for Payer: Meridian Medicaid |
$1,482.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,411.85
|
| Rate for Payer: UHCCP Medicaid |
$1,411.85
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE
|
Facility
|
OP
|
$675.91
|
|
|
Service Code
|
CPT 64620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$643.68 |
| Max. Negotiated Rate |
$675.91 |
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
|
Facility
|
OP
|
$675.91
|
|
|
Service Code
|
CPT 64640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$643.68 |
| Max. Negotiated Rate |
$675.91 |
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
|
Facility
|
OP
|
$1,482.54
|
|
|
Service Code
|
CPT 64635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,411.85 |
| Max. Negotiated Rate |
$1,482.54 |
| Rate for Payer: BCBS Complete |
$1,482.54
|
| Rate for Payer: Mclaren Medicaid |
$1,411.85
|
| Rate for Payer: Meridian Medicaid |
$1,482.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,411.85
|
| Rate for Payer: UHCCP Medicaid |
$1,411.85
|
|
|
DESTRUCTION OF INTERNAL HEMORRHOID(S) BY THERMAL ENERGY (EG, INFRARED COAGULATION, CAUTERY, RADIOFREQUENCY)
|
Facility
|
OP
|
$895.16
|
|
|
Service Code
|
CPT 46930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$852.47 |
| Max. Negotiated Rate |
$895.16 |
| Rate for Payer: BCBS Complete |
$895.16
|
| Rate for Payer: Mclaren Medicaid |
$852.47
|
| Rate for Payer: Meridian Medicaid |
$895.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$852.47
|
| Rate for Payer: UHCCP Medicaid |
$852.47
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$2,082.02
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,982.75 |
| Max. Negotiated Rate |
$2,082.02 |
| Rate for Payer: BCBS Complete |
$2,082.02
|
| Rate for Payer: Mclaren Medicaid |
$1,982.75
|
| Rate for Payer: Meridian Medicaid |
$2,082.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,982.75
|
| Rate for Payer: UHCCP Medicaid |
$1,982.75
|
|
|
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
|
$1,507.05
|
|
|
Service Code
|
NDC 00008121130
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.92 |
| Max. Negotiated Rate |
$1,356.35 |
| 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 |
$1,356.35
|
| 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
|
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
|
$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
|
$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 |
$239.65
|
| 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
|
$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 |
$239.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.25
|
|
|
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
|
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
|
|
|
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 |
$1,356.35 |
| 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 |
$1,356.35
|
| 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
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
NDC 63323050601
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.73
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$1.39
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.39
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.39
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$4.54
|
| Rate for Payer: PACE Senior Care Partners |
$1.32
|
| Rate for Payer: PACE SWMI |
$1.39
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicare Advantage |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health HMO/PPO |
$4.82
|
| Rate for Payer: Priority Health Medicare |
$1.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.88
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UHC Medicare Advantage |
$1.39
|
| Rate for Payer: VA VA |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$7.13
|
|
|
Service Code
|
NDC 70069002125
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Aetna Commercial |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$5.82
|
| Rate for Payer: BCN Commercial |
$5.51
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$6.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Healthscope Commercial |
$6.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.06
|
| Rate for Payer: Nomi Health Commercial |
$5.85
|
| Rate for Payer: PHP Commercial |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.63
|
| Rate for Payer: Priority Health HMO/PPO |
$6.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.27
|
| Rate for Payer: UHC Core |
$5.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.35
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 09900000170
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.17
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS MAPPO |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Medicare Advantage |
$0.94
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.94
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: PACE Senior Care Partners |
$0.89
|
| Rate for Payer: PACE SWMI |
$0.94
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health HMO/PPO |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.29
|
| Rate for Payer: UHC Core |
$3.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.94
|
| Rate for Payer: UHC Exchange |
$0.94
|
| Rate for Payer: UHC Medicare Advantage |
$0.94
|
| Rate for Payer: VA VA |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
NDC 63323050601
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: BCBS Trust/PPO |
$4.52
|
| Rate for Payer: BCN Commercial |
$4.28
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$4.54
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health HMO/PPO |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.88
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$7.13
|
|
|
Service Code
|
NDC 70069002125
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Aetna Commercial |
$6.06
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.23
|
| Rate for Payer: BCBS Complete |
$2.85
|
| Rate for Payer: BCBS MAPPO |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.78
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$6.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.78
|
| Rate for Payer: Healthscope Commercial |
$6.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.06
|
| Rate for Payer: Nomi Health Commercial |
$5.85
|
| Rate for Payer: PACE Senior Care Partners |
$1.69
|
| Rate for Payer: PACE SWMI |
$1.78
|
| Rate for Payer: PHP Commercial |
$6.06
|
| Rate for Payer: PHP Medicare Advantage |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.63
|
| Rate for Payer: Priority Health HMO/PPO |
$6.20
|
| Rate for Payer: Priority Health Medicare |
$1.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.27
|
| Rate for Payer: UHC Core |
$5.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Medicare Advantage |
$1.78
|
| Rate for Payer: VA VA |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.35
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 09900000170
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health HMO/PPO |
$3.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.29
|
| Rate for Payer: UHC Core |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.04 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: Aetna Medicare |
$121.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.10
|
| Rate for Payer: BCBS Complete |
$187.01
|
| Rate for Payer: BCBS MAPPO |
$116.88
|
| Rate for Payer: BCBS Trust/PPO |
$384.35
|
| Rate for Payer: BCN Commercial |
$363.50
|
| Rate for Payer: BCN Medicare Advantage |
$116.88
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.88
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: Nomi Health Commercial |
$383.37
|
| Rate for Payer: PACE Senior Care Partners |
$111.04
|
| Rate for Payer: PACE SWMI |
$116.88
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: PHP Medicare Advantage |
$116.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: Priority Health HMO/PPO |
$406.74
|
| Rate for Payer: Priority Health Medicare |
$118.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.24
|
| Rate for Payer: Railroad Medicare Medicare |
$116.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.42
|
| Rate for Payer: UHC Core |
$390.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.88
|
| Rate for Payer: UHC Exchange |
$116.88
|
| Rate for Payer: UHC Medicare Advantage |
$116.88
|
| Rate for Payer: VA VA |
$116.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.64
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.89 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: BCBS Trust/PPO |
$381.64
|
| Rate for Payer: BCN Commercial |
$361.30
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: Nomi Health Commercial |
$383.37
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: Priority Health HMO/PPO |
$406.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.42
|
| Rate for Payer: UHC Core |
$390.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.64
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
OP
|
$735.84
|
|
|
Service Code
|
NDC 00054818325
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$662.26 |
| Rate for Payer: Aetna Commercial |
$625.46
|
| Rate for Payer: Aetna Medicare |
$191.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.95
|
| Rate for Payer: BCBS Complete |
$294.34
|
| Rate for Payer: BCBS MAPPO |
$183.96
|
| Rate for Payer: BCBS Trust/PPO |
$604.93
|
| Rate for Payer: BCN Commercial |
$572.12
|
| Rate for Payer: BCN Medicare Advantage |
$183.96
|
| Rate for Payer: Cash Price |
$588.67
|
| Rate for Payer: Cofinity Commercial |
$632.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.96
|
| Rate for Payer: Healthscope Commercial |
$662.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.46
|
| Rate for Payer: Nomi Health Commercial |
$603.39
|
| Rate for Payer: PACE Senior Care Partners |
$174.76
|
| Rate for Payer: PACE SWMI |
$183.96
|
| Rate for Payer: PHP Commercial |
$625.46
|
| Rate for Payer: PHP Medicare Advantage |
$183.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.30
|
| Rate for Payer: Priority Health HMO/PPO |
$640.18
|
| Rate for Payer: Priority Health Medicare |
$185.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.01
|
| Rate for Payer: Railroad Medicare Medicare |
$183.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.54
|
| Rate for Payer: UHC Core |
$614.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.96
|
| Rate for Payer: UHC Exchange |
$183.96
|
| Rate for Payer: UHC Medicare Advantage |
$183.96
|
| Rate for Payer: VA VA |
$183.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.88
|
|
