|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.35
|
|
|
Service Code
|
NDC 00409669502
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCN Commercial |
$20.36
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.76
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.66
|
|
|
Service Code
|
NDC 67457090300
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Aetna Commercial |
$20.96
|
| Rate for Payer: BCBS Trust/PPO |
$20.13
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: Cash Price |
$19.73
|
| Rate for Payer: Cofinity Commercial |
$21.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.73
|
| Rate for Payer: Healthscope Commercial |
$22.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.96
|
| Rate for Payer: Nomi Health Commercial |
$20.22
|
| Rate for Payer: PHP Commercial |
$20.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.03
|
| Rate for Payer: Priority Health HMO/PPO |
$21.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.70
|
| Rate for Payer: UHC Core |
$20.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.50
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.06
|
|
|
Service Code
|
NDC 55150022110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: BCBS Trust/PPO |
$14.74
|
| Rate for Payer: BCN Commercial |
$13.96
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$16.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.35
|
| Rate for Payer: Nomi Health Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.74
|
| Rate for Payer: Priority Health HMO/PPO |
$15.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.89
|
| Rate for Payer: UHC Core |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.05
|
|
|
Service Code
|
NDC 65219044720
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$23.45 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.42
|
| Rate for Payer: BCN Commercial |
$20.25
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$20.84
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$23.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.14
|
| Rate for Payer: Nomi Health Commercial |
$21.36
|
| Rate for Payer: PACE Senior Care Partners |
$6.19
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$22.14
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health HMO/PPO |
$22.66
|
| Rate for Payer: Priority Health Medicare |
$6.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.45
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$21.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.51
|
| Rate for Payer: UHC Exchange |
$6.51
|
| Rate for Payer: UHC Medicare Advantage |
$6.51
|
| Rate for Payer: VA VA |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.54
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.06
|
|
|
Service Code
|
NDC 55150022110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.64
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: BCBS MAPPO |
$4.51
|
| Rate for Payer: BCBS Trust/PPO |
$14.85
|
| Rate for Payer: BCN Commercial |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.51
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.51
|
| Rate for Payer: Healthscope Commercial |
$16.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.35
|
| Rate for Payer: Nomi Health Commercial |
$14.81
|
| Rate for Payer: PACE Senior Care Partners |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.51
|
| Rate for Payer: PHP Commercial |
$15.35
|
| Rate for Payer: PHP Medicare Advantage |
$4.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.74
|
| Rate for Payer: Priority Health HMO/PPO |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$4.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.89
|
| Rate for Payer: UHC Core |
$15.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.51
|
| Rate for Payer: UHC Exchange |
$4.51
|
| Rate for Payer: UHC Medicare Advantage |
$4.51
|
| Rate for Payer: VA VA |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.54
|
|
|
Service Code
|
NDC 00143931110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$17.59 |
| Rate for Payer: Aetna Commercial |
$16.61
|
| Rate for Payer: BCBS Trust/PPO |
$15.95
|
| Rate for Payer: BCN Commercial |
$15.10
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.63
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.61
|
| Rate for Payer: Nomi Health Commercial |
$16.02
|
| Rate for Payer: PHP Commercial |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.70
|
| Rate for Payer: Priority Health HMO/PPO |
$17.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.20
|
| Rate for Payer: UHC Core |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.65
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.79
|
|
|
Service Code
|
NDC 72266014701
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Aetna Commercial |
$22.77
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.37
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS MAPPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$22.02
|
| Rate for Payer: BCN Commercial |
$20.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.70
|
| Rate for Payer: Healthscope Commercial |
$24.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.77
|
| Rate for Payer: Nomi Health Commercial |
$21.97
|
| Rate for Payer: PACE Senior Care Partners |
$6.36
|
| Rate for Payer: PACE SWMI |
$6.70
|
| Rate for Payer: PHP Commercial |
$22.77
|
| Rate for Payer: PHP Medicare Advantage |
$6.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.41
|
| Rate for Payer: Priority Health HMO/PPO |
$23.31
|
| Rate for Payer: Priority Health Medicare |
$6.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.95
|
| Rate for Payer: Railroad Medicare Medicare |
$6.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.58
|
| Rate for Payer: UHC Core |
$22.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.70
|
| Rate for Payer: UHC Exchange |
$6.70
|
| Rate for Payer: UHC Medicare Advantage |
$6.70
|
| Rate for Payer: VA VA |
$6.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.09
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.05
|
|
|
Service Code
|
NDC 65219044720
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$23.45 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$21.26
|
| Rate for Payer: BCN Commercial |
$20.13
|
| Rate for Payer: Cash Price |
$20.84
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.84
|
| Rate for Payer: Healthscope Commercial |
$23.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.14
|
| Rate for Payer: Nomi Health Commercial |
$21.36
|
| Rate for Payer: PHP Commercial |
$22.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health HMO/PPO |
$22.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.54
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.05
|
|
|
Service Code
|
NDC 65219044702
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$23.45 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$21.26
|
| Rate for Payer: BCN Commercial |
$20.13
|
| Rate for Payer: Cash Price |
$20.84
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.84
|
| Rate for Payer: Healthscope Commercial |
$23.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.14
|
| Rate for Payer: Nomi Health Commercial |
$21.36
|
| Rate for Payer: PHP Commercial |
$22.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health HMO/PPO |
$22.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.54
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.66
|
|
|
Service Code
|
NDC 67457090320
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Aetna Commercial |
$20.96
|
| Rate for Payer: Aetna Medicare |
$6.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.71
|
| Rate for Payer: BCBS Complete |
$9.86
|
| Rate for Payer: BCBS MAPPO |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$20.27
|
| Rate for Payer: BCN Commercial |
$19.17
|
| Rate for Payer: BCN Medicare Advantage |
$6.17
|
| Rate for Payer: Cash Price |
$19.73
|
| Rate for Payer: Cofinity Commercial |
$21.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.17
|
| Rate for Payer: Healthscope Commercial |
$22.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.96
|
| Rate for Payer: Nomi Health Commercial |
$20.22
|
| Rate for Payer: PACE Senior Care Partners |
$5.86
|
| Rate for Payer: PACE SWMI |
$6.17
|
| Rate for Payer: PHP Commercial |
$20.96
|
| Rate for Payer: PHP Medicare Advantage |
$6.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.03
|
| Rate for Payer: Priority Health HMO/PPO |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$6.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.52
|
| Rate for Payer: Railroad Medicare Medicare |
$6.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.70
|
| Rate for Payer: UHC Core |
$20.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.17
|
| Rate for Payer: UHC Exchange |
$6.17
|
| Rate for Payer: UHC Medicare Advantage |
$6.17
|
| Rate for Payer: VA VA |
$6.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.50
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$26.35
|
|
|
Service Code
|
NDC 00409669502
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$6.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.23
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS MAPPO |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.66
|
| Rate for Payer: BCN Commercial |
$20.49
|
| Rate for Payer: BCN Medicare Advantage |
$6.59
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.59
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: PACE Senior Care Partners |
$6.26
|
| Rate for Payer: PACE SWMI |
$6.59
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health Medicare |
$6.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.65
|
| Rate for Payer: Railroad Medicare Medicare |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.59
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
| Rate for Payer: VA VA |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.76
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$26.35
|
|
|
Service Code
|
NDC 00409669502
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCN Commercial |
$20.36
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.76
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS
|
Facility
|
OP
|
$1,230.09
|
|
|
Service Code
|
CPT 11420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$534.17
|
|
|
Service Code
|
CPT 11421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$508.70 |
| Max. Negotiated Rate |
$534.17 |
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$1,230.09
|
|
|
Service Code
|
CPT 11422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$1,230.09
|
|
|
Service Code
|
CPT 11423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$1,230.09
|
|
|
Service Code
|
CPT 11424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$534.17
|
|
|
Service Code
|
CPT 11402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$508.70 |
| Max. Negotiated Rate |
$534.17 |
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$534.17
|
|
|
Service Code
|
CPT 11403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$508.70 |
| Max. Negotiated Rate |
$534.17 |
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$1,230.09
|
|
|
Service Code
|
CPT 11404
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$1,230.09
|
|
|
Service Code
|
CPT 11406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$1,230.09
|
|
|
Service Code
|
CPT 11623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$2,172.87
|
|
|
Service Code
|
CPT 11626
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,069.26 |
| Max. Negotiated Rate |
$2,172.87 |
| Rate for Payer: BCBS Complete |
$2,172.87
|
| Rate for Payer: Mclaren Medicaid |
$2,069.26
|
| Rate for Payer: Meridian Medicaid |
$2,172.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,069.26
|
| Rate for Payer: UHCCP Medicaid |
$2,069.26
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$534.17
|
|
|
Service Code
|
CPT 11604
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$508.70 |
| Max. Negotiated Rate |
$534.17 |
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
|
|
EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19300), OPEN, MALE OR FEMALE, 1 OR MORE LESIONS
|
Facility
|
OP
|
$2,907.19
|
|
|
Service Code
|
CPT 19120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,768.57 |
| Max. Negotiated Rate |
$2,907.19 |
| Rate for Payer: BCBS Complete |
$2,907.19
|
| Rate for Payer: Mclaren Medicaid |
$2,768.57
|
| Rate for Payer: Meridian Medicaid |
$2,907.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,768.57
|
| Rate for Payer: UHCCP Medicaid |
$2,768.57
|
|
