|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$5,858.38
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$5,579.41 |
| Max. Negotiated Rate |
$5,858.38 |
| Rate for Payer: BCBS Complete |
$5,858.38
|
| Rate for Payer: Mclaren Medicaid |
$5,579.41
|
| Rate for Payer: Meridian Medicaid |
$5,858.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,579.41
|
| Rate for Payer: UHC Medicaid |
$5,579.41
|
| Rate for Payer: UHCCP Medicaid |
$5,579.41
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$5,451.91
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$5,192.29 |
| Max. Negotiated Rate |
$5,451.91 |
| Rate for Payer: BCBS Complete |
$5,451.91
|
| Rate for Payer: Mclaren Medicaid |
$5,192.29
|
| Rate for Payer: Meridian Medicaid |
$5,451.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,192.29
|
| Rate for Payer: UHC Medicaid |
$5,192.29
|
| Rate for Payer: UHCCP Medicaid |
$5,192.29
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$3,031.99
|
|
|
Service Code
|
APR-DRG 1141
|
| Min. Negotiated Rate |
$2,887.61 |
| Max. Negotiated Rate |
$3,031.99 |
| Rate for Payer: BCBS Complete |
$3,031.99
|
| Rate for Payer: Mclaren Medicaid |
$2,887.61
|
| Rate for Payer: Meridian Medicaid |
$3,031.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,887.61
|
| Rate for Payer: UHC Medicaid |
$2,887.61
|
| Rate for Payer: UHCCP Medicaid |
$2,887.61
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$3,110.34
|
|
|
Service Code
|
APR-DRG 1142
|
| Min. Negotiated Rate |
$2,962.23 |
| Max. Negotiated Rate |
$3,110.34 |
| Rate for Payer: BCBS Complete |
$3,110.34
|
| Rate for Payer: Mclaren Medicaid |
$2,962.23
|
| Rate for Payer: Meridian Medicaid |
$3,110.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,962.23
|
| Rate for Payer: UHC Medicaid |
$2,962.23
|
| Rate for Payer: UHCCP Medicaid |
$2,962.23
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$13,942.65
|
|
|
Service Code
|
APR-DRG 1144
|
| Min. Negotiated Rate |
$13,278.71 |
| Max. Negotiated Rate |
$13,942.65 |
| Rate for Payer: BCBS Complete |
$13,942.65
|
| Rate for Payer: Mclaren Medicaid |
$13,278.71
|
| Rate for Payer: Meridian Medicaid |
$13,942.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,278.71
|
| Rate for Payer: UHC Medicaid |
$13,278.71
|
| Rate for Payer: UHCCP Medicaid |
$13,278.71
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$5,718.51
|
|
|
Service Code
|
APR-DRG 1143
|
| Min. Negotiated Rate |
$5,446.20 |
| Max. Negotiated Rate |
$5,718.51 |
| Rate for Payer: BCBS Complete |
$5,718.51
|
| Rate for Payer: Mclaren Medicaid |
$5,446.20
|
| Rate for Payer: Meridian Medicaid |
$5,718.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.20
|
| Rate for Payer: UHC Medicaid |
$5,446.20
|
| Rate for Payer: UHCCP Medicaid |
$5,446.20
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$9,631.29
|
|
|
Service Code
|
APR-DRG 7514
|
| Min. Negotiated Rate |
$9,172.65 |
| Max. Negotiated Rate |
$9,631.29 |
| Rate for Payer: BCBS Complete |
$9,631.29
|
| Rate for Payer: Mclaren Medicaid |
$9,172.65
|
| Rate for Payer: Meridian Medicaid |
$9,631.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,172.65
|
| Rate for Payer: UHC Medicaid |
$9,172.65
|
| Rate for Payer: UHCCP Medicaid |
$9,172.65
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$2,634.46
|
|
|
Service Code
|
APR-DRG 7511
|
| Min. Negotiated Rate |
$2,509.01 |
| Max. Negotiated Rate |
$2,634.46 |
| Rate for Payer: BCBS Complete |
$2,634.46
|
| Rate for Payer: Mclaren Medicaid |
$2,509.01
|
| Rate for Payer: Meridian Medicaid |
$2,634.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,509.01
|
| Rate for Payer: UHC Medicaid |
$2,509.01
|
| Rate for Payer: UHCCP Medicaid |
$2,509.01
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$4,645.27
|
|
|
Service Code
|
APR-DRG 7513
|
| Min. Negotiated Rate |
$4,424.07 |
| Max. Negotiated Rate |
$4,645.27 |
| Rate for Payer: BCBS Complete |
$4,645.27
|
| Rate for Payer: Mclaren Medicaid |
$4,424.07
|
| Rate for Payer: Meridian Medicaid |
$4,645.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,424.07
|
| Rate for Payer: UHC Medicaid |
$4,424.07
|
| Rate for Payer: UHCCP Medicaid |
$4,424.07
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$3,026.74
|
|
|
Service Code
|
APR-DRG 7512
|
| Min. Negotiated Rate |
$2,882.60 |
| Max. Negotiated Rate |
$3,026.74 |
| Rate for Payer: BCBS Complete |
$3,026.74
|
| Rate for Payer: Mclaren Medicaid |
$2,882.60
|
| Rate for Payer: Meridian Medicaid |
$3,026.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,882.60
|
| Rate for Payer: UHC Medicaid |
$2,882.60
|
| Rate for Payer: UHCCP Medicaid |
$2,882.60
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
IP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: BCBS Trust/PPO |
$71.16
|
| Rate for Payer: BCN Commercial |
$71.16
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Nomi Health Commercial |
$70.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.62
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.82
|
| Rate for Payer: UHC Core |
$71.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.62
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
OP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: Aetna Medicare |
$22.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.93
|
| Rate for Payer: BCBS Complete |
$15.95
|
| Rate for Payer: BCBS MAPPO |
$21.54
|
| Rate for Payer: BCBS Trust/PPO |
$70.83
|
| Rate for Payer: BCN Commercial |
$70.83
|
| Rate for Payer: BCN Medicare Advantage |
$21.54
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.54
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.62
|
| Rate for Payer: Mclaren Medicaid |
$15.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.62
|
| Rate for Payer: Meridian Medicaid |
$15.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Nomi Health Commercial |
$70.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.62
|
| Rate for Payer: PACE Senior Care Partners |
$20.46
|
| Rate for Payer: PACE SWMI |
$21.54
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: PHP Medicare Advantage |
$21.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.96
|
| Rate for Payer: Priority Health Medicare |
$21.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.97
|
| Rate for Payer: Railroad Medicare Medicare |
$21.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.82
|
| Rate for Payer: UHC Core |
$71.94
|
| Rate for Payer: UHC Exchange |
$21.54
|
| Rate for Payer: UHC Medicaid |
$15.19
|
| Rate for Payer: UHC Medicare Advantage |
$21.54
|
| Rate for Payer: UHCCP Medicaid |
$15.19
|
| Rate for Payer: VA VA |
$21.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.62
|
|
|
DERMAPLANNING
|
Professional
|
Both
|
$42.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
NDC 45963034202
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Medicare |
$59.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.25
|
| Rate for Payer: BCBS Complete |
$42.20
|
| Rate for Payer: BCBS MAPPO |
$57.00
|
| Rate for Payer: BCBS Trust/PPO |
$187.44
|
| Rate for Payer: BCN Commercial |
$187.44
|
| Rate for Payer: BCN Medicare Advantage |
$57.00
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.00
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Mclaren Medicaid |
$40.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.85
|
| Rate for Payer: Meridian Medicaid |
$42.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Nomi Health Commercial |
$186.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.00
|
| Rate for Payer: PACE Senior Care Partners |
$54.15
|
| Rate for Payer: PACE SWMI |
$57.00
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: PHP Medicare Advantage |
$57.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.36
|
| Rate for Payer: Priority Health Medicare |
$57.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.69
|
| Rate for Payer: Railroad Medicare Medicare |
$57.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: UHC Exchange |
$57.00
|
| Rate for Payer: UHC Medicaid |
$40.20
|
| Rate for Payer: UHC Medicare Advantage |
$57.00
|
| Rate for Payer: UHCCP Medicaid |
$40.20
|
| Rate for Payer: VA VA |
$57.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 45963034202
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.69 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$188.31
|
| Rate for Payer: BCN Commercial |
$188.31
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Nomi Health Commercial |
$186.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.00
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$430.05
|
|
|
Service Code
|
NDC 23155048901
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna Medicare |
$111.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.39
|
| Rate for Payer: BCBS Complete |
$79.60
|
| Rate for Payer: BCBS MAPPO |
$107.51
|
| Rate for Payer: BCBS Trust/PPO |
$353.54
|
| Rate for Payer: BCN Commercial |
$353.54
|
| Rate for Payer: BCN Medicare Advantage |
$107.51
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.51
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Mclaren Medicaid |
$75.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.89
|
| Rate for Payer: Meridian Medicaid |
$79.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Nomi Health Commercial |
$352.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: PACE Senior Care Partners |
$102.14
|
| Rate for Payer: PACE SWMI |
$107.51
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: PHP Medicare Advantage |
$107.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.14
|
| Rate for Payer: Priority Health Medicare |
$108.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.31
|
| Rate for Payer: Railroad Medicare Medicare |
$107.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.44
|
| Rate for Payer: UHC Core |
$359.09
|
| Rate for Payer: UHC Exchange |
$107.51
|
| Rate for Payer: UHC Medicaid |
$75.82
|
| Rate for Payer: UHC Medicare Advantage |
$107.51
|
| Rate for Payer: UHCCP Medicaid |
$75.82
|
| Rate for Payer: VA VA |
$107.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$430.05
|
|
|
Service Code
|
NDC 23155048901
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.31 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: BCBS Trust/PPO |
$355.18
|
| Rate for Payer: BCN Commercial |
$355.18
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Nomi Health Commercial |
$352.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.44
|
| Rate for Payer: UHC Core |
$359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$691.13
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.85 |
| Max. Negotiated Rate |
$622.02 |
| Rate for Payer: Aetna Commercial |
$587.46
|
| Rate for Payer: Aetna Commercial |
$479.25
|
| Rate for Payer: Aetna Commercial |
$134.93
|
| Rate for Payer: Aetna Commercial |
$510.08
|
| Rate for Payer: Aetna Commercial |
$184.69
|
| Rate for Payer: Aetna Commercial |
$167.03
|
| Rate for Payer: Aetna Medicare |
$146.59
|
| Rate for Payer: Aetna Medicare |
$51.09
|
| Rate for Payer: Aetna Medicare |
$41.27
|
| Rate for Payer: Aetna Medicare |
$179.69
|
| Rate for Payer: Aetna Medicare |
$56.49
|
| Rate for Payer: Aetna Medicare |
$156.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.19
|
| Rate for Payer: BCBS Complete |
$40.22
|
| Rate for Payer: BCBS Complete |
$111.08
|
| Rate for Payer: BCBS Complete |
$36.37
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: BCBS Complete |
$127.93
|
| Rate for Payer: BCBS Complete |
$104.36
|
| Rate for Payer: BCBS MAPPO |
$140.96
|
| Rate for Payer: BCBS MAPPO |
$172.78
|
| Rate for Payer: BCBS MAPPO |
$150.02
|
| Rate for Payer: BCBS MAPPO |
$49.13
|
| Rate for Payer: BCBS MAPPO |
$39.69
|
| Rate for Payer: BCBS MAPPO |
$54.32
|
| Rate for Payer: BCBS Trust/PPO |
$130.50
|
| Rate for Payer: BCBS Trust/PPO |
$493.33
|
| Rate for Payer: BCBS Trust/PPO |
$161.55
|
| Rate for Payer: BCBS Trust/PPO |
$178.63
|
| Rate for Payer: BCBS Trust/PPO |
$463.52
|
| Rate for Payer: BCBS Trust/PPO |
$568.18
|
| Rate for Payer: BCN Commercial |
$178.63
|
| Rate for Payer: BCN Commercial |
$463.52
|
| Rate for Payer: BCN Commercial |
$130.50
|
| Rate for Payer: BCN Commercial |
$161.55
|
| Rate for Payer: BCN Commercial |
$493.33
|
| Rate for Payer: BCN Commercial |
$568.18
|
| Rate for Payer: BCN Medicare Advantage |
$150.02
|
| Rate for Payer: BCN Medicare Advantage |
$172.78
|
| Rate for Payer: BCN Medicare Advantage |
$54.32
|
| Rate for Payer: BCN Medicare Advantage |
$39.69
|
| Rate for Payer: BCN Medicare Advantage |
$140.96
|
| Rate for Payer: BCN Medicare Advantage |
$49.13
|
| Rate for Payer: Cash Price |
$451.06
|
| Rate for Payer: Cash Price |
$126.99
|
| Rate for Payer: Cash Price |
$157.21
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$480.07
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cofinity Commercial |
$484.89
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$136.52
|
| Rate for Payer: Cofinity Commercial |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$594.37
|
| Rate for Payer: Cofinity Commercial |
$516.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.13
|
| Rate for Payer: Healthscope Commercial |
$507.44
|
| Rate for Payer: Healthscope Commercial |
$622.02
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Healthscope Commercial |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$142.87
|
| Rate for Payer: Healthscope Commercial |
$540.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.06
|
| 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 |
$147.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.96
|
| Rate for Payer: Mclaren Medicaid |
$34.64
|
| Rate for Payer: Mclaren Medicaid |
$27.99
|
| Rate for Payer: Mclaren Medicaid |
$38.31
|
| Rate for Payer: Mclaren Medicaid |
$99.40
|
| Rate for Payer: Mclaren Medicaid |
$105.80
|
| Rate for Payer: Mclaren Medicaid |
$121.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.00
|
| 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 |
$51.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.04
|
| Rate for Payer: Meridian Medicaid |
$111.08
|
| Rate for Payer: Meridian Medicaid |
$127.93
|
| Rate for Payer: Meridian Medicaid |
$36.37
|
| Rate for Payer: Meridian Medicaid |
$29.38
|
| Rate for Payer: Meridian Medicaid |
$40.22
|
| Rate for Payer: Meridian Medicaid |
$104.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$165.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$155.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$190.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.46
|
| Rate for Payer: Nomi Health Commercial |
$178.17
|
| Rate for Payer: Nomi Health Commercial |
$462.33
|
| Rate for Payer: Nomi Health Commercial |
$130.17
|
| Rate for Payer: Nomi Health Commercial |
$492.07
|
| Rate for Payer: Nomi Health Commercial |
$566.73
|
| Rate for Payer: Nomi Health Commercial |
$161.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$518.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.38
|
| Rate for Payer: PACE Senior Care Partners |
$51.60
|
| Rate for Payer: PACE Senior Care Partners |
$46.67
|
| Rate for Payer: PACE Senior Care Partners |
$133.91
|
| Rate for Payer: PACE Senior Care Partners |
$142.52
|
| Rate for Payer: PACE Senior Care Partners |
$37.70
|
| Rate for Payer: PACE Senior Care Partners |
$164.14
|
| Rate for Payer: PACE SWMI |
$49.13
|
| Rate for Payer: PACE SWMI |
$140.96
|
| Rate for Payer: PACE SWMI |
$172.78
|
| Rate for Payer: PACE SWMI |
$39.69
|
| Rate for Payer: PACE SWMI |
$150.02
|
| Rate for Payer: PACE SWMI |
$54.32
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Commercial |
$167.03
|
| Rate for Payer: PHP Commercial |
$479.25
|
| Rate for Payer: PHP Commercial |
$510.08
|
| Rate for Payer: PHP Commercial |
$587.46
|
| Rate for Payer: PHP Commercial |
$134.93
|
| Rate for Payer: PHP Medicare Advantage |
$172.78
|
| Rate for Payer: PHP Medicare Advantage |
$49.13
|
| Rate for Payer: PHP Medicare Advantage |
$150.02
|
| Rate for Payer: PHP Medicare Advantage |
$39.69
|
| Rate for Payer: PHP Medicare Advantage |
$140.96
|
| Rate for Payer: PHP Medicare Advantage |
$54.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$170.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$490.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$522.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$601.28
|
| Rate for Payer: Priority Health Medicare |
$40.08
|
| Rate for Payer: Priority Health Medicare |
$174.51
|
| Rate for Payer: Priority Health Medicare |
$49.62
|
| Rate for Payer: Priority Health Medicare |
$142.36
|
| Rate for Payer: Priority Health Medicare |
$54.86
|
| Rate for Payer: Priority Health Medicare |
$151.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$417.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$481.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.42
|
| Rate for Payer: Railroad Medicare Medicare |
$39.69
|
| Rate for Payer: Railroad Medicare Medicare |
$150.02
|
| Rate for Payer: Railroad Medicare Medicare |
$140.96
|
| Rate for Payer: Railroad Medicare Medicare |
$49.13
|
| Rate for Payer: Railroad Medicare Medicare |
$54.32
|
| Rate for Payer: Railroad Medicare Medicare |
$172.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.69
|
| Rate for Payer: UHC Core |
$181.43
|
| Rate for Payer: UHC Core |
$501.08
|
| Rate for Payer: UHC Core |
$470.79
|
| Rate for Payer: UHC Core |
$577.09
|
| Rate for Payer: UHC Core |
$132.55
|
| Rate for Payer: UHC Core |
$164.09
|
| Rate for Payer: UHC Exchange |
$49.13
|
| Rate for Payer: UHC Exchange |
$39.69
|
| Rate for Payer: UHC Exchange |
$140.96
|
| Rate for Payer: UHC Exchange |
$54.32
|
| Rate for Payer: UHC Exchange |
$150.02
|
| Rate for Payer: UHC Exchange |
$172.78
|
| Rate for Payer: UHC Medicaid |
$105.80
|
| Rate for Payer: UHC Medicaid |
$99.40
|
| Rate for Payer: UHC Medicaid |
$34.64
|
| Rate for Payer: UHC Medicaid |
$38.31
|
| Rate for Payer: UHC Medicaid |
$27.99
|
| Rate for Payer: UHC Medicaid |
$121.85
|
| Rate for Payer: UHC Medicare Advantage |
$49.13
|
| Rate for Payer: UHC Medicare Advantage |
$150.02
|
| Rate for Payer: UHC Medicare Advantage |
$140.96
|
| Rate for Payer: UHC Medicare Advantage |
$54.32
|
| Rate for Payer: UHC Medicare Advantage |
$39.69
|
| Rate for Payer: UHC Medicare Advantage |
$172.78
|
| Rate for Payer: UHCCP Medicaid |
$105.80
|
| Rate for Payer: UHCCP Medicaid |
$99.40
|
| Rate for Payer: UHCCP Medicaid |
$38.31
|
| Rate for Payer: UHCCP Medicaid |
$34.64
|
| Rate for Payer: UHCCP Medicaid |
$27.99
|
| Rate for Payer: UHCCP Medicaid |
$121.85
|
| Rate for Payer: VA VA |
$54.32
|
| Rate for Payer: VA VA |
$49.13
|
| Rate for Payer: VA VA |
$150.02
|
| Rate for Payer: VA VA |
$140.96
|
| Rate for Payer: VA VA |
$39.69
|
| Rate for Payer: VA VA |
$172.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.87
|
| 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
|
|
|
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 |
$481.03 |
| Max. Negotiated Rate |
$622.02 |
| Rate for Payer: Aetna Commercial |
$587.46
|
| Rate for Payer: Aetna Commercial |
$134.93
|
| Rate for Payer: Aetna Commercial |
$184.69
|
| Rate for Payer: Aetna Commercial |
$167.03
|
| Rate for Payer: Aetna Commercial |
$479.25
|
| Rate for Payer: Aetna Commercial |
$510.08
|
| Rate for Payer: BCBS Trust/PPO |
$570.80
|
| Rate for Payer: BCBS Trust/PPO |
$465.66
|
| Rate for Payer: BCBS Trust/PPO |
$495.61
|
| Rate for Payer: BCBS Trust/PPO |
$162.30
|
| Rate for Payer: BCBS Trust/PPO |
$131.10
|
| Rate for Payer: BCBS Trust/PPO |
$179.45
|
| Rate for Payer: BCN Commercial |
$495.61
|
| Rate for Payer: BCN Commercial |
$465.66
|
| Rate for Payer: BCN Commercial |
$131.10
|
| Rate for Payer: BCN Commercial |
$179.45
|
| Rate for Payer: BCN Commercial |
$570.80
|
| Rate for Payer: BCN Commercial |
$162.30
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$157.21
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$451.06
|
| Rate for Payer: Cash Price |
$126.99
|
| Rate for Payer: Cash Price |
$480.07
|
| Rate for Payer: Cofinity Commercial |
$516.08
|
| Rate for Payer: Cofinity Commercial |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$484.89
|
| Rate for Payer: Cofinity Commercial |
$136.52
|
| Rate for Payer: Cofinity Commercial |
$594.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.90
|
| Rate for Payer: Healthscope Commercial |
$142.87
|
| Rate for Payer: Healthscope Commercial |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$540.08
|
| Rate for Payer: Healthscope Commercial |
$622.02
|
| Rate for Payer: Healthscope Commercial |
$507.44
|
| Rate for Payer: Healthscope Commercial |
$195.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.93
|
| 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 |
$184.69
|
| Rate for Payer: Nomi Health Commercial |
$492.07
|
| Rate for Payer: Nomi Health Commercial |
$130.17
|
| Rate for Payer: Nomi Health Commercial |
$161.14
|
| Rate for Payer: Nomi Health Commercial |
$462.33
|
| Rate for Payer: Nomi Health Commercial |
$178.17
|
| Rate for Payer: Nomi Health Commercial |
$566.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$518.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.87
|
| Rate for Payer: PHP Commercial |
$510.08
|
| Rate for Payer: PHP Commercial |
$587.46
|
| Rate for Payer: PHP Commercial |
$479.25
|
| Rate for Payer: PHP Commercial |
$134.93
|
| Rate for Payer: PHP Commercial |
$167.03
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$170.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$490.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$522.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$601.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$417.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$481.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.19
|
| Rate for Payer: UHC Core |
$577.09
|
| Rate for Payer: UHC Core |
$164.09
|
| Rate for Payer: UHC Core |
$181.43
|
| Rate for Payer: UHC Core |
$501.08
|
| Rate for Payer: UHC Core |
$470.79
|
| Rate for Payer: UHC Core |
$132.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.06
|
|
|
DESVENLAFAXINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$374.19
|
|
|
Service Code
|
NDC 63304019130
|
| Hospital Charge Code |
166026
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.44 |
| Max. Negotiated Rate |
$336.77 |
| Rate for Payer: Aetna Commercial |
$318.06
|
| Rate for Payer: BCBS Trust/PPO |
$309.04
|
| Rate for Payer: BCN Commercial |
$309.04
|
| Rate for Payer: Cash Price |
$299.35
|
| Rate for Payer: Cofinity Commercial |
$321.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.35
|
| Rate for Payer: Healthscope Commercial |
$336.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.06
|
| Rate for Payer: Nomi Health Commercial |
$306.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.64
|
| Rate for Payer: PHP Commercial |
$318.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.29
|
| Rate for Payer: UHC Core |
$312.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.64
|
|
|
DESVENLAFAXINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$374.19
|
|
|
Service Code
|
NDC 63304019130
|
| Hospital Charge Code |
166026
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$336.77 |
| Rate for Payer: Aetna Commercial |
$318.06
|
| Rate for Payer: Aetna Medicare |
$97.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.93
|
| Rate for Payer: BCBS Complete |
$69.26
|
| Rate for Payer: BCBS MAPPO |
$93.55
|
| Rate for Payer: BCBS Trust/PPO |
$307.62
|
| Rate for Payer: BCN Commercial |
$307.62
|
| Rate for Payer: BCN Medicare Advantage |
$93.55
|
| Rate for Payer: Cash Price |
$299.35
|
| Rate for Payer: Cofinity Commercial |
$321.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.55
|
| Rate for Payer: Healthscope Commercial |
$336.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.64
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.22
|
| Rate for Payer: Meridian Medicaid |
$69.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.06
|
| Rate for Payer: Nomi Health Commercial |
$306.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.64
|
| Rate for Payer: PACE Senior Care Partners |
$88.87
|
| Rate for Payer: PACE SWMI |
$93.55
|
| Rate for Payer: PHP Commercial |
$318.06
|
| Rate for Payer: PHP Medicare Advantage |
$93.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.55
|
| Rate for Payer: Priority Health Medicare |
$94.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: Railroad Medicare Medicare |
$93.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.29
|
| Rate for Payer: UHC Core |
$312.45
|
| Rate for Payer: UHC Exchange |
$93.55
|
| Rate for Payer: UHC Medicaid |
$65.97
|
| Rate for Payer: UHC Medicare Advantage |
$93.55
|
| Rate for Payer: UHCCP Medicaid |
$65.97
|
| Rate for Payer: VA VA |
$93.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.64
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$235.88
|
|
|
Service Code
|
NDC 60687060721
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.17 |
| Max. Negotiated Rate |
$212.29 |
| Rate for Payer: Aetna Commercial |
$200.50
|
| Rate for Payer: BCBS Trust/PPO |
$194.81
|
| Rate for Payer: BCN Commercial |
$194.81
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cofinity Commercial |
$202.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.70
|
| Rate for Payer: Healthscope Commercial |
$212.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.50
|
| Rate for Payer: Nomi Health Commercial |
$193.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.91
|
| Rate for Payer: PHP Commercial |
$200.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.57
|
| Rate for Payer: UHC Core |
$196.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.91
|
|
|
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 |
$265.69 |
| 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 |
$278.95
|
| Rate for Payer: BCBS MAPPO |
$376.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.95
|
| Rate for Payer: BCN Commercial |
$1,238.95
|
| 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: Mclaren Medicaid |
$265.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.60
|
| Rate for Payer: Meridian Medicaid |
$278.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$433.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$414.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.99
|
| Rate for Payer: Nomi Health Commercial |
$1,235.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.29
|
| 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 Choice Medicaid |
$265.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,311.13
|
| Rate for Payer: Priority Health Medicare |
$380.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,048.91
|
| 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 Exchange |
$376.76
|
| Rate for Payer: UHC Medicaid |
$265.69
|
| Rate for Payer: UHC Medicare Advantage |
$376.76
|
| Rate for Payer: UHCCP Medicaid |
$265.69
|
| 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
|
$7.87
|
|
|
Service Code
|
NDC 60687060711
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: BCBS Trust/PPO |
$6.50
|
| Rate for Payer: BCN Commercial |
$6.50
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$6.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$7.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.69
|
| Rate for Payer: Nomi Health Commercial |
$6.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.90
|
| Rate for Payer: PHP Commercial |
$6.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.93
|
| Rate for Payer: UHC Core |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.90
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$235.88
|
|
|
Service Code
|
NDC 60687060721
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$212.29 |
| Rate for Payer: Aetna Commercial |
$200.50
|
| Rate for Payer: Aetna Medicare |
$61.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.71
|
| Rate for Payer: BCBS Complete |
$43.66
|
| Rate for Payer: BCBS MAPPO |
$58.97
|
| Rate for Payer: BCBS Trust/PPO |
$193.92
|
| Rate for Payer: BCN Commercial |
$193.92
|
| Rate for Payer: BCN Medicare Advantage |
$58.97
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cofinity Commercial |
$202.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.97
|
| Rate for Payer: Healthscope Commercial |
$212.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.91
|
| Rate for Payer: Mclaren Medicaid |
$41.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.92
|
| Rate for Payer: Meridian Medicaid |
$43.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.50
|
| Rate for Payer: Nomi Health Commercial |
$193.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.91
|
| Rate for Payer: PACE Senior Care Partners |
$56.02
|
| Rate for Payer: PACE SWMI |
$58.97
|
| Rate for Payer: PHP Commercial |
$200.50
|
| Rate for Payer: PHP Medicare Advantage |
$58.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.22
|
| Rate for Payer: Priority Health Medicare |
$59.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.17
|
| Rate for Payer: Railroad Medicare Medicare |
$58.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.57
|
| Rate for Payer: UHC Core |
$196.96
|
| Rate for Payer: UHC Exchange |
$58.97
|
| Rate for Payer: UHC Medicaid |
$41.59
|
| Rate for Payer: UHC Medicare Advantage |
$58.97
|
| Rate for Payer: UHCCP Medicaid |
$41.59
|
| Rate for Payer: VA VA |
$58.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.91
|
|
