|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29,932.38
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,832.94 |
| Max. Negotiated Rate |
$26,939.14 |
| Rate for Payer: Aetna Commercial |
$25,442.52
|
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: BCBS Trust/PPO |
$24,721.15
|
| Rate for Payer: BCBS Trust/PPO |
$25,462.80
|
| Rate for Payer: BCN Commercial |
$24,721.15
|
| Rate for Payer: BCN Commercial |
$25,462.80
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Cofinity Commercial |
$25,741.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Healthscope Commercial |
$26,939.14
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,449.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,122.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$24,544.55
|
| Rate for Payer: Nomi Health Commercial |
$25,280.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,449.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: PHP Commercial |
$25,442.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26,822.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26,041.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,832.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21,457.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,340.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,130.73
|
| Rate for Payer: UHC Core |
$24,993.54
|
| Rate for Payer: UHC Core |
$25,743.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,449.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,122.78
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$25.99
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$23.39 |
| Rate for Payer: Aetna Commercial |
$22.09
|
| Rate for Payer: BCBS Trust/PPO |
$21.47
|
| Rate for Payer: BCN Commercial |
$21.47
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$22.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$23.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.09
|
| Rate for Payer: Nomi Health Commercial |
$21.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.49
|
| Rate for Payer: PHP Commercial |
$22.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.87
|
| Rate for Payer: UHC Core |
$21.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.49
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
NDC 00067399842
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$24.80
|
| Rate for Payer: BCN Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.02
|
| Rate for Payer: Healthscope Commercial |
$27.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.53
|
| Rate for Payer: Nomi Health Commercial |
$24.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.52
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.43
|
| Rate for Payer: UHC Core |
$25.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.52
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
NDC 00067399842
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: Aetna Medicare |
$7.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.38
|
| Rate for Payer: BCBS Complete |
$5.56
|
| Rate for Payer: BCBS MAPPO |
$7.51
|
| Rate for Payer: BCBS Trust/PPO |
$24.69
|
| Rate for Payer: BCN Commercial |
$24.69
|
| Rate for Payer: BCN Medicare Advantage |
$7.51
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.51
|
| Rate for Payer: Healthscope Commercial |
$27.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.52
|
| Rate for Payer: Mclaren Medicaid |
$5.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.88
|
| Rate for Payer: Meridian Medicaid |
$5.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.53
|
| Rate for Payer: Nomi Health Commercial |
$24.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.52
|
| Rate for Payer: PACE Senior Care Partners |
$7.13
|
| Rate for Payer: PACE SWMI |
$7.51
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.13
|
| Rate for Payer: Priority Health Medicare |
$7.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.43
|
| Rate for Payer: UHC Core |
$25.08
|
| Rate for Payer: UHC Exchange |
$7.51
|
| Rate for Payer: UHC Medicaid |
$5.29
|
| Rate for Payer: UHC Medicare Advantage |
$7.51
|
| Rate for Payer: UHCCP Medicaid |
$5.29
|
| Rate for Payer: VA VA |
$7.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.52
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$25.99
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$23.39 |
| Rate for Payer: Aetna Commercial |
$22.09
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.12
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.37
|
| Rate for Payer: BCN Commercial |
$21.37
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$22.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.49
|
| Rate for Payer: Mclaren Medicaid |
$4.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.82
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.09
|
| Rate for Payer: Nomi Health Commercial |
$21.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.49
|
| Rate for Payer: PACE Senior Care Partners |
$6.17
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.09
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.61
|
| Rate for Payer: Priority Health Medicare |
$6.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.09
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.87
|
| Rate for Payer: UHC Core |
$21.70
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicaid |
$4.58
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$4.58
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.49
|
|
|
TERCONAZOLE 0.4 % VAGINAL CREAM
|
Facility
|
IP
|
$87.26
|
|
|
Service Code
|
NDC 51672130406
|
| Hospital Charge Code |
11510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.73 |
| Max. Negotiated Rate |
$78.53 |
| Rate for Payer: Aetna Commercial |
$74.17
|
| Rate for Payer: BCBS Trust/PPO |
$72.07
|
| Rate for Payer: BCN Commercial |
$72.07
|
| Rate for Payer: Cash Price |
$69.81
|
| Rate for Payer: Cofinity Commercial |
$75.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.81
|
| Rate for Payer: Healthscope Commercial |
$78.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.17
|
| Rate for Payer: Nomi Health Commercial |
$71.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.44
|
| Rate for Payer: PHP Commercial |
$74.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.79
|
| Rate for Payer: UHC Core |
$72.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.44
|
|
|
TERCONAZOLE 0.4 % VAGINAL CREAM
|
Facility
|
OP
|
$87.26
|
|
|
Service Code
|
NDC 51672130406
|
| Hospital Charge Code |
11510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$78.53 |
| Rate for Payer: Aetna Commercial |
$74.17
|
| Rate for Payer: Aetna Medicare |
$22.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.27
|
| Rate for Payer: BCBS Complete |
$16.15
|
| Rate for Payer: BCBS MAPPO |
$21.82
|
| Rate for Payer: BCBS Trust/PPO |
$71.74
|
| Rate for Payer: BCN Commercial |
$71.74
|
| Rate for Payer: BCN Medicare Advantage |
$21.82
|
| Rate for Payer: Cash Price |
$69.81
|
| Rate for Payer: Cofinity Commercial |
$75.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.82
|
| Rate for Payer: Healthscope Commercial |
$78.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.44
|
| Rate for Payer: Mclaren Medicaid |
$15.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.91
|
| Rate for Payer: Meridian Medicaid |
$16.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.17
|
| Rate for Payer: Nomi Health Commercial |
$71.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.44
|
| Rate for Payer: PACE Senior Care Partners |
$20.72
|
| Rate for Payer: PACE SWMI |
$21.82
|
| Rate for Payer: PHP Commercial |
$74.17
|
| Rate for Payer: PHP Medicare Advantage |
$21.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.92
|
| Rate for Payer: Priority Health Medicare |
$22.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.73
|
| Rate for Payer: Railroad Medicare Medicare |
$21.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.79
|
| Rate for Payer: UHC Core |
$72.86
|
| Rate for Payer: UHC Exchange |
$21.82
|
| Rate for Payer: UHC Medicaid |
$15.38
|
| Rate for Payer: UHC Medicare Advantage |
$21.82
|
| Rate for Payer: UHCCP Medicaid |
$15.38
|
| Rate for Payer: VA VA |
$21.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.44
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$110.60
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.98 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna Commercial |
$31.15
|
| Rate for Payer: BCBS Trust/PPO |
$91.34
|
| Rate for Payer: BCBS Trust/PPO |
$30.27
|
| Rate for Payer: BCN Commercial |
$91.34
|
| Rate for Payer: BCN Commercial |
$30.27
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cofinity Commercial |
$31.52
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Healthscope Commercial |
$32.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.15
|
| Rate for Payer: Nomi Health Commercial |
$90.69
|
| Rate for Payer: Nomi Health Commercial |
$30.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.49
|
| Rate for Payer: PHP Commercial |
$31.15
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.25
|
| Rate for Payer: UHC Core |
$92.35
|
| Rate for Payer: UHC Core |
$30.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.49
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$110.60
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna Commercial |
$31.15
|
| Rate for Payer: Aetna Medicare |
$9.53
|
| Rate for Payer: Aetna Medicare |
$28.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.45
|
| Rate for Payer: BCBS Complete |
$20.47
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$27.65
|
| Rate for Payer: BCBS MAPPO |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$90.92
|
| Rate for Payer: BCBS Trust/PPO |
$30.13
|
| Rate for Payer: BCN Commercial |
$30.13
|
| Rate for Payer: BCN Commercial |
$90.92
|
| Rate for Payer: BCN Medicare Advantage |
$9.16
|
| Rate for Payer: BCN Medicare Advantage |
$27.65
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Cofinity Commercial |
$31.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.65
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Healthscope Commercial |
$32.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.49
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.03
|
| Rate for Payer: Meridian Medicaid |
$20.47
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: Nomi Health Commercial |
$30.05
|
| Rate for Payer: Nomi Health Commercial |
$90.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.49
|
| Rate for Payer: PACE Senior Care Partners |
$8.70
|
| Rate for Payer: PACE Senior Care Partners |
$26.27
|
| Rate for Payer: PACE SWMI |
$9.16
|
| Rate for Payer: PACE SWMI |
$27.65
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: PHP Commercial |
$31.15
|
| Rate for Payer: PHP Medicare Advantage |
$27.65
|
| Rate for Payer: PHP Medicare Advantage |
$9.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.22
|
| Rate for Payer: Priority Health Medicare |
$9.25
|
| Rate for Payer: Priority Health Medicare |
$27.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.51
|
| Rate for Payer: Railroad Medicare Medicare |
$27.65
|
| Rate for Payer: Railroad Medicare Medicare |
$9.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.25
|
| Rate for Payer: UHC Core |
$30.60
|
| Rate for Payer: UHC Core |
$92.35
|
| Rate for Payer: UHC Exchange |
$9.16
|
| Rate for Payer: UHC Exchange |
$27.65
|
| Rate for Payer: UHC Medicaid |
$6.46
|
| Rate for Payer: UHC Medicaid |
$19.50
|
| Rate for Payer: UHC Medicare Advantage |
$27.65
|
| Rate for Payer: UHC Medicare Advantage |
$9.16
|
| Rate for Payer: UHCCP Medicaid |
$19.50
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$27.65
|
| Rate for Payer: VA VA |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.95
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,694.95
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.82 |
| Max. Negotiated Rate |
$1,525.45 |
| Rate for Payer: Aetna Commercial |
$1,440.71
|
| Rate for Payer: Aetna Medicare |
$440.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$529.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$529.67
|
| Rate for Payer: BCBS Complete |
$313.74
|
| Rate for Payer: BCBS MAPPO |
$423.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.42
|
| Rate for Payer: BCN Commercial |
$1,393.42
|
| Rate for Payer: BCN Medicare Advantage |
$423.74
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cofinity Commercial |
$1,457.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,355.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.74
|
| Rate for Payer: Healthscope Commercial |
$1,525.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,271.21
|
| Rate for Payer: Mclaren Medicaid |
$298.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.92
|
| Rate for Payer: Meridian Medicaid |
$313.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$487.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$466.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,440.71
|
| Rate for Payer: Nomi Health Commercial |
$1,389.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.21
|
| Rate for Payer: PACE Senior Care Partners |
$402.55
|
| Rate for Payer: PACE SWMI |
$423.74
|
| Rate for Payer: PHP Commercial |
$1,440.71
|
| Rate for Payer: PHP Medicare Advantage |
$423.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,474.61
|
| Rate for Payer: Priority Health Medicare |
$427.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,179.69
|
| Rate for Payer: Railroad Medicare Medicare |
$423.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,491.56
|
| Rate for Payer: UHC Core |
$1,415.28
|
| Rate for Payer: UHC Exchange |
$423.74
|
| Rate for Payer: UHC Medicaid |
$298.82
|
| Rate for Payer: UHC Medicare Advantage |
$423.74
|
| Rate for Payer: UHCCP Medicaid |
$298.82
|
| Rate for Payer: VA VA |
$423.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,271.21
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,694.95
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,179.69 |
| Max. Negotiated Rate |
$1,525.45 |
| Rate for Payer: Aetna Commercial |
$1,440.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.86
|
| Rate for Payer: BCN Commercial |
$1,399.86
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cofinity Commercial |
$1,457.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,355.96
|
| Rate for Payer: Healthscope Commercial |
$1,525.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,271.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,440.71
|
| Rate for Payer: Nomi Health Commercial |
$1,389.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.21
|
| Rate for Payer: PHP Commercial |
$1,440.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,474.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,179.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,491.56
|
| Rate for Payer: UHC Core |
$1,415.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,271.21
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
IP
|
$43.07
|
|
|
Service Code
|
NDC 00065074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$38.76 |
| Rate for Payer: Aetna Commercial |
$36.61
|
| Rate for Payer: BCBS Trust/PPO |
$35.57
|
| Rate for Payer: BCN Commercial |
$35.57
|
| Rate for Payer: Cash Price |
$34.46
|
| Rate for Payer: Cofinity Commercial |
$37.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.46
|
| Rate for Payer: Healthscope Commercial |
$38.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.61
|
| Rate for Payer: Nomi Health Commercial |
$35.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.30
|
| Rate for Payer: PHP Commercial |
$36.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.90
|
| Rate for Payer: UHC Core |
$35.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.30
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
OP
|
$43.07
|
|
|
Service Code
|
NDC 00065074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$38.76 |
| Rate for Payer: Aetna Commercial |
$36.61
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.46
|
| Rate for Payer: BCBS Complete |
$7.97
|
| Rate for Payer: BCBS MAPPO |
$10.77
|
| Rate for Payer: BCBS Trust/PPO |
$35.41
|
| Rate for Payer: BCN Commercial |
$35.41
|
| Rate for Payer: BCN Medicare Advantage |
$10.77
|
| Rate for Payer: Cash Price |
$34.46
|
| Rate for Payer: Cofinity Commercial |
$37.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.77
|
| Rate for Payer: Healthscope Commercial |
$38.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.30
|
| Rate for Payer: Mclaren Medicaid |
$7.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.31
|
| Rate for Payer: Meridian Medicaid |
$7.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.61
|
| Rate for Payer: Nomi Health Commercial |
$35.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.30
|
| Rate for Payer: PACE Senior Care Partners |
$10.23
|
| Rate for Payer: PACE SWMI |
$10.77
|
| Rate for Payer: PHP Commercial |
$36.61
|
| Rate for Payer: PHP Medicare Advantage |
$10.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.47
|
| Rate for Payer: Priority Health Medicare |
$10.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.98
|
| Rate for Payer: Railroad Medicare Medicare |
$10.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.90
|
| Rate for Payer: UHC Core |
$35.96
|
| Rate for Payer: UHC Exchange |
$10.77
|
| Rate for Payer: UHC Medicaid |
$7.59
|
| Rate for Payer: UHC Medicare Advantage |
$10.77
|
| Rate for Payer: UHCCP Medicaid |
$7.59
|
| Rate for Payer: VA VA |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.30
|
|
|
THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$436.32
|
|
|
Service Code
|
NDC 62332002531
|
| Hospital Charge Code |
12098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.68 |
| Max. Negotiated Rate |
$392.69 |
| Rate for Payer: Aetna Commercial |
$370.87
|
| Rate for Payer: BCBS Trust/PPO |
$360.36
|
| Rate for Payer: BCN Commercial |
$360.36
|
| Rate for Payer: Cash Price |
$349.06
|
| Rate for Payer: Cofinity Commercial |
$375.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.06
|
| Rate for Payer: Healthscope Commercial |
$392.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.87
|
| Rate for Payer: Nomi Health Commercial |
$357.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.24
|
| Rate for Payer: PHP Commercial |
$370.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$379.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$303.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.96
|
| Rate for Payer: UHC Core |
$364.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.24
|
|
|
THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$436.32
|
|
|
Service Code
|
NDC 62332002531
|
| Hospital Charge Code |
12098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$392.69 |
| Rate for Payer: Aetna Commercial |
$370.87
|
| Rate for Payer: Aetna Medicare |
$113.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.35
|
| Rate for Payer: BCBS Complete |
$80.76
|
| Rate for Payer: BCBS MAPPO |
$109.08
|
| Rate for Payer: BCBS Trust/PPO |
$358.70
|
| Rate for Payer: BCN Commercial |
$358.70
|
| Rate for Payer: BCN Medicare Advantage |
$109.08
|
| Rate for Payer: Cash Price |
$349.06
|
| Rate for Payer: Cofinity Commercial |
$375.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.08
|
| Rate for Payer: Healthscope Commercial |
$392.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.24
|
| Rate for Payer: Mclaren Medicaid |
$76.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.53
|
| Rate for Payer: Meridian Medicaid |
$80.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$119.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.87
|
| Rate for Payer: Nomi Health Commercial |
$357.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.24
|
| Rate for Payer: PACE Senior Care Partners |
$103.63
|
| Rate for Payer: PACE SWMI |
$109.08
|
| Rate for Payer: PHP Commercial |
$370.87
|
| Rate for Payer: PHP Medicare Advantage |
$109.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$379.60
|
| Rate for Payer: Priority Health Medicare |
$110.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$303.68
|
| Rate for Payer: Railroad Medicare Medicare |
$109.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.96
|
| Rate for Payer: UHC Core |
$364.33
|
| Rate for Payer: UHC Exchange |
$109.08
|
| Rate for Payer: UHC Medicaid |
$76.92
|
| Rate for Payer: UHC Medicare Advantage |
$109.08
|
| Rate for Payer: UHCCP Medicaid |
$76.92
|
| Rate for Payer: VA VA |
$109.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.24
|
|
|
THERAPEUTIC MULTIVITAMIN TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 00904053961
|
| Hospital Charge Code |
7857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.01 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: BCBS Trust/PPO |
$122.23
|
| Rate for Payer: BCN Commercial |
$122.23
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
THERAPEUTIC MULTIVITAMIN TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 00904053961
|
| Hospital Charge Code |
7857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$38.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.25
|
| Rate for Payer: BCBS Complete |
$27.39
|
| Rate for Payer: BCBS MAPPO |
$37.00
|
| Rate for Payer: BCBS Trust/PPO |
$121.67
|
| Rate for Payer: BCN Commercial |
$121.67
|
| Rate for Payer: BCN Medicare Advantage |
$37.00
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.00
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Mclaren Medicaid |
$26.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.85
|
| Rate for Payer: Meridian Medicaid |
$27.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PACE Senior Care Partners |
$35.15
|
| Rate for Payer: PACE SWMI |
$37.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: PHP Medicare Advantage |
$37.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.76
|
| Rate for Payer: Priority Health Medicare |
$37.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.01
|
| Rate for Payer: Railroad Medicare Medicare |
$37.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicaid |
$26.09
|
| Rate for Payer: UHC Medicare Advantage |
$37.00
|
| Rate for Payer: UHCCP Medicaid |
$26.09
|
| Rate for Payer: VA VA |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
THERMAGE
|
Professional
|
Both
|
$1,051.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$420.40 |
| Max. Negotiated Rate |
$788.25 |
| Rate for Payer: Aetna Medicare |
$525.50
|
| Rate for Payer: BCBS Complete |
$420.40
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.25
|
|
|
THERMAGE ABDOMEN - ENTIRE
|
Professional
|
Both
|
$3,257.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,302.80 |
| Max. Negotiated Rate |
$2,442.75 |
| Rate for Payer: Aetna Medicare |
$1,628.50
|
| Rate for Payer: BCBS Complete |
$1,302.80
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
|
|
THERMAGE ABDOMEN - LOWER
|
Professional
|
Both
|
$2,101.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: Aetna Medicare |
$1,050.50
|
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
|
|
THERMAGE ARMS - 1 ARM
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
|
|
THERMAGE ARMS - BILATERAL
|
Professional
|
Both
|
$2,206.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$882.40 |
| Max. Negotiated Rate |
$1,654.50 |
| Rate for Payer: Aetna Medicare |
$1,103.00
|
| Rate for Payer: BCBS Complete |
$882.40
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,654.50
|
|
|
THERMAGE EYES
|
Professional
|
Both
|
$998.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$399.20 |
| Max. Negotiated Rate |
$748.50 |
| Rate for Payer: Aetna Medicare |
$499.00
|
| Rate for Payer: BCBS Complete |
$399.20
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$748.50
|
|
|
THERMAGE FACE
|
Professional
|
Both
|
$2,101.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: Aetna Medicare |
$1,050.50
|
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
|
|
THERMAGE FACE & EYES
|
Professional
|
Both
|
$2,837.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,134.80 |
| Max. Negotiated Rate |
$2,127.75 |
| Rate for Payer: Aetna Medicare |
$1,418.50
|
| Rate for Payer: BCBS Complete |
$1,134.80
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.75
|
|
