|
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); LESS THAN 10 SQ CM
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 17106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$546.92
|
| Rate for Payer: BCN Commercial |
$546.92
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO OR CHEMICAL)
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.17 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$262.17
|
| Rate for Payer: BCN Commercial |
$262.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,494.45
|
| Rate for Payer: BCN Commercial |
$3,494.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$2,765.68
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 46910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.00 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$292.00
|
| Rate for Payer: BCN Commercial |
$292.00
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,892.83
|
| Rate for Payer: BCN Commercial |
$1,892.83
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$2,765.68
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,907.57
|
| Rate for Payer: BCN Commercial |
$2,907.57
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$2,765.68
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 54055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.58 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$113.58
|
| Rate for Payer: BCN Commercial |
$113.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 54057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.74
|
| Rate for Payer: BCN Commercial |
$1,693.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 54060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.76
|
| Rate for Payer: BCN Commercial |
$2,264.76
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 56515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,534.69
|
| Rate for Payer: BCN Commercial |
$3,534.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
DESTRUCTION OF LESION(S), VULVA; SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 56501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,338.54
|
| Rate for Payer: BCN Commercial |
$2,338.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
DESTRUCTION OF RECTAL TUMOR (EG, ELECTRODESICCATION, ELECTROSURGERY, LASER ABLATION, LASER RESECTION, CRYOSURGERY) TRANSANAL APPROACH
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 45190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,445.64
|
| Rate for Payer: BCN Commercial |
$2,445.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$2,765.68
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
DESTRUCTION OF VAGINAL LESION(S); SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$100.42
|
| Rate for Payer: BCN Commercial |
$100.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$73.30
|
|
|
Service Code
|
NDC 51991000633
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$65.97 |
| Rate for Payer: Aetna American Axle |
$47.65
|
| Rate for Payer: Aetna Commercial |
$62.30
|
| Rate for Payer: Aetna Medicare |
$36.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.65
|
| Rate for Payer: BCBS Complete |
$29.32
|
| Rate for Payer: Cash Price |
$58.64
|
| Rate for Payer: Cofinity Advantage |
$51.31
|
| Rate for Payer: Cofinity Commercial |
$63.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.64
|
| Rate for Payer: Healthscope Commercial |
$65.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.98
|
| Rate for Payer: PHP Commercial |
$62.30
|
| Rate for Payer: Priority Health SBD |
$46.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.65
|
| Rate for Payer: UHC Core |
$38.19
|
| Rate for Payer: UHC Exchange |
$28.81
|
| Rate for Payer: UMR Bronson Commercial |
$27.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.98
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$73.30
|
|
|
Service Code
|
NDC 51991000633
|
| Hospital Charge Code |
163481
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$65.97 |
| Rate for Payer: Aetna American Axle |
$47.65
|
| Rate for Payer: Aetna Commercial |
$62.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.65
|
| Rate for Payer: Cash Price |
$58.64
|
| Rate for Payer: Cofinity Advantage |
$51.31
|
| Rate for Payer: Cofinity Commercial |
$63.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.64
|
| Rate for Payer: Healthscope Commercial |
$65.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.98
|
| Rate for Payer: PHP Commercial |
$62.30
|
| Rate for Payer: Priority Health SBD |
$46.18
|
| Rate for Payer: UMR Bronson Commercial |
$32.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.98
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$240.63
|
|
|
Service Code
|
NDC 51991031190
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.88 |
| Max. Negotiated Rate |
$216.57 |
| Rate for Payer: Aetna American Axle |
$156.41
|
| Rate for Payer: Aetna Commercial |
$204.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.41
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cofinity Advantage |
$168.44
|
| Rate for Payer: Cofinity Commercial |
$206.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.50
|
| Rate for Payer: Healthscope Commercial |
$216.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.47
|
| Rate for Payer: PHP Commercial |
$204.54
|
| Rate for Payer: Priority Health SBD |
$151.60
|
| Rate for Payer: UMR Bronson Commercial |
$105.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.47
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,507.05
|
|
|
Service Code
|
NDC 00008121130
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$663.10 |
| Max. Negotiated Rate |
$1,356.35 |
| Rate for Payer: Aetna American Axle |
$979.58
|
| Rate for Payer: Aetna Commercial |
$1,280.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.58
|
| Rate for Payer: Cash Price |
$1,205.64
|
| Rate for Payer: Cofinity Advantage |
$1,054.93
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,054.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,130.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.29
|
| Rate for Payer: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health SBD |
$949.44
|
| Rate for Payer: UMR Bronson Commercial |
$663.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,130.29
|
|
|
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 |
$557.61 |
| Max. Negotiated Rate |
$1,356.35 |
| Rate for Payer: Aetna American Axle |
$979.58
|
| Rate for Payer: Aetna Commercial |
$1,280.99
|
| Rate for Payer: Aetna Medicare |
$753.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.58
|
| Rate for Payer: BCBS Complete |
$602.82
|
| Rate for Payer: Cash Price |
$1,205.64
|
| Rate for Payer: Cofinity Advantage |
$1,054.93
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,054.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,130.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,205.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.29
|
| Rate for Payer: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health SBD |
$949.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.58
|
| Rate for Payer: UHC Core |
$785.17
|
| Rate for Payer: UHC Exchange |
$592.27
|
| Rate for Payer: UMR Bronson Commercial |
$557.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,130.29
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$373.64
|
|
|
Service Code
|
NDC 72888014390
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$336.28 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.59
|
| Rate for Payer: Aetna Medicare |
$186.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: Cash Price |
$298.91
|
| Rate for Payer: Cofinity Advantage |
$261.55
|
| Rate for Payer: Cofinity Commercial |
$321.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.91
|
| Rate for Payer: Healthscope Commercial |
$336.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.23
|
| Rate for Payer: PHP Commercial |
$317.59
|
| Rate for Payer: Priority Health SBD |
$235.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.87
|
| Rate for Payer: UHC Core |
$194.67
|
| Rate for Payer: UHC Exchange |
$146.84
|
| Rate for Payer: UMR Bronson Commercial |
$138.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.23
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,521.15
|
|
|
Service Code
|
NDC 00008121101
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,989.31 |
| Max. Negotiated Rate |
$4,069.03 |
| Rate for Payer: Aetna American Axle |
$2,938.75
|
| Rate for Payer: Aetna Commercial |
$3,842.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,938.75
|
| Rate for Payer: Cash Price |
$3,616.92
|
| Rate for Payer: Cofinity Advantage |
$3,164.80
|
| Rate for Payer: Cofinity Commercial |
$3,888.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,616.92
|
| Rate for Payer: Healthscope Commercial |
$4,069.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,164.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,390.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,842.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,390.86
|
| Rate for Payer: PHP Commercial |
$3,842.98
|
| Rate for Payer: Priority Health SBD |
$2,848.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,989.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,390.86
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$87.56
|
|
|
Service Code
|
NDC 68180059206
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna American Axle |
$56.91
|
| Rate for Payer: Aetna Commercial |
$74.43
|
| Rate for Payer: Aetna Medicare |
$43.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.91
|
| Rate for Payer: BCBS Complete |
$35.02
|
| Rate for Payer: Cash Price |
$70.05
|
| Rate for Payer: Cofinity Advantage |
$61.29
|
| Rate for Payer: Cofinity Commercial |
$75.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.05
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.67
|
| Rate for Payer: PHP Commercial |
$74.43
|
| Rate for Payer: Priority Health SBD |
$55.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.91
|
| Rate for Payer: UHC Core |
$45.62
|
| Rate for Payer: UHC Exchange |
$34.41
|
| Rate for Payer: UMR Bronson Commercial |
$32.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.67
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4,521.15
|
|
|
Service Code
|
NDC 00008121101
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,672.83 |
| Max. Negotiated Rate |
$4,069.03 |
| Rate for Payer: Aetna American Axle |
$2,938.75
|
| Rate for Payer: Aetna Commercial |
$3,842.98
|
| Rate for Payer: Aetna Medicare |
$2,260.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,938.75
|
| Rate for Payer: BCBS Complete |
$1,808.46
|
| Rate for Payer: Cash Price |
$3,616.92
|
| Rate for Payer: Cofinity Advantage |
$3,164.80
|
| Rate for Payer: Cofinity Commercial |
$3,888.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,616.92
|
| Rate for Payer: Healthscope Commercial |
$4,069.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,164.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,390.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,616.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,842.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,390.86
|
| Rate for Payer: PHP Commercial |
$3,842.98
|
| Rate for Payer: Priority Health SBD |
$2,848.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,938.75
|
| Rate for Payer: UHC Core |
$2,355.52
|
| Rate for Payer: UHC Exchange |
$1,776.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,672.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,390.86
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$373.64
|
|
|
Service Code
|
NDC 72888014390
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$336.28 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: Cash Price |
$298.91
|
| Rate for Payer: Cofinity Advantage |
$261.55
|
| Rate for Payer: Cofinity Commercial |
$321.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.91
|
| Rate for Payer: Healthscope Commercial |
$336.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.23
|
| Rate for Payer: PHP Commercial |
$317.59
|
| Rate for Payer: Priority Health SBD |
$235.39
|
| Rate for Payer: UMR Bronson Commercial |
$164.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.23
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$240.63
|
|
|
Service Code
|
NDC 51991031190
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$216.57 |
| Rate for Payer: Aetna American Axle |
$156.41
|
| Rate for Payer: Aetna Commercial |
$204.54
|
| Rate for Payer: Aetna Medicare |
$120.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.41
|
| Rate for Payer: BCBS Complete |
$96.25
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cofinity Advantage |
$168.44
|
| Rate for Payer: Cofinity Commercial |
$206.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.50
|
| Rate for Payer: Healthscope Commercial |
$216.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.47
|
| Rate for Payer: PHP Commercial |
$204.54
|
| Rate for Payer: Priority Health SBD |
$151.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.41
|
| Rate for Payer: UHC Core |
$125.37
|
| Rate for Payer: UHC Exchange |
$94.57
|
| Rate for Payer: UMR Bronson Commercial |
$89.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.47
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$87.56
|
|
|
Service Code
|
NDC 68180059206
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna American Axle |
$56.91
|
| Rate for Payer: Aetna Commercial |
$74.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.91
|
| Rate for Payer: Cash Price |
$70.05
|
| Rate for Payer: Cofinity Advantage |
$61.29
|
| Rate for Payer: Cofinity Commercial |
$75.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.05
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.67
|
| Rate for Payer: PHP Commercial |
$74.43
|
| Rate for Payer: Priority Health SBD |
$55.16
|
| Rate for Payer: UMR Bronson Commercial |
$38.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.67
|
|
