|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$3,035.62
|
|
|
Service Code
|
APR-DRG 1381
|
| Min. Negotiated Rate |
$2,891.07 |
| Max. Negotiated Rate |
$3,035.62 |
| Rate for Payer: BCBS Complete |
$3,035.62
|
| Rate for Payer: Mclaren Medicaid |
$2,891.07
|
| Rate for Payer: Meridian Medicaid |
$3,035.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,891.07
|
| Rate for Payer: UHC Medicaid |
$2,891.07
|
| Rate for Payer: UHCCP Medicaid |
$2,891.07
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$6,883.61
|
|
|
Service Code
|
APR-DRG 1383
|
| Min. Negotiated Rate |
$6,555.82 |
| Max. Negotiated Rate |
$6,883.61 |
| Rate for Payer: BCBS Complete |
$6,883.61
|
| Rate for Payer: Mclaren Medicaid |
$6,555.82
|
| Rate for Payer: Meridian Medicaid |
$6,883.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,555.82
|
| Rate for Payer: UHC Medicaid |
$6,555.82
|
| Rate for Payer: UHCCP Medicaid |
$6,555.82
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$9,094.26
|
|
|
Service Code
|
APR-DRG 1384
|
| Min. Negotiated Rate |
$8,661.20 |
| Max. Negotiated Rate |
$9,094.26 |
| Rate for Payer: BCBS Complete |
$9,094.26
|
| Rate for Payer: Mclaren Medicaid |
$8,661.20
|
| Rate for Payer: Meridian Medicaid |
$9,094.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,661.20
|
| Rate for Payer: UHC Medicaid |
$8,661.20
|
| Rate for Payer: UHCCP Medicaid |
$8,661.20
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$15,830.56
|
|
|
Service Code
|
MSDRG 202
|
| Min. Negotiated Rate |
$7,680.42 |
| Max. Negotiated Rate |
$15,830.56 |
| Rate for Payer: Aetna Medicare |
$8,408.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,105.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,105.81
|
| Rate for Payer: BCBS MAPPO |
$8,084.65
|
| Rate for Payer: BCBS Trust/PPO |
$11,608.03
|
| Rate for Payer: BCN Commercial |
$11,608.03
|
| Rate for Payer: BCN Medicare Advantage |
$8,084.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,084.65
|
| Rate for Payer: Mclaren Medicare |
$8,084.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,488.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,297.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,893.11
|
| Rate for Payer: Nomi Health Commercial |
$12,528.48
|
| Rate for Payer: PACE Medicare |
$7,680.42
|
| Rate for Payer: PACE SWMI |
$8,084.65
|
| Rate for Payer: PHP Medicare Advantage |
$8,084.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,657.82
|
| Rate for Payer: Priority Health Medicare |
$8,084.65
|
| Rate for Payer: Priority Health Tiered Network |
$12,526.26
|
| Rate for Payer: Railroad Medicare Medicare |
$8,084.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,830.56
|
| Rate for Payer: UHC Core |
$13,244.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,084.65
|
| Rate for Payer: UHC Exchange |
$10,816.25
|
| Rate for Payer: VA VA |
$8,084.65
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$10,921.00
|
|
|
Service Code
|
MSDRG 203
|
| Min. Negotiated Rate |
$5,469.07 |
| Max. Negotiated Rate |
$10,921.00 |
| Rate for Payer: Aetna Medicare |
$5,987.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,196.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,196.15
|
| Rate for Payer: BCBS MAPPO |
$5,756.92
|
| Rate for Payer: BCBS Trust/PPO |
$6,366.98
|
| Rate for Payer: BCN Commercial |
$6,366.98
|
| Rate for Payer: BCN Medicare Advantage |
$5,756.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,756.92
|
| Rate for Payer: Mclaren Medicare |
$5,756.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,044.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,620.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,332.61
|
| Rate for Payer: Nomi Health Commercial |
$8,643.00
|
| Rate for Payer: PACE Medicare |
$5,469.07
|
| Rate for Payer: PACE SWMI |
$5,756.92
|
| Rate for Payer: PHP Medicare Advantage |
$5,756.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,801.83
|
| Rate for Payer: Priority Health Medicare |
$5,756.92
|
| Rate for Payer: Priority Health Tiered Network |
$8,641.47
|
| Rate for Payer: Railroad Medicare Medicare |
$5,756.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,921.00
|
| Rate for Payer: UHC Core |
$9,136.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,756.92
|
| Rate for Payer: UHC Exchange |
$7,461.79
|
| Rate for Payer: VA VA |
$5,756.92
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,281.21
|
| Rate for Payer: BCN Commercial |
$1,281.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$927.54
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.74
|
| Rate for Payer: BCN Commercial |
$1,193.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$927.54
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), 3 OR MORE MEDIASTINAL AND/OR HILAR LYMPH NODE STATIONS OR STRUCTURES
|
Facility
|
OP
|
$12,013.78
|
|
|
Service Code
|
CPT 31653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,254.27
|
| Rate for Payer: BCN Commercial |
$2,254.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$1,942.91
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), ONE OR TWO MEDIASTINAL AND/OR HILAR LYMPH NODE STATIONS OR STRUCTURES
|
Facility
|
OP
|
$12,013.78
|
|
|
Service Code
|
CPT 31652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,000.29
|
| Rate for Payer: BCN Commercial |
$2,000.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$1,942.91
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$31.41
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$28.27 |
| Rate for Payer: Aetna Commercial |
$26.70
|
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Aetna Medicare |
$15.71
|
| Rate for Payer: Aetna Medicare |
$12.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: BCBS Complete |
$12.56
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: BCBS Complete |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cofinity Advantage |
$21.99
|
| Rate for Payer: Cofinity Advantage |
$18.14
|
| Rate for Payer: Cofinity Advantage |
$6.69
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$27.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.17
|
| Rate for Payer: PHP Commercial |
$22.03
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: PHP Commercial |
$26.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: Priority Health SBD |
$16.33
|
| Rate for Payer: Priority Health SBD |
$19.79
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.85
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Core |
$16.36
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Exchange |
$12.34
|
| Rate for Payer: UHC Exchange |
$10.19
|
| Rate for Payer: UHC Exchange |
$3.76
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$31.41
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$28.27 |
| Rate for Payer: Aetna Commercial |
$26.70
|
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.85
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cofinity Advantage |
$6.69
|
| Rate for Payer: Cofinity Advantage |
$18.14
|
| Rate for Payer: Cofinity Advantage |
$21.99
|
| Rate for Payer: Cofinity Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.13
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Commercial |
$28.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.56
|
| Rate for Payer: PHP Commercial |
$22.03
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: PHP Commercial |
$26.70
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: Priority Health SBD |
$19.79
|
| Rate for Payer: Priority Health SBD |
$16.33
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$36.98
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Aetna Commercial |
$10.43
|
| Rate for Payer: Aetna Commercial |
$25.93
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Aetna Medicare |
$7.41
|
| Rate for Payer: Aetna Medicare |
$6.13
|
| Rate for Payer: Aetna Medicare |
$18.49
|
| Rate for Payer: Aetna Medicare |
$15.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.83
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS Complete |
$4.91
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS Complete |
$14.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cofinity Advantage |
$10.37
|
| Rate for Payer: Cofinity Advantage |
$8.59
|
| Rate for Payer: Cofinity Advantage |
$7.19
|
| Rate for Payer: Cofinity Advantage |
$25.89
|
| Rate for Payer: Cofinity Advantage |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Commercial |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$10.55
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$11.04
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$13.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.73
|
| Rate for Payer: PHP Commercial |
$12.59
|
| Rate for Payer: PHP Commercial |
$10.43
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health SBD |
$6.47
|
| Rate for Payer: Priority Health SBD |
$7.73
|
| Rate for Payer: Priority Health SBD |
$9.33
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: Priority Health SBD |
$19.22
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.83
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: UHC Core |
$19.27
|
| Rate for Payer: UHC Core |
$6.39
|
| Rate for Payer: UHC Core |
$7.72
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Exchange |
$4.82
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UHC Exchange |
$11.99
|
| Rate for Payer: UHC Exchange |
$14.53
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$36.98
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Commercial |
$10.43
|
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Aetna Commercial |
$25.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cofinity Advantage |
$21.36
|
| Rate for Payer: Cofinity Advantage |
$10.37
|
| Rate for Payer: Cofinity Advantage |
$25.89
|
| Rate for Payer: Cofinity Advantage |
$7.19
|
| Rate for Payer: Cofinity Advantage |
$8.59
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$10.55
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Healthscope Commercial |
$13.33
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$11.04
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.73
|
| Rate for Payer: PHP Commercial |
$8.73
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$10.43
|
| Rate for Payer: PHP Commercial |
$12.59
|
| Rate for Payer: Priority Health SBD |
$19.22
|
| Rate for Payer: Priority Health SBD |
$9.33
|
| Rate for Payer: Priority Health SBD |
$7.73
|
| Rate for Payer: Priority Health SBD |
$6.47
|
| Rate for Payer: Priority Health SBD |
$23.30
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
OP
|
$50.05
|
|
|
Service Code
|
NDC 60687059633
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: Aetna Commercial |
$42.54
|
| Rate for Payer: Aetna Medicare |
$25.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.53
|
| Rate for Payer: BCBS Complete |
$20.02
|
| Rate for Payer: Cash Price |
$40.04
|
| Rate for Payer: Cofinity Advantage |
$35.03
|
| Rate for Payer: Cofinity Commercial |
$43.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.04
|
| Rate for Payer: Healthscope Commercial |
$45.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.54
|
| Rate for Payer: PHP Commercial |
$42.54
|
| Rate for Payer: Priority Health SBD |
$31.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.53
|
| Rate for Payer: UHC Core |
$26.08
|
| Rate for Payer: UHC Exchange |
$19.67
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$1,000.85
|
|
|
Service Code
|
NDC 60687059632
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$630.54 |
| Max. Negotiated Rate |
$900.76 |
| Rate for Payer: Aetna Commercial |
$850.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.55
|
| Rate for Payer: Cash Price |
$800.68
|
| Rate for Payer: Cofinity Advantage |
$700.60
|
| Rate for Payer: Cofinity Commercial |
$860.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.68
|
| Rate for Payer: Healthscope Commercial |
$900.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.64
|
| Rate for Payer: PHP Commercial |
$850.72
|
| Rate for Payer: Priority Health SBD |
$630.54
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$50.05
|
|
|
Service Code
|
NDC 60687059633
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.53 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: Aetna Commercial |
$42.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.53
|
| Rate for Payer: Cash Price |
$40.04
|
| Rate for Payer: Cofinity Advantage |
$35.03
|
| Rate for Payer: Cofinity Commercial |
$43.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.04
|
| Rate for Payer: Healthscope Commercial |
$45.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.54
|
| Rate for Payer: PHP Commercial |
$42.54
|
| Rate for Payer: Priority Health SBD |
$31.53
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
OP
|
$1,000.85
|
|
|
Service Code
|
NDC 60687059632
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.33 |
| Max. Negotiated Rate |
$900.76 |
| Rate for Payer: Aetna Commercial |
$850.72
|
| Rate for Payer: Aetna Medicare |
$500.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.55
|
| Rate for Payer: BCBS Complete |
$400.34
|
| Rate for Payer: Cash Price |
$800.68
|
| Rate for Payer: Cofinity Advantage |
$700.60
|
| Rate for Payer: Cofinity Commercial |
$860.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.68
|
| Rate for Payer: Healthscope Commercial |
$900.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$800.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.64
|
| Rate for Payer: PHP Commercial |
$850.72
|
| Rate for Payer: Priority Health SBD |
$630.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$650.55
|
| Rate for Payer: UHC Core |
$521.44
|
| Rate for Payer: UHC Exchange |
$393.33
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$317.76
|
|
|
Service Code
|
NDC 65162077810
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.19 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.54
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Advantage |
$222.43
|
| Rate for Payer: Cofinity Commercial |
$273.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$285.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: Priority Health SBD |
$200.19
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
OP
|
$317.76
|
|
|
Service Code
|
NDC 65162077810
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.88 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Aetna Medicare |
$158.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.54
|
| Rate for Payer: BCBS Complete |
$127.10
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Advantage |
$222.43
|
| Rate for Payer: Cofinity Commercial |
$273.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$285.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: Priority Health SBD |
$200.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.54
|
| Rate for Payer: UHC Core |
$165.55
|
| Rate for Payer: UHC Exchange |
$124.88
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$96.60
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
300057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$82.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.79
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Cofinity Advantage |
$67.62
|
| Rate for Payer: Cofinity Commercial |
$83.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.28
|
| Rate for Payer: Healthscope Commercial |
$86.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.45
|
| Rate for Payer: PHP Commercial |
$82.11
|
| Rate for Payer: Priority Health SBD |
$60.86
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$96.60
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
300057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$82.11
|
| Rate for Payer: Aetna Medicare |
$48.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.79
|
| Rate for Payer: BCBS Complete |
$38.64
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Cofinity Advantage |
$67.62
|
| Rate for Payer: Cofinity Commercial |
$83.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.28
|
| Rate for Payer: Healthscope Commercial |
$86.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.45
|
| Rate for Payer: PHP Commercial |
$82.11
|
| Rate for Payer: Priority Health SBD |
$60.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.79
|
| Rate for Payer: UHC Core |
$50.33
|
| Rate for Payer: UHC Exchange |
$37.96
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$96.60
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$82.11
|
| Rate for Payer: Aetna Medicare |
$48.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.79
|
| Rate for Payer: BCBS Complete |
$38.64
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Cofinity Advantage |
$67.62
|
| Rate for Payer: Cofinity Commercial |
$83.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.28
|
| Rate for Payer: Healthscope Commercial |
$86.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.45
|
| Rate for Payer: PHP Commercial |
$82.11
|
| Rate for Payer: Priority Health SBD |
$60.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.79
|
| Rate for Payer: UHC Core |
$50.33
|
| Rate for Payer: UHC Exchange |
$37.96
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$96.60
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$82.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.79
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Cofinity Advantage |
$67.62
|
| Rate for Payer: Cofinity Commercial |
$83.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.28
|
| Rate for Payer: Healthscope Commercial |
$86.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.45
|
| Rate for Payer: PHP Commercial |
$82.11
|
| Rate for Payer: Priority Health SBD |
$60.86
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$193.41
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
300059
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.85 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Aetna Commercial |
$164.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.72
|
| Rate for Payer: Cash Price |
$154.73
|
| Rate for Payer: Cofinity Advantage |
$135.39
|
| Rate for Payer: Cofinity Commercial |
$166.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.73
|
| Rate for Payer: Healthscope Commercial |
$174.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.06
|
| Rate for Payer: PHP Commercial |
$164.40
|
| Rate for Payer: Priority Health SBD |
$121.85
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$193.41
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
300059
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.01 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Aetna Commercial |
$164.40
|
| Rate for Payer: Aetna Medicare |
$96.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.72
|
| Rate for Payer: BCBS Complete |
$77.36
|
| Rate for Payer: Cash Price |
$154.73
|
| Rate for Payer: Cofinity Advantage |
$135.39
|
| Rate for Payer: Cofinity Commercial |
$166.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.73
|
| Rate for Payer: Healthscope Commercial |
$174.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.06
|
| Rate for Payer: PHP Commercial |
$164.40
|
| Rate for Payer: Priority Health SBD |
$121.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.72
|
| Rate for Payer: UHC Core |
$100.77
|
| Rate for Payer: UHC Exchange |
$76.01
|
|
