|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$499.17
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.67 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna Medicare |
$249.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: BCBS Complete |
$199.67
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.29
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.46
|
| Rate for Payer: Priority Health SBD |
$314.48
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$349.37
|
|
|
Service Code
|
NDC 82182077305
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$314.43 |
| Rate for Payer: Aetna Commercial |
$296.96
|
| Rate for Payer: Aetna Medicare |
$174.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.09
|
| Rate for Payer: BCBS Complete |
$139.75
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cofinity Commercial |
$244.56
|
| Rate for Payer: Cofinity Commercial |
$300.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$244.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.50
|
| Rate for Payer: Healthscope Commercial |
$314.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.96
|
| Rate for Payer: PHP Commercial |
$296.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.09
|
| Rate for Payer: Priority Health SBD |
$220.10
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$349.37
|
|
|
Service Code
|
NDC 82182077305
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.10 |
| Max. Negotiated Rate |
$314.43 |
| Rate for Payer: Aetna Commercial |
$296.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.09
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cofinity Commercial |
$244.56
|
| Rate for Payer: Cofinity Commercial |
$300.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$244.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.50
|
| Rate for Payer: Healthscope Commercial |
$314.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.96
|
| Rate for Payer: PHP Commercial |
$296.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.09
|
| Rate for Payer: Priority Health SBD |
$220.10
|
|
|
BRIVARACETAM 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$5,068.26
|
|
|
Service Code
|
NDC 50474087015
|
| Hospital Charge Code |
178914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,027.30 |
| Max. Negotiated Rate |
$4,561.43 |
| Rate for Payer: Aetna Commercial |
$4,308.02
|
| Rate for Payer: Aetna Medicare |
$2,534.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,294.37
|
| Rate for Payer: BCBS Complete |
$2,027.30
|
| Rate for Payer: Cash Price |
$4,054.61
|
| Rate for Payer: Cofinity Commercial |
$3,547.78
|
| Rate for Payer: Cofinity Commercial |
$4,358.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,547.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,054.61
|
| Rate for Payer: Healthscope Commercial |
$4,561.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,308.02
|
| Rate for Payer: PHP Commercial |
$4,308.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,294.37
|
| Rate for Payer: Priority Health SBD |
$3,193.00
|
|
|
BRIVARACETAM 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$5,068.26
|
|
|
Service Code
|
NDC 50474087015
|
| Hospital Charge Code |
178914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,193.00 |
| Max. Negotiated Rate |
$4,561.43 |
| Rate for Payer: Aetna Commercial |
$4,308.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,294.37
|
| Rate for Payer: Cash Price |
$4,054.61
|
| Rate for Payer: Cofinity Commercial |
$3,547.78
|
| Rate for Payer: Cofinity Commercial |
$4,358.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,547.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,054.61
|
| Rate for Payer: Healthscope Commercial |
$4,561.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,308.02
|
| Rate for Payer: PHP Commercial |
$4,308.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,294.37
|
| Rate for Payer: Priority Health SBD |
$3,193.00
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$636.48
|
|
|
Service Code
|
NDC 60687028621
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$400.98 |
| Max. Negotiated Rate |
$572.83 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.71
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Cofinity Commercial |
$445.54
|
| Rate for Payer: Cofinity Commercial |
$547.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.18
|
| Rate for Payer: Healthscope Commercial |
$572.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.01
|
| Rate for Payer: PHP Commercial |
$541.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.71
|
| Rate for Payer: Priority Health SBD |
$400.98
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$202.76
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.74 |
| Max. Negotiated Rate |
$182.48 |
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.79
|
| Rate for Payer: Cash Price |
$162.21
|
| Rate for Payer: Cofinity Commercial |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.21
|
| Rate for Payer: Healthscope Commercial |
$182.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.79
|
| Rate for Payer: Priority Health SBD |
$127.74
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
NDC 60687028611
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$636.48
|
|
|
Service Code
|
NDC 60687028621
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.59 |
| Max. Negotiated Rate |
$572.83 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Medicare |
$318.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.71
|
| Rate for Payer: BCBS Complete |
$254.59
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Cofinity Commercial |
$445.54
|
| Rate for Payer: Cofinity Commercial |
$547.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.18
|
| Rate for Payer: Healthscope Commercial |
$572.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.01
|
| Rate for Payer: PHP Commercial |
$541.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.71
|
| Rate for Payer: Priority Health SBD |
$400.98
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$202.76
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.10 |
| Max. Negotiated Rate |
$182.48 |
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna Medicare |
$101.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.79
|
| Rate for Payer: BCBS Complete |
$81.10
|
| Rate for Payer: Cash Price |
$162.21
|
| Rate for Payer: Cofinity Commercial |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.21
|
| Rate for Payer: Healthscope Commercial |
$182.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.79
|
| Rate for Payer: Priority Health SBD |
$127.74
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
NDC 60687028611
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
BROMPHENIRAMINE-PSEUDOEPHEDRINE 1 MG-15 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$644.70
|
|
|
Service Code
|
NDC 00485020616
|
| Hospital Charge Code |
29801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$406.16 |
| Max. Negotiated Rate |
$580.23 |
| Rate for Payer: Aetna Commercial |
$548.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.06
|
| Rate for Payer: Cash Price |
$515.76
|
| Rate for Payer: Cofinity Commercial |
$451.29
|
| Rate for Payer: Cofinity Commercial |
$554.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$451.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.76
|
| Rate for Payer: Healthscope Commercial |
$580.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.00
|
| Rate for Payer: PHP Commercial |
$548.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.06
|
| Rate for Payer: Priority Health SBD |
$406.16
|
|
|
BROMPHENIRAMINE-PSEUDOEPHEDRINE 1 MG-15 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$644.70
|
|
|
Service Code
|
NDC 00485020616
|
| Hospital Charge Code |
29801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.88 |
| Max. Negotiated Rate |
$580.23 |
| Rate for Payer: Aetna Commercial |
$548.00
|
| Rate for Payer: Aetna Medicare |
$322.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.06
|
| Rate for Payer: BCBS Complete |
$257.88
|
| Rate for Payer: Cash Price |
$515.76
|
| Rate for Payer: Cofinity Commercial |
$451.29
|
| Rate for Payer: Cofinity Commercial |
$554.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$451.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.76
|
| Rate for Payer: Healthscope Commercial |
$580.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.00
|
| Rate for Payer: PHP Commercial |
$548.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.06
|
| Rate for Payer: Priority Health SBD |
$406.16
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31622
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.01 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.33
|
| Rate for Payer: BCN Commercial |
$1,468.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.01
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$951.24
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.33 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,000.26
|
| Rate for Payer: BCN Commercial |
$1,000.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.33
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$951.24
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$163.09 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$931.97
|
| Rate for Payer: BCN Commercial |
$931.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.09
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$951.24
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$963.26
|
| Rate for Payer: BCN Commercial |
$963.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.59
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$951.24
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
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
|
$11,353.72
|
|
|
Service Code
|
CPT 31653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.05 |
| Max. Negotiated Rate |
$11,353.72 |
| Rate for Payer: Aetna Medicare |
$3,756.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,515.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,515.50
|
| Rate for Payer: BCBS Complete |
$2,033.06
|
| Rate for Payer: BCBS MAPPO |
$3,612.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,227.07
|
| Rate for Payer: BCN Commercial |
$3,227.07
|
| Rate for Payer: BCN Medicare Advantage |
$3,612.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,612.40
|
| Rate for Payer: Mclaren Medicaid |
$1,936.25
|
| Rate for Payer: Mclaren Medicare |
$3,612.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,793.02
|
| Rate for Payer: Meridian Medicaid |
$2,033.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,154.26
|
| Rate for Payer: Nomi Health Commercial |
$7,586.04
|
| Rate for Payer: PACE Medicare |
$3,431.78
|
| Rate for Payer: PACE SWMI |
$3,612.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,612.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,936.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,353.72
|
| Rate for Payer: Priority Health Medicare |
$3,612.40
|
| Rate for Payer: Priority Health Narrow Network |
$9,082.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,612.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.05
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$2,033.78
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
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
|
$11,353.72
|
|
|
Service Code
|
CPT 31652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$11,353.72 |
| Rate for Payer: Aetna Medicare |
$3,756.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,515.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,515.50
|
| Rate for Payer: BCBS Complete |
$2,033.06
|
| Rate for Payer: BCBS MAPPO |
$3,612.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,863.49
|
| Rate for Payer: BCN Commercial |
$2,863.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,612.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,612.40
|
| Rate for Payer: Mclaren Medicaid |
$1,936.25
|
| Rate for Payer: Mclaren Medicare |
$3,612.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,793.02
|
| Rate for Payer: Meridian Medicaid |
$2,033.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,154.26
|
| Rate for Payer: Nomi Health Commercial |
$7,586.04
|
| Rate for Payer: PACE Medicare |
$3,431.78
|
| Rate for Payer: PACE SWMI |
$3,612.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,612.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,936.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,353.72
|
| Rate for Payer: Priority Health Medicare |
$3,612.40
|
| Rate for Payer: Priority Health Narrow Network |
$9,082.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,612.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.90
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$2,033.78
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, INITIAL
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.72 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$593.62
|
| Rate for Payer: BCN Commercial |
$593.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.72
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$951.24
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL LUNG BIOPSY(S), EACH ADDITIONAL LOBE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 31632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$133.42
|
| Rate for Payer: BCN Commercial |
$133.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.07
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL LUNG BIOPSY(S), SINGLE LOBE
|
Facility
|
OP
|
$11,353.72
|
|
|
Service Code
|
CPT 31628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.29 |
| Max. Negotiated Rate |
$11,353.72 |
| Rate for Payer: Aetna Medicare |
$3,756.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,515.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,515.50
|
| Rate for Payer: BCBS Complete |
$2,033.06
|
| Rate for Payer: BCBS MAPPO |
$3,612.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,067.27
|
| Rate for Payer: BCN Commercial |
$1,067.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,612.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,612.40
|
| Rate for Payer: Mclaren Medicaid |
$1,936.25
|
| Rate for Payer: Mclaren Medicare |
$3,612.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,793.02
|
| Rate for Payer: Meridian Medicaid |
$2,033.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,154.26
|
| Rate for Payer: Nomi Health Commercial |
$7,586.04
|
| Rate for Payer: PACE Medicare |
$3,431.78
|
| Rate for Payer: PACE SWMI |
$3,612.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,612.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,936.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,353.72
|
| Rate for Payer: Priority Health Medicare |
$3,612.40
|
| Rate for Payer: Priority Health Narrow Network |
$9,082.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,612.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.29
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$2,033.78
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY(S), TRACHEA, MAIN STEM AND/OR LOBAR BRONCHUS(I)
|
Facility
|
OP
|
$11,353.72
|
|
|
Service Code
|
CPT 31629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$194.91 |
| Max. Negotiated Rate |
$11,353.72 |
| Rate for Payer: Aetna Medicare |
$3,756.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,515.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,515.50
|
| Rate for Payer: BCBS Complete |
$2,033.06
|
| Rate for Payer: BCBS MAPPO |
$3,612.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,615.87
|
| Rate for Payer: BCN Commercial |
$1,615.87
|
| Rate for Payer: BCN Medicare Advantage |
$3,612.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,612.40
|
| Rate for Payer: Mclaren Medicaid |
$1,936.25
|
| Rate for Payer: Mclaren Medicare |
$3,612.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,793.02
|
| Rate for Payer: Meridian Medicaid |
$2,033.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,154.26
|
| Rate for Payer: Nomi Health Commercial |
$7,586.04
|
| Rate for Payer: PACE Medicare |
$3,431.78
|
| Rate for Payer: PACE SWMI |
$3,612.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,612.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,936.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,353.72
|
| Rate for Payer: Priority Health Medicare |
$3,612.40
|
| Rate for Payer: Priority Health Narrow Network |
$9,082.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,612.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.91
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$2,033.78
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSENDOSCOPIC ENDOBRONCHIAL ULTRASOUND (EBUS) DURING BRONCHOSCOPIC DIAGNOSTIC OR THERAPEUTIC INTERVENTION(S) FOR PERIPHERAL LESION(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE[S])
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 31654
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$70.03 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$477.34
|
| Rate for Payer: BCN Commercial |
$477.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.03
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
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 |
$1.13 |
| Max. Negotiated Rate |
$28.27 |
| Rate for Payer: Aetna Commercial |
$26.70
|
| Rate for Payer: Aetna Commercial |
$6.37
|
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: Aetna Medicare |
$3.74
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.74
|
| Rate for Payer: BCBS Complete |
$12.56
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$7.59
|
| Rate for Payer: Cofinity Commercial |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$21.99
|
| Rate for Payer: Cofinity Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$5.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.51
|
| Rate for Payer: PHP Commercial |
$7.51
|
| Rate for Payer: PHP Commercial |
$6.37
|
| Rate for Payer: PHP Commercial |
$26.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.41
|
| Rate for Payer: Priority Health Narrow Network |
$1.13
|
| Rate for Payer: Priority Health Narrow Network |
$1.13
|
| Rate for Payer: Priority Health Narrow Network |
$1.13
|
| Rate for Payer: Priority Health SBD |
$19.79
|
| Rate for Payer: Priority Health SBD |
$4.72
|
| Rate for Payer: Priority Health SBD |
$5.56
|
|
