|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$300.95 |
| Rate for Payer: Aetna Medicare |
$231.50
|
| Rate for Payer: BCBS Complete |
$185.20
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.95
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$212.86 |
| Max. Negotiated Rate |
$360.75 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Medicare |
$221.37
|
| Rate for Payer: BCBS Complete |
$222.00
|
| Rate for Payer: BCBS MAPPO |
$212.86
|
| Rate for Payer: BCN Medicare Advantage |
$212.86
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$306.52
|
| Rate for Payer: Cofinity Commercial |
$285.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.50
|
| Rate for Payer: Nomi Health Commercial |
$255.43
|
| Rate for Payer: PACE SWMI |
$212.86
|
| Rate for Payer: PHP Medicare Advantage |
$212.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health Medicare |
$214.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.86
|
| Rate for Payer: UHC Exchange |
$212.86
|
| Rate for Payer: UHC Medicare Advantage |
$212.86
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$360.75 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Aetna Commercial |
$471.75
|
| Rate for Payer: BCBS Trust/PPO |
$453.05
|
| Rate for Payer: BCN Commercial |
$428.90
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$477.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.00
|
| Rate for Payer: Healthscope Commercial |
$499.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.75
|
| Rate for Payer: Nomi Health Commercial |
$455.10
|
| Rate for Payer: PHP Commercial |
$471.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health HMO/PPO |
$482.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$371.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.40
|
| Rate for Payer: UHC Core |
$463.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.25
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Aetna Commercial |
$471.75
|
| Rate for Payer: Aetna Medicare |
$144.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.44
|
| Rate for Payer: BCBS Complete |
$416.27
|
| Rate for Payer: BCBS MAPPO |
$138.75
|
| Rate for Payer: BCBS Trust/PPO |
$456.27
|
| Rate for Payer: BCN Commercial |
$431.51
|
| Rate for Payer: BCN Medicare Advantage |
$138.75
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$477.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.75
|
| Rate for Payer: Healthscope Commercial |
$499.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.25
|
| Rate for Payer: Mclaren Medicaid |
$396.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.69
|
| Rate for Payer: Meridian Medicaid |
$416.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.75
|
| Rate for Payer: Nomi Health Commercial |
$455.10
|
| Rate for Payer: PACE Senior Care Partners |
$131.81
|
| Rate for Payer: PACE SWMI |
$138.75
|
| Rate for Payer: PHP Commercial |
$471.75
|
| Rate for Payer: PHP Medicare Advantage |
$138.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health HMO/PPO |
$482.85
|
| Rate for Payer: Priority Health Medicare |
$140.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$371.85
|
| Rate for Payer: Railroad Medicare Medicare |
$138.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.40
|
| Rate for Payer: UHC Core |
$463.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.75
|
| Rate for Payer: UHC Exchange |
$138.75
|
| Rate for Payer: UHC Medicare Advantage |
$138.75
|
| Rate for Payer: UHCCP Medicaid |
$396.42
|
| Rate for Payer: VA VA |
$138.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.25
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$212.86 |
| Max. Negotiated Rate |
$360.75 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Medicare |
$221.37
|
| Rate for Payer: BCBS Complete |
$222.00
|
| Rate for Payer: BCBS MAPPO |
$212.86
|
| Rate for Payer: BCN Medicare Advantage |
$212.86
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$306.52
|
| Rate for Payer: Cofinity Commercial |
$285.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.50
|
| Rate for Payer: Nomi Health Commercial |
$255.43
|
| Rate for Payer: PACE SWMI |
$212.86
|
| Rate for Payer: PHP Medicare Advantage |
$212.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health Medicare |
$214.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.86
|
| Rate for Payer: UHC Exchange |
$212.86
|
| Rate for Payer: UHC Medicare Advantage |
$212.86
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$122.42 |
| Max. Negotiated Rate |
$319.80 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$127.32
|
| Rate for Payer: Aetna Medicare |
$127.32
|
| Rate for Payer: BCBS Complete |
$196.80
|
| Rate for Payer: BCBS Complete |
$135.60
|
| Rate for Payer: BCBS MAPPO |
$122.42
|
| Rate for Payer: BCBS MAPPO |
$122.42
|
| Rate for Payer: BCN Medicare Advantage |
$122.42
|
| Rate for Payer: BCN Medicare Advantage |
$122.42
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.54
|
| Rate for Payer: Nomi Health Commercial |
$146.90
|
| Rate for Payer: Nomi Health Commercial |
$146.90
|
| Rate for Payer: PACE SWMI |
$122.42
|
| Rate for Payer: PACE SWMI |
$122.42
|
| Rate for Payer: PHP Medicare Advantage |
$122.42
|
| Rate for Payer: PHP Medicare Advantage |
$122.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health Medicare |
$123.64
|
| Rate for Payer: Priority Health Medicare |
$123.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.42
|
| Rate for Payer: UHC Exchange |
$122.42
|
| Rate for Payer: UHC Exchange |
$122.42
|
| Rate for Payer: UHC Medicare Advantage |
$122.42
|
| Rate for Payer: UHC Medicare Advantage |
$122.42
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$126.59 |
| Rate for Payer: Aetna Commercial |
$117.80
|
| Rate for Payer: Aetna Commercial |
$117.80
|
| Rate for Payer: Aetna Medicare |
$91.43
|
| Rate for Payer: Aetna Medicare |
$91.43
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$87.91
|
| Rate for Payer: BCBS MAPPO |
$87.91
|
| Rate for Payer: BCN Medicare Advantage |
$87.91
|
| Rate for Payer: BCN Medicare Advantage |
$87.91
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$126.59
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$126.59
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.31
|
| Rate for Payer: Nomi Health Commercial |
$105.49
|
| Rate for Payer: Nomi Health Commercial |
$105.49
|
| Rate for Payer: PACE SWMI |
$87.91
|
| Rate for Payer: PACE SWMI |
$87.91
|
| Rate for Payer: PHP Medicare Advantage |
$87.91
|
| Rate for Payer: PHP Medicare Advantage |
$87.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health Medicare |
$88.79
|
| Rate for Payer: Priority Health Medicare |
$88.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Exchange |
$87.91
|
| Rate for Payer: UHC Exchange |
$87.91
|
| Rate for Payer: UHC Medicare Advantage |
$87.91
|
| Rate for Payer: UHC Medicare Advantage |
$87.91
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$222.31
|
| Rate for Payer: Aetna Commercial |
$222.31
|
| Rate for Payer: Aetna Medicare |
$172.54
|
| Rate for Payer: Aetna Medicare |
$172.54
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$165.90
|
| Rate for Payer: BCBS MAPPO |
$165.90
|
| Rate for Payer: BCN Medicare Advantage |
$165.90
|
| Rate for Payer: BCN Medicare Advantage |
$165.90
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.19
|
| Rate for Payer: Nomi Health Commercial |
$199.08
|
| Rate for Payer: Nomi Health Commercial |
$199.08
|
| Rate for Payer: PACE SWMI |
$165.90
|
| Rate for Payer: PACE SWMI |
$165.90
|
| Rate for Payer: PHP Medicare Advantage |
$165.90
|
| Rate for Payer: PHP Medicare Advantage |
$165.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Medicare |
$167.56
|
| Rate for Payer: Priority Health Medicare |
$167.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Exchange |
$165.90
|
| Rate for Payer: UHC Exchange |
$165.90
|
| Rate for Payer: UHC Medicare Advantage |
$165.90
|
| Rate for Payer: UHC Medicare Advantage |
$165.90
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$235.84
|
| Rate for Payer: Aetna Commercial |
$235.84
|
| Rate for Payer: Aetna Medicare |
$183.04
|
| Rate for Payer: Aetna Medicare |
$183.04
|
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS MAPPO |
$176.00
|
| Rate for Payer: BCBS MAPPO |
$176.00
|
| Rate for Payer: BCN Medicare Advantage |
$176.00
|
| Rate for Payer: BCN Medicare Advantage |
$176.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$253.44
|
| Rate for Payer: Cofinity Commercial |
$235.84
|
| Rate for Payer: Cofinity Commercial |
$253.44
|
| Rate for Payer: Cofinity Commercial |
$235.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.80
|
| Rate for Payer: Nomi Health Commercial |
$211.20
|
| Rate for Payer: Nomi Health Commercial |
$211.20
|
| Rate for Payer: PACE SWMI |
$176.00
|
| Rate for Payer: PACE SWMI |
$176.00
|
| Rate for Payer: PHP Medicare Advantage |
$176.00
|
| Rate for Payer: PHP Medicare Advantage |
$176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$177.76
|
| Rate for Payer: Priority Health Medicare |
$177.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Exchange |
$176.00
|
| Rate for Payer: UHC Exchange |
$176.00
|
| Rate for Payer: UHC Medicare Advantage |
$176.00
|
| Rate for Payer: UHC Medicare Advantage |
$176.00
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$222.55 |
| Max. Negotiated Rate |
$514.80 |
| Rate for Payer: Aetna Commercial |
$298.22
|
| Rate for Payer: Aetna Medicare |
$231.45
|
| Rate for Payer: BCBS Complete |
$316.80
|
| Rate for Payer: BCBS MAPPO |
$222.55
|
| Rate for Payer: BCN Medicare Advantage |
$222.55
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$320.47
|
| Rate for Payer: Cofinity Commercial |
$298.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.68
|
| Rate for Payer: Nomi Health Commercial |
$267.06
|
| Rate for Payer: PACE SWMI |
$222.55
|
| Rate for Payer: PHP Medicare Advantage |
$222.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health Medicare |
$224.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.55
|
| Rate for Payer: UHC Exchange |
$222.55
|
| Rate for Payer: UHC Medicare Advantage |
$222.55
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$328.70 |
| Max. Negotiated Rate |
$683.15 |
| Rate for Payer: Aetna Commercial |
$440.46
|
| Rate for Payer: Aetna Medicare |
$341.85
|
| Rate for Payer: BCBS Complete |
$420.40
|
| Rate for Payer: BCBS MAPPO |
$328.70
|
| Rate for Payer: BCN Medicare Advantage |
$328.70
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cofinity Commercial |
$473.33
|
| Rate for Payer: Cofinity Commercial |
$440.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.13
|
| Rate for Payer: Nomi Health Commercial |
$394.44
|
| Rate for Payer: PACE SWMI |
$328.70
|
| Rate for Payer: PHP Medicare Advantage |
$328.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.15
|
| Rate for Payer: Priority Health Medicare |
$331.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.70
|
| Rate for Payer: UHC Exchange |
$328.70
|
| Rate for Payer: UHC Medicare Advantage |
$328.70
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$426.51 |
| Rate for Payer: Aetna Commercial |
$396.89
|
| Rate for Payer: Aetna Medicare |
$308.04
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: BCBS MAPPO |
$296.19
|
| Rate for Payer: BCN Medicare Advantage |
$296.19
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$426.51
|
| Rate for Payer: Cofinity Commercial |
$396.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.00
|
| Rate for Payer: Nomi Health Commercial |
$355.43
|
| Rate for Payer: PACE SWMI |
$296.19
|
| Rate for Payer: PHP Medicare Advantage |
$296.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health Medicare |
$299.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.19
|
| Rate for Payer: UHC Exchange |
$296.19
|
| Rate for Payer: UHC Medicare Advantage |
$296.19
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$2,607.00
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$798.71 |
| Max. Negotiated Rate |
$1,694.55 |
| Rate for Payer: Aetna Commercial |
$1,070.27
|
| Rate for Payer: Aetna Medicare |
$830.66
|
| Rate for Payer: BCBS Complete |
$1,042.80
|
| Rate for Payer: BCBS MAPPO |
$798.71
|
| Rate for Payer: BCN Medicare Advantage |
$798.71
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Cofinity Commercial |
$1,150.14
|
| Rate for Payer: Cofinity Commercial |
$1,070.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.65
|
| Rate for Payer: Nomi Health Commercial |
$958.45
|
| Rate for Payer: PACE SWMI |
$798.71
|
| Rate for Payer: PHP Medicare Advantage |
$798.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.55
|
| Rate for Payer: Priority Health Medicare |
$806.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.71
|
| Rate for Payer: UHC Exchange |
$798.71
|
| Rate for Payer: UHC Medicare Advantage |
$798.71
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
HCPCS 33954
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$656.99 |
| Rate for Payer: Aetna Commercial |
$611.36
|
| Rate for Payer: Aetna Medicare |
$474.49
|
| Rate for Payer: BCBS Complete |
$385.60
|
| Rate for Payer: BCBS MAPPO |
$456.24
|
| Rate for Payer: BCN Medicare Advantage |
$456.24
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cofinity Commercial |
$656.99
|
| Rate for Payer: Cofinity Commercial |
$611.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$456.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$479.05
|
| Rate for Payer: Nomi Health Commercial |
$547.49
|
| Rate for Payer: PACE SWMI |
$456.24
|
| Rate for Payer: PHP Medicare Advantage |
$456.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: Priority Health Medicare |
$460.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$456.24
|
| Rate for Payer: UHC Exchange |
$456.24
|
| Rate for Payer: UHC Medicare Advantage |
$456.24
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 33952
|
| Min. Negotiated Rate |
$359.60 |
| Max. Negotiated Rate |
$586.60 |
| Rate for Payer: Aetna Commercial |
$545.86
|
| Rate for Payer: Aetna Medicare |
$423.65
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$407.36
|
| Rate for Payer: BCN Medicare Advantage |
$407.36
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cofinity Commercial |
$586.60
|
| Rate for Payer: Cofinity Commercial |
$545.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.73
|
| Rate for Payer: Nomi Health Commercial |
$488.83
|
| Rate for Payer: PACE SWMI |
$407.36
|
| Rate for Payer: PHP Medicare Advantage |
$407.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health Medicare |
$411.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.36
|
| Rate for Payer: UHC Exchange |
$407.36
|
| Rate for Payer: UHC Medicare Advantage |
$407.36
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 33953
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$649.83 |
| Rate for Payer: Aetna Commercial |
$604.70
|
| Rate for Payer: Aetna Medicare |
$469.32
|
| Rate for Payer: BCBS Complete |
$289.60
|
| Rate for Payer: BCBS MAPPO |
$451.27
|
| Rate for Payer: BCN Medicare Advantage |
$451.27
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cofinity Commercial |
$649.83
|
| Rate for Payer: Cofinity Commercial |
$604.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$473.83
|
| Rate for Payer: Nomi Health Commercial |
$541.52
|
| Rate for Payer: PACE SWMI |
$451.27
|
| Rate for Payer: PHP Medicare Advantage |
$451.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health Medicare |
$455.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.27
|
| Rate for Payer: UHC Exchange |
$451.27
|
| Rate for Payer: UHC Medicare Advantage |
$451.27
|
|
|
PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33986
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$724.16 |
| Rate for Payer: Aetna Commercial |
$673.87
|
| Rate for Payer: Aetna Medicare |
$523.01
|
| Rate for Payer: BCBS Complete |
$440.00
|
| Rate for Payer: BCBS MAPPO |
$502.89
|
| Rate for Payer: BCN Medicare Advantage |
$502.89
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$724.16
|
| Rate for Payer: Cofinity Commercial |
$673.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$528.03
|
| Rate for Payer: Nomi Health Commercial |
$603.47
|
| Rate for Payer: PACE SWMI |
$502.89
|
| Rate for Payer: PHP Medicare Advantage |
$502.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health Medicare |
$507.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.89
|
| Rate for Payer: UHC Exchange |
$502.89
|
| Rate for Payer: UHC Medicare Advantage |
$502.89
|
|
|
PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 95836
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$133.84
|
| Rate for Payer: Aetna Medicare |
$103.88
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$99.88
|
| Rate for Payer: BCN Medicare Advantage |
$99.88
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$143.83
|
| Rate for Payer: Cofinity Commercial |
$133.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.87
|
| Rate for Payer: Nomi Health Commercial |
$119.86
|
| Rate for Payer: PACE SWMI |
$99.88
|
| Rate for Payer: PHP Medicare Advantage |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$100.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.88
|
| Rate for Payer: UHC Exchange |
$99.88
|
| Rate for Payer: UHC Medicare Advantage |
$99.88
|
|
|
PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
HCPCS 43259
|
| Min. Negotiated Rate |
$212.84 |
| Max. Negotiated Rate |
$648.70 |
| Rate for Payer: Aetna Commercial |
$285.21
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: BCBS Complete |
$399.20
|
| Rate for Payer: BCBS MAPPO |
$212.84
|
| Rate for Payer: BCN Medicare Advantage |
$212.84
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cofinity Commercial |
$306.49
|
| Rate for Payer: Cofinity Commercial |
$285.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.48
|
| Rate for Payer: Nomi Health Commercial |
$255.41
|
| Rate for Payer: PACE SWMI |
$212.84
|
| Rate for Payer: PHP Medicare Advantage |
$212.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.70
|
| Rate for Payer: Priority Health Medicare |
$214.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.84
|
| Rate for Payer: UHC Exchange |
$212.84
|
| Rate for Payer: UHC Medicare Advantage |
$212.84
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,895.04
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,231.78 |
| Max. Negotiated Rate |
$1,705.54 |
| Rate for Payer: Aetna Commercial |
$1,610.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.92
|
| Rate for Payer: BCN Commercial |
$1,464.49
|
| Rate for Payer: Cash Price |
$1,516.03
|
| Rate for Payer: Cofinity Commercial |
$1,629.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,516.03
|
| Rate for Payer: Healthscope Commercial |
$1,705.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,421.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,610.78
|
| Rate for Payer: Nomi Health Commercial |
$1,553.93
|
| Rate for Payer: PHP Commercial |
$1,610.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,231.78
|
| Rate for Payer: Priority Health HMO/PPO |
$1,648.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,269.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,667.64
|
| Rate for Payer: UHC Core |
$1,582.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,421.28
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$1,895.04
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$450.07 |
| Max. Negotiated Rate |
$1,705.54 |
| Rate for Payer: Aetna Commercial |
$1,610.78
|
| Rate for Payer: Aetna Medicare |
$492.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$592.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$592.20
|
| Rate for Payer: BCBS Complete |
$758.02
|
| Rate for Payer: BCBS MAPPO |
$473.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.91
|
| Rate for Payer: BCN Commercial |
$1,473.39
|
| Rate for Payer: BCN Medicare Advantage |
$473.76
|
| Rate for Payer: Cash Price |
$1,516.03
|
| Rate for Payer: Cofinity Commercial |
$1,629.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,516.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$473.76
|
| Rate for Payer: Healthscope Commercial |
$1,705.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,421.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$544.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,610.78
|
| Rate for Payer: Nomi Health Commercial |
$1,553.93
|
| Rate for Payer: PACE Senior Care Partners |
$450.07
|
| Rate for Payer: PACE SWMI |
$473.76
|
| Rate for Payer: PHP Commercial |
$1,610.78
|
| Rate for Payer: PHP Medicare Advantage |
$473.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,231.78
|
| Rate for Payer: Priority Health HMO/PPO |
$1,648.68
|
| Rate for Payer: Priority Health Medicare |
$478.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,269.68
|
| Rate for Payer: Railroad Medicare Medicare |
$473.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,667.64
|
| Rate for Payer: UHC Core |
$1,582.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$473.76
|
| Rate for Payer: UHC Exchange |
$473.76
|
| Rate for Payer: UHC Medicare Advantage |
$473.76
|
| Rate for Payer: VA VA |
$473.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,421.28
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$103.01
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$92.71 |
| Rate for Payer: Aetna Commercial |
$87.56
|
| Rate for Payer: Aetna Medicare |
$26.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.19
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$25.75
|
| Rate for Payer: BCBS Trust/PPO |
$84.68
|
| Rate for Payer: BCN Commercial |
$80.09
|
| Rate for Payer: BCN Medicare Advantage |
$25.75
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Cofinity Commercial |
$88.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.75
|
| Rate for Payer: Healthscope Commercial |
$92.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.56
|
| Rate for Payer: Nomi Health Commercial |
$84.47
|
| Rate for Payer: PACE Senior Care Partners |
$24.46
|
| Rate for Payer: PACE SWMI |
$25.75
|
| Rate for Payer: PHP Commercial |
$87.56
|
| Rate for Payer: PHP Medicare Advantage |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.96
|
| Rate for Payer: Priority Health HMO/PPO |
$89.62
|
| Rate for Payer: Priority Health Medicare |
$26.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.02
|
| Rate for Payer: Railroad Medicare Medicare |
$25.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.65
|
| Rate for Payer: UHC Core |
$86.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.75
|
| Rate for Payer: UHC Exchange |
$25.75
|
| Rate for Payer: UHC Medicare Advantage |
$25.75
|
| Rate for Payer: VA VA |
$25.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$103.01
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$92.71 |
| Rate for Payer: Aetna Commercial |
$87.56
|
| Rate for Payer: BCBS Trust/PPO |
$84.09
|
| Rate for Payer: BCN Commercial |
$79.61
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Cofinity Commercial |
$88.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.41
|
| Rate for Payer: Healthscope Commercial |
$92.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.56
|
| Rate for Payer: Nomi Health Commercial |
$84.47
|
| Rate for Payer: PHP Commercial |
$87.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.96
|
| Rate for Payer: Priority Health HMO/PPO |
$89.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.65
|
| Rate for Payer: UHC Core |
$86.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$7.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$7.19 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Commercial |
$686.44
|
| Rate for Payer: BCBS Trust/PPO |
$6.52
|
| Rate for Payer: BCBS Trust/PPO |
$659.23
|
| Rate for Payer: BCN Commercial |
$6.17
|
| Rate for Payer: BCN Commercial |
$624.10
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cash Price |
$646.06
|
| Rate for Payer: Cofinity Commercial |
$694.52
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.39
|
| Rate for Payer: Healthscope Commercial |
$7.19
|
| Rate for Payer: Healthscope Commercial |
$726.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.44
|
| Rate for Payer: Nomi Health Commercial |
$6.55
|
| Rate for Payer: Nomi Health Commercial |
$662.22
|
| Rate for Payer: PHP Commercial |
$6.79
|
| Rate for Payer: PHP Commercial |
$686.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$524.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.19
|
| Rate for Payer: Priority Health HMO/PPO |
$702.59
|
| Rate for Payer: Priority Health HMO/PPO |
$6.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$541.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.67
|
| Rate for Payer: UHC Core |
$6.67
|
| Rate for Payer: UHC Core |
$674.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.68
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$807.58
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$726.82 |
| Rate for Payer: Aetna Commercial |
$686.44
|
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Medicare |
$209.97
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$252.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$252.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.50
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Complete |
$323.03
|
| Rate for Payer: BCBS MAPPO |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$201.90
|
| Rate for Payer: BCBS Trust/PPO |
$663.91
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCN Commercial |
$627.89
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: BCN Medicare Advantage |
$201.90
|
| Rate for Payer: BCN Medicare Advantage |
$2.00
|
| Rate for Payer: Cash Price |
$646.06
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Cofinity Commercial |
$694.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.90
|
| Rate for Payer: Healthscope Commercial |
$7.19
|
| Rate for Payer: Healthscope Commercial |
$726.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.79
|
| Rate for Payer: Nomi Health Commercial |
$662.22
|
| Rate for Payer: Nomi Health Commercial |
$6.55
|
| Rate for Payer: PACE Senior Care Partners |
$191.80
|
| Rate for Payer: PACE Senior Care Partners |
$1.90
|
| Rate for Payer: PACE SWMI |
$201.90
|
| Rate for Payer: PACE SWMI |
$2.00
|
| Rate for Payer: PHP Commercial |
$686.44
|
| Rate for Payer: PHP Commercial |
$6.79
|
| Rate for Payer: PHP Medicare Advantage |
$2.00
|
| Rate for Payer: PHP Medicare Advantage |
$201.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$524.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.19
|
| Rate for Payer: Priority Health HMO/PPO |
$6.95
|
| Rate for Payer: Priority Health HMO/PPO |
$702.59
|
| Rate for Payer: Priority Health Medicare |
$203.91
|
| Rate for Payer: Priority Health Medicare |
$2.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$541.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2.00
|
| Rate for Payer: Railroad Medicare Medicare |
$201.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.67
|
| Rate for Payer: UHC Core |
$674.33
|
| Rate for Payer: UHC Core |
$6.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.00
|
| Rate for Payer: UHC Exchange |
$2.00
|
| Rate for Payer: UHC Exchange |
$201.90
|
| Rate for Payer: UHC Medicare Advantage |
$2.00
|
| Rate for Payer: UHC Medicare Advantage |
$201.90
|
| Rate for Payer: VA VA |
$2.00
|
| Rate for Payer: VA VA |
$201.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.99
|
|
