|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$1,789.88 |
| 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: Aetna New Business (MI Preferred) |
$117.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.80
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS MAPPO |
$87.91
|
| Rate for Payer: BCBS MAPPO |
$87.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCN Commercial |
$143.67
|
| Rate for Payer: BCN Commercial |
$143.67
|
| Rate for Payer: BCN Medicare Advantage |
$87.91
|
| Rate for Payer: BCN Medicare Advantage |
$87.91
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$126.59
|
| 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: Meridian Medicaid |
$16.33
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| 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 Commercial |
$123.07
|
| Rate for Payer: PHP Commercial |
$123.07
|
| Rate for Payer: PHP Medicare Advantage |
$87.91
|
| Rate for Payer: PHP Medicare Advantage |
$87.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| 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 HMO/PPO/Tiered Network |
$139.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.37
|
| Rate for Payer: Priority Health Medicare |
$87.91
|
| Rate for Payer: Priority Health Medicare |
$87.91
|
| Rate for Payer: Priority Health Narrow Network |
$139.37
|
| Rate for Payer: Priority Health Narrow Network |
$139.37
|
| Rate for Payer: Priority Health SBD |
$34.37
|
| Rate for Payer: Priority Health SBD |
$34.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Medicare Advantage |
$87.91
|
| Rate for Payer: UHC Medicare Advantage |
$87.91
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
| Rate for Payer: UMR Bronson Commercial |
$81.42
|
| Rate for Payer: UMR Bronson Commercial |
$133.40
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$1,950.48 |
| 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: Aetna New Business (MI Preferred) |
$222.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.31
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS MAPPO |
$165.90
|
| Rate for Payer: BCBS MAPPO |
$165.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.48
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: BCN Medicare Advantage |
$165.90
|
| Rate for Payer: BCN Medicare Advantage |
$165.90
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| 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 |
$174.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.20
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| 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 Commercial |
$232.26
|
| Rate for Payer: PHP Commercial |
$232.26
|
| Rate for Payer: PHP Medicare Advantage |
$165.90
|
| Rate for Payer: PHP Medicare Advantage |
$165.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| 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 HMO/PPO/Tiered Network |
$261.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.79
|
| Rate for Payer: Priority Health Medicare |
$165.90
|
| Rate for Payer: Priority Health Medicare |
$165.90
|
| Rate for Payer: Priority Health Narrow Network |
$261.79
|
| Rate for Payer: Priority Health Narrow Network |
$261.79
|
| Rate for Payer: Priority Health SBD |
$95.11
|
| Rate for Payer: Priority Health SBD |
$95.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Medicare Advantage |
$165.90
|
| Rate for Payer: UHC Medicare Advantage |
$165.90
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
| Rate for Payer: UMR Bronson Commercial |
$207.92
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$1,092.00 |
| 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: Aetna New Business (MI Preferred) |
$235.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.84
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS MAPPO |
$176.00
|
| Rate for Payer: BCBS MAPPO |
$176.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.00
|
| Rate for Payer: BCN Commercial |
$286.36
|
| Rate for Payer: BCN Commercial |
$286.36
|
| Rate for Payer: BCN Medicare Advantage |
$176.00
|
| Rate for Payer: BCN Medicare Advantage |
$176.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$235.84
|
| Rate for Payer: Cofinity Commercial |
$253.44
|
| 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: Meridian Medicaid |
$45.18
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| 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 Commercial |
$246.40
|
| Rate for Payer: PHP Commercial |
$246.40
|
| Rate for Payer: PHP Medicare Advantage |
$176.00
|
| Rate for Payer: PHP Medicare Advantage |
$176.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| 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 HMO/PPO/Tiered Network |
$277.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.32
|
| Rate for Payer: Priority Health Medicare |
$176.00
|
| Rate for Payer: Priority Health Medicare |
$176.00
|
| Rate for Payer: Priority Health Narrow Network |
$277.32
|
| Rate for Payer: Priority Health Narrow Network |
$277.32
|
| Rate for Payer: Priority Health SBD |
$95.11
|
| Rate for Payer: Priority Health SBD |
$95.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Medicare Advantage |
$176.00
|
| Rate for Payer: UHC Medicare Advantage |
$176.00
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UMR Bronson Commercial |
$460.00
|
| Rate for Payer: UMR Bronson Commercial |
$124.20
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$1,551.62 |
| Rate for Payer: Aetna Commercial |
$298.22
|
| Rate for Payer: Aetna Medicare |
$231.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.47
|
| Rate for Payer: BCBS Complete |
$153.65
|
| Rate for Payer: BCBS MAPPO |
$222.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.62
|
| Rate for Payer: BCN Commercial |
$329.86
|
| 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 |
$298.22
|
| Rate for Payer: Cofinity Commercial |
$320.47
|
| 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: Meridian Medicaid |
$153.65
|
| Rate for Payer: Nomi Health Commercial |
$267.06
|
| Rate for Payer: PACE SWMI |
$222.55
|
| Rate for Payer: PHP Commercial |
$311.57
|
| Rate for Payer: PHP Medicare Advantage |
$222.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$362.18
|
| Rate for Payer: Priority Health Medicare |
$222.55
|
| Rate for Payer: Priority Health Narrow Network |
$362.18
|
| Rate for Payer: Priority Health SBD |
$362.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.55
|
| Rate for Payer: UHC Medicare Advantage |
$222.55
|
| Rate for Payer: UHCCP Medicaid |
$146.33
|
| Rate for Payer: UMR Bronson Commercial |
$364.32
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$214.92 |
| Max. Negotiated Rate |
$1,408.45 |
| Rate for Payer: Aetna Commercial |
$440.46
|
| Rate for Payer: Aetna Medicare |
$341.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.33
|
| Rate for Payer: BCBS Complete |
$225.67
|
| Rate for Payer: BCBS MAPPO |
$328.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,408.45
|
| Rate for Payer: BCN Commercial |
$489.17
|
| 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 |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$473.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.14
|
| Rate for Payer: Meridian Medicaid |
$225.67
|
| Rate for Payer: Nomi Health Commercial |
$394.44
|
| Rate for Payer: PACE SWMI |
$328.70
|
| Rate for Payer: PHP Commercial |
$460.18
|
| Rate for Payer: PHP Medicare Advantage |
$328.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.96
|
| Rate for Payer: Priority Health Medicare |
$328.70
|
| Rate for Payer: Priority Health Narrow Network |
$533.96
|
| Rate for Payer: Priority Health SBD |
$533.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.70
|
| Rate for Payer: UHC Medicare Advantage |
$328.70
|
| Rate for Payer: UHCCP Medicaid |
$214.92
|
| Rate for Payer: UMR Bronson Commercial |
$483.46
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$193.83 |
| Max. Negotiated Rate |
$1,643.01 |
| Rate for Payer: Aetna Commercial |
$396.89
|
| Rate for Payer: Aetna Medicare |
$308.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.51
|
| Rate for Payer: BCBS Complete |
$203.52
|
| Rate for Payer: BCBS MAPPO |
$296.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.01
|
| Rate for Payer: BCN Commercial |
$442.25
|
| 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 |
$396.89
|
| Rate for Payer: Cofinity Commercial |
$426.51
|
| 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: Meridian Medicaid |
$203.52
|
| Rate for Payer: Nomi Health Commercial |
$355.43
|
| Rate for Payer: PACE SWMI |
$296.19
|
| Rate for Payer: PHP Commercial |
$414.67
|
| Rate for Payer: PHP Medicare Advantage |
$296.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$482.37
|
| Rate for Payer: Priority Health Medicare |
$296.19
|
| Rate for Payer: Priority Health Narrow Network |
$482.37
|
| Rate for Payer: Priority Health SBD |
$482.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.19
|
| Rate for Payer: UHC Medicare Advantage |
$296.19
|
| Rate for Payer: UHCCP Medicaid |
$193.83
|
| Rate for Payer: UMR Bronson Commercial |
$218.50
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$2,607.00
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$521.00 |
| Max. Negotiated Rate |
$3,231.61 |
| Rate for Payer: Aetna Commercial |
$1,070.27
|
| Rate for Payer: Aetna Medicare |
$830.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.14
|
| Rate for Payer: BCBS Complete |
$547.05
|
| Rate for Payer: BCBS MAPPO |
$798.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,231.61
|
| Rate for Payer: BCN Commercial |
$1,192.37
|
| 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 |
$1,070.27
|
| Rate for Payer: Cofinity Commercial |
$1,150.14
|
| 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: Meridian Medicaid |
$547.05
|
| Rate for Payer: Nomi Health Commercial |
$958.45
|
| Rate for Payer: PACE SWMI |
$798.71
|
| Rate for Payer: PHP Commercial |
$1,118.19
|
| Rate for Payer: PHP Medicare Advantage |
$798.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$521.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,300.84
|
| Rate for Payer: Priority Health Medicare |
$798.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,300.84
|
| Rate for Payer: Priority Health SBD |
$1,300.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.71
|
| Rate for Payer: UHC Medicare Advantage |
$798.71
|
| Rate for Payer: UHCCP Medicaid |
$521.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,199.22
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
HCPCS 33954
|
| Min. Negotiated Rate |
$297.77 |
| Max. Negotiated Rate |
$4,413.95 |
| Rate for Payer: Aetna Commercial |
$611.36
|
| Rate for Payer: Aetna Medicare |
$474.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$656.99
|
| Rate for Payer: BCBS Complete |
$312.66
|
| Rate for Payer: BCBS MAPPO |
$456.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,413.95
|
| Rate for Payer: BCN Commercial |
$678.28
|
| 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 |
$611.36
|
| Rate for Payer: Cofinity Commercial |
$656.99
|
| 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: Meridian Medicaid |
$312.66
|
| Rate for Payer: Nomi Health Commercial |
$547.49
|
| Rate for Payer: PACE SWMI |
$456.24
|
| Rate for Payer: PHP Commercial |
$638.74
|
| Rate for Payer: PHP Medicare Advantage |
$456.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.30
|
| Rate for Payer: Priority Health Medicare |
$456.24
|
| Rate for Payer: Priority Health Narrow Network |
$740.30
|
| Rate for Payer: Priority Health SBD |
$740.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$456.24
|
| Rate for Payer: UHC Medicare Advantage |
$456.24
|
| Rate for Payer: UHCCP Medicaid |
$297.77
|
| Rate for Payer: UMR Bronson Commercial |
$443.44
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 33952
|
| Min. Negotiated Rate |
$266.46 |
| Max. Negotiated Rate |
$3,277.57 |
| Rate for Payer: Aetna Commercial |
$545.86
|
| Rate for Payer: Aetna Medicare |
$423.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.60
|
| Rate for Payer: BCBS Complete |
$279.78
|
| Rate for Payer: BCBS MAPPO |
$407.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,277.57
|
| Rate for Payer: BCN Commercial |
$609.87
|
| 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 |
$545.86
|
| Rate for Payer: Cofinity Commercial |
$586.60
|
| 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: Meridian Medicaid |
$279.78
|
| Rate for Payer: Nomi Health Commercial |
$488.83
|
| Rate for Payer: PACE SWMI |
$407.36
|
| Rate for Payer: PHP Commercial |
$570.30
|
| Rate for Payer: PHP Medicare Advantage |
$407.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$664.77
|
| Rate for Payer: Priority Health Medicare |
$407.36
|
| Rate for Payer: Priority Health Narrow Network |
$664.77
|
| Rate for Payer: Priority Health SBD |
$664.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.36
|
| Rate for Payer: UHC Medicare Advantage |
$407.36
|
| Rate for Payer: UHCCP Medicaid |
$266.46
|
| Rate for Payer: UMR Bronson Commercial |
$413.54
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 33953
|
| Min. Negotiated Rate |
$294.37 |
| Max. Negotiated Rate |
$3,959.61 |
| Rate for Payer: Aetna Commercial |
$604.70
|
| Rate for Payer: Aetna Medicare |
$469.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.83
|
| Rate for Payer: BCBS Complete |
$309.09
|
| Rate for Payer: BCBS MAPPO |
$451.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,959.61
|
| Rate for Payer: BCN Commercial |
$672.91
|
| 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 |
$604.70
|
| Rate for Payer: Cofinity Commercial |
$649.83
|
| 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: Meridian Medicaid |
$309.09
|
| Rate for Payer: Nomi Health Commercial |
$541.52
|
| Rate for Payer: PACE SWMI |
$451.27
|
| Rate for Payer: PHP Commercial |
$631.78
|
| Rate for Payer: PHP Medicare Advantage |
$451.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.25
|
| Rate for Payer: Priority Health Medicare |
$451.27
|
| Rate for Payer: Priority Health Narrow Network |
$731.25
|
| Rate for Payer: Priority Health SBD |
$731.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.27
|
| Rate for Payer: UHC Medicare Advantage |
$451.27
|
| Rate for Payer: UHCCP Medicaid |
$294.37
|
| Rate for Payer: UMR Bronson Commercial |
$333.04
|
|
|
PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33986
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$814.75 |
| Rate for Payer: Aetna Commercial |
$673.87
|
| Rate for Payer: Aetna Medicare |
$523.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.16
|
| Rate for Payer: BCBS Complete |
$344.64
|
| Rate for Payer: BCBS MAPPO |
$502.89
|
| Rate for Payer: BCBS Trust/PPO |
$128.38
|
| Rate for Payer: BCN Commercial |
$747.19
|
| 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 |
$673.87
|
| Rate for Payer: Cofinity Commercial |
$724.16
|
| 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: Meridian Medicaid |
$344.64
|
| Rate for Payer: Nomi Health Commercial |
$603.47
|
| Rate for Payer: PACE SWMI |
$502.89
|
| Rate for Payer: PHP Commercial |
$704.05
|
| Rate for Payer: PHP Medicare Advantage |
$502.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.75
|
| Rate for Payer: Priority Health Medicare |
$502.89
|
| Rate for Payer: Priority Health Narrow Network |
$814.75
|
| Rate for Payer: Priority Health SBD |
$814.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.89
|
| Rate for Payer: UHC Medicare Advantage |
$502.89
|
| Rate for Payer: UHCCP Medicaid |
$328.23
|
| Rate for Payer: UMR Bronson Commercial |
$506.00
|
|
|
PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 95836
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$658.26 |
| Rate for Payer: Aetna Commercial |
$133.84
|
| Rate for Payer: Aetna Medicare |
$103.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.83
|
| Rate for Payer: BCBS Complete |
$70.46
|
| Rate for Payer: BCBS MAPPO |
$99.88
|
| Rate for Payer: BCBS Trust/PPO |
$658.26
|
| Rate for Payer: BCN Commercial |
$152.47
|
| 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 |
$133.84
|
| Rate for Payer: Cofinity Commercial |
$143.83
|
| 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: Meridian Medicaid |
$70.46
|
| Rate for Payer: Nomi Health Commercial |
$119.86
|
| Rate for Payer: PACE SWMI |
$99.88
|
| Rate for Payer: PHP Commercial |
$139.83
|
| Rate for Payer: PHP Medicare Advantage |
$99.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.57
|
| Rate for Payer: Priority Health Medicare |
$99.88
|
| Rate for Payer: Priority Health Narrow Network |
$141.57
|
| Rate for Payer: Priority Health SBD |
$141.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.88
|
| Rate for Payer: UHC Medicare Advantage |
$99.88
|
| Rate for Payer: UHCCP Medicaid |
$67.10
|
| Rate for Payer: UMR Bronson Commercial |
$105.80
|
|
|
PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
HCPCS 43259
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$946.19 |
| Rate for Payer: Aetna Commercial |
$285.21
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.49
|
| Rate for Payer: BCBS Complete |
$149.62
|
| Rate for Payer: BCBS MAPPO |
$212.84
|
| Rate for Payer: BCBS Trust/PPO |
$946.19
|
| Rate for Payer: BCN Commercial |
$322.53
|
| 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 |
$285.21
|
| Rate for Payer: Cofinity Commercial |
$306.49
|
| 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: Meridian Medicaid |
$149.62
|
| Rate for Payer: Nomi Health Commercial |
$255.41
|
| Rate for Payer: PACE SWMI |
$212.84
|
| Rate for Payer: PHP Commercial |
$297.98
|
| Rate for Payer: PHP Medicare Advantage |
$212.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.73
|
| Rate for Payer: Priority Health Medicare |
$212.84
|
| Rate for Payer: Priority Health Narrow Network |
$396.73
|
| Rate for Payer: Priority Health SBD |
$396.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.84
|
| Rate for Payer: UHC Medicare Advantage |
$212.84
|
| Rate for Payer: UHCCP Medicaid |
$142.50
|
| Rate for Payer: UMR Bronson Commercial |
$459.08
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$473.76
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$426.38 |
| Rate for Payer: Aetna American Axle |
$307.94
|
| Rate for Payer: Aetna Commercial |
$402.70
|
| Rate for Payer: Aetna Medicare |
$236.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.94
|
| Rate for Payer: BCBS Complete |
$189.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.03
|
| Rate for Payer: BCN Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$379.01
|
| Rate for Payer: Cash Price |
$379.01
|
| Rate for Payer: Cofinity Commercial |
$331.63
|
| Rate for Payer: Cofinity Commercial |
$407.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.01
|
| Rate for Payer: Healthscope Commercial |
$426.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.70
|
| Rate for Payer: PHP Commercial |
$402.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.94
|
| Rate for Payer: Priority Health SBD |
$298.47
|
| Rate for Payer: UMR Bronson Commercial |
$175.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.32
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$473.76
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.45 |
| Max. Negotiated Rate |
$426.38 |
| Rate for Payer: Aetna American Axle |
$307.94
|
| Rate for Payer: Aetna Commercial |
$402.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.94
|
| Rate for Payer: Cash Price |
$379.01
|
| Rate for Payer: Cofinity Commercial |
$331.63
|
| Rate for Payer: Cofinity Commercial |
$407.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.01
|
| Rate for Payer: Healthscope Commercial |
$426.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.70
|
| Rate for Payer: PHP Commercial |
$402.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.94
|
| Rate for Payer: Priority Health SBD |
$298.47
|
| Rate for Payer: UMR Bronson Commercial |
$208.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.32
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$173.25
|
|
|
Service Code
|
NDC 61314063710
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.10 |
| Max. Negotiated Rate |
$155.92 |
| Rate for Payer: Aetna American Axle |
$112.61
|
| Rate for Payer: Aetna Commercial |
$147.26
|
| Rate for Payer: Aetna Medicare |
$86.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.61
|
| Rate for Payer: BCBS Complete |
$69.30
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Cofinity Commercial |
$149.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.60
|
| Rate for Payer: Healthscope Commercial |
$155.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.26
|
| Rate for Payer: PHP Commercial |
$147.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.61
|
| Rate for Payer: Priority Health SBD |
$109.15
|
| Rate for Payer: UMR Bronson Commercial |
$64.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.94
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$423.71
|
|
|
Service Code
|
NDC 11980018005
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.77 |
| Max. Negotiated Rate |
$381.34 |
| Rate for Payer: Aetna American Axle |
$275.41
|
| Rate for Payer: Aetna Commercial |
$360.15
|
| Rate for Payer: Aetna Medicare |
$211.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.41
|
| Rate for Payer: BCBS Complete |
$169.48
|
| Rate for Payer: Cash Price |
$338.97
|
| Rate for Payer: Cofinity Commercial |
$296.60
|
| Rate for Payer: Cofinity Commercial |
$364.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.97
|
| Rate for Payer: Healthscope Commercial |
$381.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.15
|
| Rate for Payer: PHP Commercial |
$360.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.41
|
| Rate for Payer: Priority Health SBD |
$266.94
|
| Rate for Payer: UMR Bronson Commercial |
$156.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.78
|
|
|
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 |
$45.32 |
| Max. Negotiated Rate |
$92.71 |
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Aetna American Axle |
$66.96
|
| Rate for Payer: Aetna Commercial |
$87.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.96
|
| Rate for Payer: Cofinity Commercial |
$72.11
|
| Rate for Payer: Cofinity Commercial |
$88.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.41
|
| Rate for Payer: Healthscope Commercial |
$92.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.56
|
| Rate for Payer: PHP Commercial |
$87.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.96
|
| Rate for Payer: Priority Health SBD |
$64.90
|
| Rate for Payer: UMR Bronson Commercial |
$45.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$143.22
|
|
|
Service Code
|
NDC 60758011905
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.02 |
| Max. Negotiated Rate |
$128.90 |
| Rate for Payer: Aetna American Axle |
$93.09
|
| Rate for Payer: Aetna Commercial |
$121.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.09
|
| Rate for Payer: Cash Price |
$114.58
|
| Rate for Payer: Cofinity Commercial |
$100.25
|
| Rate for Payer: Cofinity Commercial |
$123.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.58
|
| Rate for Payer: Healthscope Commercial |
$128.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.74
|
| Rate for Payer: PHP Commercial |
$121.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.09
|
| Rate for Payer: Priority Health SBD |
$90.23
|
| Rate for Payer: UMR Bronson Commercial |
$63.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.42
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$423.71
|
|
|
Service Code
|
NDC 11980018005
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.43 |
| Max. Negotiated Rate |
$381.34 |
| Rate for Payer: Aetna American Axle |
$275.41
|
| Rate for Payer: Aetna Commercial |
$360.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.41
|
| Rate for Payer: Cash Price |
$338.97
|
| Rate for Payer: Cofinity Commercial |
$296.60
|
| Rate for Payer: Cofinity Commercial |
$364.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.97
|
| Rate for Payer: Healthscope Commercial |
$381.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.15
|
| Rate for Payer: PHP Commercial |
$360.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.41
|
| Rate for Payer: Priority Health SBD |
$266.94
|
| Rate for Payer: UMR Bronson Commercial |
$186.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.78
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$143.22
|
|
|
Service Code
|
NDC 60758011905
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.99 |
| Max. Negotiated Rate |
$128.90 |
| Rate for Payer: Aetna American Axle |
$93.09
|
| Rate for Payer: Aetna Commercial |
$121.74
|
| Rate for Payer: Aetna Medicare |
$71.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.09
|
| Rate for Payer: BCBS Complete |
$57.29
|
| Rate for Payer: Cash Price |
$114.58
|
| Rate for Payer: Cofinity Commercial |
$100.25
|
| Rate for Payer: Cofinity Commercial |
$123.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.58
|
| Rate for Payer: Healthscope Commercial |
$128.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.74
|
| Rate for Payer: PHP Commercial |
$121.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.09
|
| Rate for Payer: Priority Health SBD |
$90.23
|
| Rate for Payer: UMR Bronson Commercial |
$52.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.42
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$845.85
|
|
|
Service Code
|
NDC 11980018010
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.96 |
| Max. Negotiated Rate |
$761.26 |
| Rate for Payer: Aetna American Axle |
$549.80
|
| Rate for Payer: Aetna Commercial |
$718.97
|
| Rate for Payer: Aetna Medicare |
$422.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.80
|
| Rate for Payer: BCBS Complete |
$338.34
|
| Rate for Payer: Cash Price |
$676.68
|
| Rate for Payer: Cofinity Commercial |
$592.10
|
| Rate for Payer: Cofinity Commercial |
$727.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$592.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.68
|
| Rate for Payer: Healthscope Commercial |
$761.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$592.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.97
|
| Rate for Payer: PHP Commercial |
$718.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.80
|
| Rate for Payer: Priority Health SBD |
$532.89
|
| Rate for Payer: UMR Bronson Commercial |
$312.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.39
|
|
|
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 |
$38.11 |
| Max. Negotiated Rate |
$92.71 |
| Rate for Payer: Aetna American Axle |
$66.96
|
| Rate for Payer: Aetna Commercial |
$87.56
|
| Rate for Payer: Aetna Medicare |
$51.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.96
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Cofinity Commercial |
$72.11
|
| Rate for Payer: Cofinity Commercial |
$88.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.41
|
| Rate for Payer: Healthscope Commercial |
$92.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.56
|
| Rate for Payer: PHP Commercial |
$87.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.96
|
| Rate for Payer: Priority Health SBD |
$64.90
|
| Rate for Payer: UMR Bronson Commercial |
$38.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$173.25
|
|
|
Service Code
|
NDC 61314063710
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$155.92 |
| Rate for Payer: Aetna American Axle |
$112.61
|
| Rate for Payer: Aetna Commercial |
$147.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.61
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Cofinity Commercial |
$149.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.60
|
| Rate for Payer: Healthscope Commercial |
$155.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.26
|
| Rate for Payer: PHP Commercial |
$147.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.61
|
| Rate for Payer: Priority Health SBD |
$109.15
|
| Rate for Payer: UMR Bronson Commercial |
$76.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.94
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$845.85
|
|
|
Service Code
|
NDC 11980018010
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$372.17 |
| Max. Negotiated Rate |
$761.26 |
| Rate for Payer: Aetna American Axle |
$549.80
|
| Rate for Payer: Aetna Commercial |
$718.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.80
|
| Rate for Payer: Cash Price |
$676.68
|
| Rate for Payer: Cofinity Commercial |
$592.10
|
| Rate for Payer: Cofinity Commercial |
$727.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$592.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.68
|
| Rate for Payer: Healthscope Commercial |
$761.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$592.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.97
|
| Rate for Payer: PHP Commercial |
$718.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.80
|
| Rate for Payer: Priority Health SBD |
$532.89
|
| Rate for Payer: UMR Bronson Commercial |
$372.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.39
|
|
