|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$202.76
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$182.48 |
| Rate for Payer: Aetna American Axle |
$131.79
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$141.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.07
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$75.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.07
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
IP
|
$613.92
|
|
|
Service Code
|
NDC 00574010601
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.12 |
| Max. Negotiated Rate |
$552.53 |
| Rate for Payer: Aetna American Axle |
$399.05
|
| Rate for Payer: Aetna Commercial |
$521.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.05
|
| Rate for Payer: Cash Price |
$491.14
|
| Rate for Payer: Cofinity Commercial |
$429.74
|
| Rate for Payer: Cofinity Commercial |
$527.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$429.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.14
|
| Rate for Payer: Healthscope Commercial |
$552.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$429.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.83
|
| Rate for Payer: PHP Commercial |
$521.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.05
|
| Rate for Payer: Priority Health SBD |
$386.77
|
| Rate for Payer: UMR Bronson Commercial |
$270.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.44
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$613.92
|
|
|
Service Code
|
NDC 00574010601
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.15 |
| Max. Negotiated Rate |
$552.53 |
| Rate for Payer: Aetna American Axle |
$399.05
|
| Rate for Payer: Aetna Commercial |
$521.83
|
| Rate for Payer: Aetna Medicare |
$306.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.05
|
| Rate for Payer: BCBS Complete |
$245.57
|
| Rate for Payer: Cash Price |
$491.14
|
| Rate for Payer: Cofinity Commercial |
$429.74
|
| Rate for Payer: Cofinity Commercial |
$527.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$429.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.14
|
| Rate for Payer: Healthscope Commercial |
$552.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$429.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.83
|
| Rate for Payer: PHP Commercial |
$521.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.05
|
| Rate for Payer: Priority Health SBD |
$386.77
|
| Rate for Payer: UMR Bronson Commercial |
$227.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.44
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
OP
|
$2,562.99
|
|
|
Service Code
|
NDC 00378709601
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$948.31 |
| Max. Negotiated Rate |
$2,306.69 |
| Rate for Payer: Aetna American Axle |
$1,665.94
|
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna Medicare |
$1,281.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.94
|
| Rate for Payer: BCBS Complete |
$1,025.20
|
| Rate for Payer: Cash Price |
$2,050.39
|
| Rate for Payer: Cofinity Commercial |
$1,794.09
|
| Rate for Payer: Cofinity Commercial |
$2,204.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,794.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.39
|
| Rate for Payer: Healthscope Commercial |
$2,306.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,794.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,922.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.54
|
| Rate for Payer: PHP Commercial |
$2,178.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.94
|
| Rate for Payer: Priority Health SBD |
$1,614.68
|
| Rate for Payer: UMR Bronson Commercial |
$948.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,922.24
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
OP
|
$469.53
|
|
|
Service Code
|
NDC 68382011006
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.73 |
| Max. Negotiated Rate |
$422.58 |
| Rate for Payer: Aetna American Axle |
$305.19
|
| Rate for Payer: Aetna Commercial |
$399.10
|
| Rate for Payer: Aetna Medicare |
$234.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.19
|
| Rate for Payer: BCBS Complete |
$187.81
|
| Rate for Payer: Cash Price |
$375.62
|
| Rate for Payer: Cofinity Commercial |
$328.67
|
| Rate for Payer: Cofinity Commercial |
$403.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.62
|
| Rate for Payer: Healthscope Commercial |
$422.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.10
|
| Rate for Payer: PHP Commercial |
$399.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.19
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: UMR Bronson Commercial |
$173.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.15
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
OP
|
$1,211.01
|
|
|
Service Code
|
NDC 63304015801
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$448.07 |
| Max. Negotiated Rate |
$1,089.91 |
| Rate for Payer: Aetna American Axle |
$787.16
|
| Rate for Payer: Aetna Commercial |
$1,029.36
|
| Rate for Payer: Aetna Medicare |
$605.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.16
|
| Rate for Payer: BCBS Complete |
$484.40
|
| Rate for Payer: Cash Price |
$968.81
|
| Rate for Payer: Cofinity Commercial |
$1,041.47
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.81
|
| Rate for Payer: Healthscope Commercial |
$1,089.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$847.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.36
|
| Rate for Payer: PHP Commercial |
$1,029.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.16
|
| Rate for Payer: Priority Health SBD |
$762.94
|
| Rate for Payer: UMR Bronson Commercial |
$448.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.26
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$2,562.99
|
|
|
Service Code
|
NDC 00378709601
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,127.72 |
| Max. Negotiated Rate |
$2,306.69 |
| Rate for Payer: Aetna American Axle |
$1,665.94
|
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.94
|
| Rate for Payer: Cash Price |
$2,050.39
|
| Rate for Payer: Cofinity Commercial |
$1,794.09
|
| Rate for Payer: Cofinity Commercial |
$2,204.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,794.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.39
|
| Rate for Payer: Healthscope Commercial |
$2,306.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,794.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,922.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.54
|
| Rate for Payer: PHP Commercial |
$2,178.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.94
|
| Rate for Payer: Priority Health SBD |
$1,614.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,922.24
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$1,211.01
|
|
|
Service Code
|
NDC 63304015801
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$532.84 |
| Max. Negotiated Rate |
$1,089.91 |
| Rate for Payer: Aetna American Axle |
$787.16
|
| Rate for Payer: Aetna Commercial |
$1,029.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.16
|
| Rate for Payer: Cash Price |
$968.81
|
| Rate for Payer: Cofinity Commercial |
$1,041.47
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.81
|
| Rate for Payer: Healthscope Commercial |
$1,089.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$847.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.36
|
| Rate for Payer: PHP Commercial |
$1,029.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.16
|
| Rate for Payer: Priority Health SBD |
$762.94
|
| Rate for Payer: UMR Bronson Commercial |
$532.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.26
|
|
|
BROMOCRIPTINE 5 MG CAPSULE
|
Facility
|
IP
|
$469.53
|
|
|
Service Code
|
NDC 68382011006
|
| Hospital Charge Code |
9296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.59 |
| Max. Negotiated Rate |
$422.58 |
| Rate for Payer: Aetna American Axle |
$305.19
|
| Rate for Payer: Aetna Commercial |
$399.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.19
|
| Rate for Payer: Cash Price |
$375.62
|
| Rate for Payer: Cofinity Commercial |
$328.67
|
| Rate for Payer: Cofinity Commercial |
$403.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.62
|
| Rate for Payer: Healthscope Commercial |
$422.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.10
|
| Rate for Payer: PHP Commercial |
$399.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.19
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: UMR Bronson Commercial |
$206.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.15
|
|
|
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 |
$126.37 |
| 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 |
$2,558.46
|
| Rate for Payer: BCN Commercial |
$2,558.46
|
| 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 |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$126.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| 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 |
$126.66 |
| 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 |
$1,742.88
|
| Rate for Payer: BCN Commercial |
$1,742.88
|
| 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 |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$126.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| 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 |
$148.26 |
| 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 |
$1,623.90
|
| Rate for Payer: BCN Commercial |
$1,623.90
|
| 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 |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$148.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| 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 |
$125.08 |
| 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 |
$1,678.41
|
| Rate for Payer: BCN Commercial |
$1,678.41
|
| 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 |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$125.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH COMPUTER-ASSISTED, IMAGE-GUIDED NAVIGATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE[S])
|
Facility
|
OP
|
$5,288.93
|
|
|
Service Code
|
CPT 31627
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.75 |
| Max. Negotiated Rate |
$5,288.93 |
| Rate for Payer: BCBS Trust/PPO |
$5,288.93
|
| Rate for Payer: BCN Commercial |
$5,288.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.92
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$91.75
|
|
|
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 |
$231.86 |
| 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 |
$3,512.24
|
| Rate for Payer: BCN Commercial |
$3,512.24
|
| 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 |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$231.86
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$1,936.25
|
| 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 |
$209.00 |
| 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 |
$3,116.53
|
| Rate for Payer: BCN Commercial |
$3,116.53
|
| 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 |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$209.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$1,936.25
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$166.85 |
| 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 |
$903.08
|
| Rate for Payer: BCN Commercial |
$903.08
|
| 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) |
$183.54
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$166.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
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 |
$139.75 |
| 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 |
$1,034.34
|
| Rate for Payer: BCN Commercial |
$1,034.34
|
| 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 |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$139.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRACHEAL/BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE
|
Facility
|
OP
|
$11,353.72
|
|
|
Service Code
|
CPT 31630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$188.66 |
| 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 |
$4,072.99
|
| Rate for Payer: BCN Commercial |
$4,072.99
|
| 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) |
$207.53
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$188.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$1,936.25
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
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 |
$166.63 |
| 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 |
$1,859.65
|
| Rate for Payer: BCN Commercial |
$1,859.65
|
| 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 |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$166.63
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$1,936.25
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY(S), EACH ADDITIONAL LOBE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 31633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$289.33
|
| Rate for Payer: BCN Commercial |
$289.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.84
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$59.85
|
|
|
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 |
$177.19 |
| 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 |
$2,815.54
|
| Rate for Payer: BCN Commercial |
$2,815.54
|
| 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 |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$177.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$1,936.25
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$31.41
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$28.27 |
| Rate for Payer: Aetna American Axle |
$20.42
|
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna American Axle |
$6.68
|
| Rate for Payer: Aetna American Axle |
$6.35
|
| Rate for Payer: Aetna Commercial |
$26.70
|
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.42
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$21.99
|
| Rate for Payer: Cofinity Commercial |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$14.72
|
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.70
|
| Rate for Payer: PHP Commercial |
$26.70
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$8.73
|
| Rate for Payer: PHP Commercial |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.68
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: Priority Health SBD |
$6.47
|
| Rate for Payer: Priority Health SBD |
$10.30
|
| Rate for Payer: Priority Health SBD |
$19.79
|
| Rate for Payer: UMR Bronson Commercial |
$13.82
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: UMR Bronson Commercial |
$7.19
|
| Rate for Payer: UMR Bronson Commercial |
$4.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.56
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$9.77
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Healthscope Commercial |
$14.72
|
| Rate for Payer: Aetna American Axle |
$6.35
|
| Rate for Payer: Aetna American Axle |
$20.42
|
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna American Axle |
$6.68
|
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Commercial |
$26.70
|
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.63
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS Complete |
$12.56
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cofinity Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$21.99
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$11.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$28.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$8.73
|
| Rate for Payer: PHP Commercial |
$26.70
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| 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 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 Narrow Network |
$1.13
|
| Rate for Payer: Priority Health SBD |
$10.30
|
| Rate for Payer: Priority Health SBD |
$19.79
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: Priority Health SBD |
$6.47
|
| Rate for Payer: UMR Bronson Commercial |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.61
|
| Rate for Payer: UMR Bronson Commercial |
$11.62
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.26
|
|
|
BUDESONIDE 0.5 MG/2 ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.89
|
|
|
Service Code
|
NDC 00093681673
|
| Hospital Charge Code |
180108
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna American Axle |
$5.13
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UMR Bronson Commercial |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
