|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,548.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$149.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.72 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,600.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.39
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$126.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
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
|
$5,042.78
|
|
|
Service Code
|
CPT 31627
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$5,042.78 |
| Rate for Payer: BCBS Trust/PPO |
$5,042.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.57
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$92.34
|
|
|
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
|
$10,478.92
|
|
|
Service Code
|
CPT 31653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$234.12 |
| Max. Negotiated Rate |
$10,478.92 |
| Rate for Payer: Aetna Medicare |
$3,461.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,160.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,160.89
|
| Rate for Payer: BCBS Complete |
$1,912.01
|
| Rate for Payer: BCBS MAPPO |
$3,328.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,278.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,328.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,328.71
|
| Rate for Payer: Mclaren Medicaid |
$1,820.80
|
| Rate for Payer: Mclaren Medicare |
$3,328.71
|
| Rate for Payer: Meridian Medicaid |
$1,912.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,495.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,828.02
|
| Rate for Payer: PACE Medicare |
$3,162.27
|
| Rate for Payer: PACE SWMI |
$3,328.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,328.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,820.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,478.92
|
| Rate for Payer: Priority Health Medicare |
$3,328.71
|
| Rate for Payer: Priority Health Narrow Network |
$8,383.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,328.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.53
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,328.71
|
| Rate for Payer: UHC Exchange |
$234.12
|
| Rate for Payer: UHC Medicare Advantage |
$3,428.57
|
| Rate for Payer: VA VA |
$3,328.71
|
|
|
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
|
$10,478.92
|
|
|
Service Code
|
CPT 31652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$10,478.92 |
| Rate for Payer: Aetna Medicare |
$3,461.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,160.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,160.89
|
| Rate for Payer: BCBS Complete |
$1,912.01
|
| Rate for Payer: BCBS MAPPO |
$3,328.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,909.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,328.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,328.71
|
| Rate for Payer: Mclaren Medicaid |
$1,820.80
|
| Rate for Payer: Mclaren Medicare |
$3,328.71
|
| Rate for Payer: Meridian Medicaid |
$1,912.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,495.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,828.02
|
| Rate for Payer: PACE Medicare |
$3,162.27
|
| Rate for Payer: PACE SWMI |
$3,328.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,328.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,820.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,478.92
|
| Rate for Payer: Priority Health Medicare |
$3,328.71
|
| Rate for Payer: Priority Health Narrow Network |
$8,383.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,328.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.32
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,328.71
|
| Rate for Payer: UHC Exchange |
$211.20
|
| Rate for Payer: UHC Medicare Advantage |
$3,428.57
|
| Rate for Payer: VA VA |
$3,328.71
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$168.63 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$861.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.49
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$168.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, INITIAL
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$141.45 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$986.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.60
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$141.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRACHEAL/BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE
|
Facility
|
OP
|
$10,478.92
|
|
|
Service Code
|
CPT 31630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.57 |
| Max. Negotiated Rate |
$10,478.92 |
| Rate for Payer: Aetna Medicare |
$3,461.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,160.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,160.89
|
| Rate for Payer: BCBS Complete |
$1,912.01
|
| Rate for Payer: BCBS MAPPO |
$3,328.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,883.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,328.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,328.71
|
| Rate for Payer: Mclaren Medicaid |
$1,820.80
|
| Rate for Payer: Mclaren Medicare |
$3,328.71
|
| Rate for Payer: Meridian Medicaid |
$1,912.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,495.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,828.02
|
| Rate for Payer: PACE Medicare |
$3,162.27
|
| Rate for Payer: PACE SWMI |
$3,328.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,328.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,820.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,478.92
|
| Rate for Payer: Priority Health Medicare |
$3,328.71
|
| Rate for Payer: Priority Health Narrow Network |
$8,383.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,328.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.63
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,328.71
|
| Rate for Payer: UHC Exchange |
$190.57
|
| Rate for Payer: UHC Medicare Advantage |
$3,428.57
|
| Rate for Payer: VA VA |
$3,328.71
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL LUNG BIOPSY(S), SINGLE LOBE
|
Facility
|
OP
|
$10,478.92
|
|
|
Service Code
|
CPT 31628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$168.63 |
| Max. Negotiated Rate |
$10,478.92 |
| Rate for Payer: Aetna Medicare |
$3,461.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,160.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,160.89
|
| Rate for Payer: BCBS Complete |
$1,912.01
|
| Rate for Payer: BCBS MAPPO |
$3,328.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,773.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,328.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,328.71
|
| Rate for Payer: Mclaren Medicaid |
$1,820.80
|
| Rate for Payer: Mclaren Medicare |
$3,328.71
|
| Rate for Payer: Meridian Medicaid |
$1,912.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,495.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,828.02
|
| Rate for Payer: PACE Medicare |
$3,162.27
|
| Rate for Payer: PACE SWMI |
$3,328.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,328.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,820.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,478.92
|
| Rate for Payer: Priority Health Medicare |
$3,328.71
|
| Rate for Payer: Priority Health Narrow Network |
$8,383.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,328.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.49
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,328.71
|
| Rate for Payer: UHC Exchange |
$168.63
|
| Rate for Payer: UHC Medicare Advantage |
$3,428.57
|
| Rate for Payer: VA VA |
$3,328.71
|
|
|
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 |
$60.25 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$275.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.28
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$60.25
|
|
|
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
|
$10,478.92
|
|
|
Service Code
|
CPT 31629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.11 |
| Max. Negotiated Rate |
$10,478.92 |
| Rate for Payer: Aetna Medicare |
$3,461.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,160.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,160.89
|
| Rate for Payer: BCBS Complete |
$1,912.01
|
| Rate for Payer: BCBS MAPPO |
$3,328.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,684.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,328.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,328.71
|
| Rate for Payer: Mclaren Medicaid |
$1,820.80
|
| Rate for Payer: Mclaren Medicare |
$3,328.71
|
| Rate for Payer: Meridian Medicaid |
$1,912.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,495.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,828.02
|
| Rate for Payer: PACE Medicare |
$3,162.27
|
| Rate for Payer: PACE SWMI |
$3,328.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,328.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,820.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,478.92
|
| Rate for Payer: Priority Health Medicare |
$3,328.71
|
| Rate for Payer: Priority Health Narrow Network |
$8,383.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,328.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.02
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,328.71
|
| Rate for Payer: UHC Exchange |
$179.11
|
| Rate for Payer: UHC Medicare Advantage |
$3,428.57
|
| Rate for Payer: VA VA |
$3,328.71
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.97
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UMR Bronson Commercial |
$13.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
BUDESONIDE 0.5 MG/2 ML ORAL SUSPENSION
|
Facility
|
IP
|
$15.70
|
|
|
Service Code
|
NDC 0093-6816-73
|
| Hospital Charge Code |
180108
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$14.13 |
| Rate for Payer: Aetna American Axle |
$10.20
|
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: Cofinity Commercial |
$10.99
|
| Rate for Payer: Cofinity Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$14.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.34
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.99
|
| Rate for Payer: Priority Health SBD |
$9.89
|
| Rate for Payer: UMR Bronson Commercial |
$6.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.78
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna American Axle |
$7.86
|
| Rate for Payer: Aetna American Axle |
$5.62
|
| Rate for Payer: Aetna American Axle |
$22.93
|
| Rate for Payer: Aetna American Axle |
$8.87
|
| Rate for Payer: Aetna American Axle |
$11.17
|
| Rate for Payer: Aetna American Axle |
$20.78
|
| Rate for Payer: Aetna Commercial |
$11.60
|
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Commercial |
$29.98
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$14.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.87
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$12.03
|
| Rate for Payer: Cofinity Commercial |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$30.33
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Commercial |
$11.74
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Cofinity Commercial |
$22.38
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$12.28
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$31.74
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$15.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.60
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$14.60
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: PHP Commercial |
$11.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.05
|
| Rate for Payer: Priority Health SBD |
$20.14
|
| Rate for Payer: Priority Health SBD |
$7.62
|
| Rate for Payer: Priority Health SBD |
$10.82
|
| Rate for Payer: Priority Health SBD |
$8.60
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: Priority Health SBD |
$22.22
|
| Rate for Payer: UMR Bronson Commercial |
$15.52
|
| Rate for Payer: UMR Bronson Commercial |
$14.07
|
| Rate for Payer: UMR Bronson Commercial |
$6.01
|
| Rate for Payer: UMR Bronson Commercial |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.32
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
|
IP
|
$861.28
|
|
|
Service Code
|
NDC 0186-0916-12
|
| Hospital Charge Code |
96977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.96 |
| Max. Negotiated Rate |
$775.15 |
| Rate for Payer: Aetna American Axle |
$559.83
|
| Rate for Payer: Aetna Commercial |
$732.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.83
|
| Rate for Payer: Cash Price |
$689.02
|
| Rate for Payer: Cofinity Commercial |
$740.70
|
| Rate for Payer: Cofinity Commercial |
$602.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.02
|
| Rate for Payer: Healthscope Commercial |
$775.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$732.09
|
| Rate for Payer: PHP Commercial |
$732.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.90
|
| Rate for Payer: Priority Health SBD |
$542.61
|
| Rate for Payer: UMR Bronson Commercial |
$378.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.96
|
|
|
BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$31.11
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$45.86
|
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Cash Price |
$56.45
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$60.68
|
| Rate for Payer: Cofinity Commercial |
$49.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$63.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.98
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$59.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.39
|
| Rate for Payer: Priority Health SBD |
$44.45
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: UMR Bronson Commercial |
$31.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.92
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$1,529.58
|
|
|
Service Code
|
NDC 0378-7155-01
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$673.02 |
| Max. Negotiated Rate |
$1,376.62 |
| Rate for Payer: Aetna American Axle |
$994.23
|
| Rate for Payer: Aetna Commercial |
$1,300.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.23
|
| Rate for Payer: Cash Price |
$1,223.66
|
| Rate for Payer: Cofinity Commercial |
$1,070.71
|
| Rate for Payer: Cofinity Commercial |
$1,315.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,223.66
|
| Rate for Payer: Healthscope Commercial |
$1,376.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,070.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,147.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,300.14
|
| Rate for Payer: PHP Commercial |
$1,300.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.71
|
| Rate for Payer: Priority Health SBD |
$963.64
|
| Rate for Payer: UMR Bronson Commercial |
$673.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,147.18
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$312.96
|
|
|
Service Code
|
NDC 65162-778-10
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$281.66 |
| Rate for Payer: Aetna American Axle |
$203.42
|
| Rate for Payer: Aetna Commercial |
$266.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.42
|
| Rate for Payer: Cash Price |
$250.37
|
| Rate for Payer: Cofinity Commercial |
$219.07
|
| Rate for Payer: Cofinity Commercial |
$269.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.37
|
| Rate for Payer: Healthscope Commercial |
$281.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.02
|
| Rate for Payer: PHP Commercial |
$266.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.07
|
| Rate for Payer: Priority Health SBD |
$197.16
|
| Rate for Payer: UMR Bronson Commercial |
$137.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.72
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$440.64
|
|
|
Service Code
|
NDC 0574-9855-10
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.88 |
| Max. Negotiated Rate |
$396.58 |
| Rate for Payer: Aetna American Axle |
$286.42
|
| Rate for Payer: Aetna Commercial |
$374.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.42
|
| Rate for Payer: Cash Price |
$352.51
|
| Rate for Payer: Cofinity Commercial |
$308.45
|
| Rate for Payer: Cofinity Commercial |
$378.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.51
|
| Rate for Payer: Healthscope Commercial |
$396.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.54
|
| Rate for Payer: PHP Commercial |
$374.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.45
|
| Rate for Payer: Priority Health SBD |
$277.60
|
| Rate for Payer: UMR Bronson Commercial |
$193.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.48
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
NDC 0186-0370-28
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.68 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$129.95
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.79
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health SBD |
$116.95
|
| Rate for Payer: UMR Bronson Commercial |
$81.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
NDC 0186-0372-28
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.68 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Cofinity Commercial |
$129.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.79
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health SBD |
$116.95
|
| Rate for Payer: UMR Bronson Commercial |
$81.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUFFERED LIDOCAINE 1% SOLUTION CUSTOM
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 0990-0001-06
|
| Hospital Charge Code |
500546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.44
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: UMR Bronson Commercial |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
BUFFERED LIDOCAINE 1% WITH EPI
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
NDC 9900-0001-49
|
| Hospital Charge Code |
500548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna American Axle |
$10.76
|
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.76
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$11.59
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.08
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health SBD |
$10.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.42
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.77
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$25.89 |
| Rate for Payer: Aetna American Axle |
$18.70
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.70
|
| Rate for Payer: BCBS Complete |
$11.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.45
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: Priority Health SBD |
$18.13
|
| Rate for Payer: UMR Bronson Commercial |
$10.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$27.99
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$25.19 |
| Rate for Payer: Aetna American Axle |
$18.19
|
| Rate for Payer: Aetna American Axle |
$12.66
|
| Rate for Payer: Aetna American Axle |
$18.70
|
| Rate for Payer: Aetna American Axle |
$14.96
|
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna American Axle |
$13.38
|
| Rate for Payer: Aetna American Axle |
$16.74
|
| Rate for Payer: Aetna American Axle |
$16.59
|
| Rate for Payer: Aetna American Axle |
$15.80
|
| Rate for Payer: Aetna American Axle |
$15.68
|
| Rate for Payer: Aetna American Axle |
$14.53
|
| Rate for Payer: Aetna Commercial |
$20.66
|
| Rate for Payer: Aetna Commercial |
$22.68
|
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Commercial |
$19.57
|
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| Rate for Payer: Aetna Commercial |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$18.68
|
| Rate for Payer: Cofinity Commercial |
$14.41
|
| Rate for Payer: Cofinity Commercial |
$17.02
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$19.80
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$15.64
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$20.91
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$13.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$20.12
|
| Rate for Payer: Healthscope Commercial |
$17.52
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$21.88
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$24.01
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.55
|
| Rate for Payer: PHP Commercial |
$20.51
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: PHP Commercial |
$22.68
|
| Rate for Payer: PHP Commercial |
$23.79
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: PHP Commercial |
$19.57
|
| Rate for Payer: PHP Commercial |
$20.66
|
| Rate for Payer: PHP Commercial |
$17.49
|
| Rate for Payer: PHP Commercial |
$16.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: Priority Health SBD |
$14.50
|
| Rate for Payer: Priority Health SBD |
$15.32
|
| Rate for Payer: Priority Health SBD |
$14.08
|
| Rate for Payer: Priority Health SBD |
$17.63
|
| Rate for Payer: Priority Health SBD |
$16.81
|
| Rate for Payer: Priority Health SBD |
$18.13
|
| Rate for Payer: Priority Health SBD |
$12.27
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$15.20
|
| Rate for Payer: Priority Health SBD |
$12.97
|
| Rate for Payer: Priority Health SBD |
$16.23
|
| Rate for Payer: UMR Bronson Commercial |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.23
|
| Rate for Payer: UMR Bronson Commercial |
$9.83
|
| Rate for Payer: UMR Bronson Commercial |
$12.66
|
| Rate for Payer: UMR Bronson Commercial |
$10.70
|
| Rate for Payer: UMR Bronson Commercial |
$11.74
|
| Rate for Payer: UMR Bronson Commercial |
$12.32
|
| Rate for Payer: UMR Bronson Commercial |
$8.57
|
| Rate for Payer: UMR Bronson Commercial |
$10.62
|
| Rate for Payer: UMR Bronson Commercial |
$10.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
|
