|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,105.56
|
| Rate for Payer: BCN Commercial |
$2,105.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,961.82
|
| Rate for Payer: BCN Commercial |
$1,961.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,027.68
|
| Rate for Payer: BCN Commercial |
$2,027.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
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
|
$12,013.78
|
|
|
Service Code
|
CPT 31653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,704.72
|
| Rate for Payer: BCN Commercial |
$3,704.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$3,714.94
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
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
|
$12,013.78
|
|
|
Service Code
|
CPT 31652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,287.32
|
| Rate for Payer: BCN Commercial |
$3,287.32
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$3,714.94
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.01
|
| Rate for Payer: BCN Commercial |
$1,091.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, INITIAL
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.58
|
| Rate for Payer: BCN Commercial |
$1,249.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRACHEAL/BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE
|
Facility
|
OP
|
$12,013.78
|
|
|
Service Code
|
CPT 31630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$4,920.56
|
| Rate for Payer: BCN Commercial |
$4,920.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$3,714.94
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL LUNG BIOPSY(S), SINGLE LOBE
|
Facility
|
OP
|
$12,013.78
|
|
|
Service Code
|
CPT 31628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,246.63
|
| Rate for Payer: BCN Commercial |
$2,246.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$3,714.94
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$16.35
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$14.71 |
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna American Axle |
$5.64
|
| Rate for Payer: Aetna American Axle |
$6.35
|
| Rate for Payer: Aetna American Axle |
$6.68
|
| Rate for Payer: Aetna American Axle |
$20.42
|
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Commercial |
$26.70
|
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Commercial |
$7.38
|
| Rate for Payer: Aetna Medicare |
$4.34
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: Aetna Medicare |
$15.71
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| 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) |
$10.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.64
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS Complete |
$3.47
|
| Rate for Payer: BCBS Complete |
$12.56
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cofinity Advantage |
$6.08
|
| Rate for Payer: Cofinity Advantage |
$21.99
|
| Rate for Payer: Cofinity Advantage |
$6.84
|
| Rate for Payer: Cofinity Advantage |
$11.45
|
| Rate for Payer: Cofinity Advantage |
$7.19
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$14.06
|
| 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: Encore Health Key Benefits Commercial |
$6.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$7.81
|
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$14.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.08
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$7.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.22
|
| 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 |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.51
|
| Rate for Payer: PHP Commercial |
$7.38
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$26.70
|
| Rate for Payer: PHP Commercial |
$13.90
|
| Rate for Payer: PHP Commercial |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health SBD |
$6.47
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: Priority Health SBD |
$19.79
|
| Rate for Payer: Priority Health SBD |
$10.30
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.35
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: UHC Core |
$8.52
|
| Rate for Payer: UHC Core |
$5.09
|
| Rate for Payer: UHC Core |
$16.36
|
| Rate for Payer: UHC Core |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Exchange |
$3.41
|
| Rate for Payer: UHC Exchange |
$6.43
|
| Rate for Payer: UHC Exchange |
$12.34
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: UMR Bronson Commercial |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$3.61
|
| Rate for Payer: UMR Bronson Commercial |
$3.21
|
| Rate for Payer: UMR Bronson Commercial |
$11.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$8.68
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$7.81 |
| Rate for Payer: Aetna American Axle |
$5.64
|
| Rate for Payer: Aetna American Axle |
$20.42
|
| Rate for Payer: Aetna American Axle |
$6.35
|
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna American Axle |
$6.68
|
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna Commercial |
$26.70
|
| Rate for Payer: Aetna Commercial |
$7.38
|
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.35
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cofinity Advantage |
$7.19
|
| Rate for Payer: Cofinity Advantage |
$6.84
|
| Rate for Payer: Cofinity Advantage |
$11.45
|
| Rate for Payer: Cofinity Advantage |
$6.08
|
| Rate for Payer: Cofinity Advantage |
$21.99
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Commercial |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$7.81
|
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.45
|
| 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 |
$6.08
|
| 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 |
$23.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.51
|
| Rate for Payer: PHP Commercial |
$26.70
|
| Rate for Payer: PHP Commercial |
$8.73
|
| Rate for Payer: PHP Commercial |
$7.38
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$13.90
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: Priority Health SBD |
$10.30
|
| Rate for Payer: Priority Health SBD |
$6.47
|
| Rate for Payer: Priority Health SBD |
$19.79
|
| Rate for Payer: UMR Bronson Commercial |
$7.19
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: UMR Bronson Commercial |
$13.82
|
| Rate for Payer: UMR Bronson Commercial |
$4.52
|
| Rate for Payer: UMR Bronson Commercial |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.56
|
| 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
|
|
|
BUDESONIDE 0.5 MG/2 ML ORAL SUSPENSION
|
Facility
|
OP
|
$30.51
|
|
|
Service Code
|
NDC 00093681673
|
| Hospital Charge Code |
180108
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$27.46 |
| Rate for Payer: Aetna American Axle |
$19.83
|
| Rate for Payer: Aetna Commercial |
$25.93
|
| Rate for Payer: Aetna Medicare |
$15.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.83
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cofinity Advantage |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$27.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: Priority Health SBD |
$19.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.83
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: UHC Exchange |
$11.99
|
| Rate for Payer: UMR Bronson Commercial |
$11.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.88
|
|
|
BUDESONIDE 0.5 MG/2 ML ORAL SUSPENSION
|
Facility
|
IP
|
$30.51
|
|
|
Service Code
|
NDC 00093681673
|
| Hospital Charge Code |
180108
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$27.46 |
| Rate for Payer: Aetna American Axle |
$19.83
|
| Rate for Payer: Aetna Commercial |
$25.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.83
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cofinity Advantage |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$27.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: Priority Health SBD |
$19.22
|
| Rate for Payer: UMR Bronson Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.88
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$8.36
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Aetna American Axle |
$5.43
|
| Rate for Payer: Aetna American Axle |
$5.42
|
| Rate for Payer: Aetna American Axle |
$6.68
|
| Rate for Payer: Aetna American Axle |
$5.41
|
| Rate for Payer: Aetna American Axle |
$24.04
|
| Rate for Payer: Aetna American Axle |
$20.78
|
| Rate for Payer: Aetna American Axle |
$19.83
|
| Rate for Payer: Aetna American Axle |
$10.88
|
| Rate for Payer: Aetna American Axle |
$9.63
|
| Rate for Payer: Aetna Commercial |
$7.09
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna Commercial |
$25.93
|
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Advantage |
$21.36
|
| Rate for Payer: Cofinity Advantage |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$10.37
|
| Rate for Payer: Cofinity Advantage |
$5.85
|
| Rate for Payer: Cofinity Advantage |
$5.82
|
| Rate for Payer: Cofinity Advantage |
$25.89
|
| Rate for Payer: Cofinity Advantage |
$5.84
|
| Rate for Payer: Cofinity Advantage |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$7.17
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Healthscope Commercial |
$7.51
|
| Rate for Payer: Healthscope Commercial |
$13.33
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$7.52
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: PHP Commercial |
$12.59
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Commercial |
$7.09
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: PHP Commercial |
$7.11
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: Priority Health SBD |
$20.14
|
| Rate for Payer: Priority Health SBD |
$5.27
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: Priority Health SBD |
$9.33
|
| Rate for Payer: Priority Health SBD |
$6.48
|
| Rate for Payer: Priority Health SBD |
$5.25
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: Priority Health SBD |
$19.22
|
| Rate for Payer: UMR Bronson Commercial |
$4.52
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: UMR Bronson Commercial |
$16.27
|
| Rate for Payer: UMR Bronson Commercial |
$13.42
|
| Rate for Payer: UMR Bronson Commercial |
$3.66
|
| Rate for Payer: UMR Bronson Commercial |
$14.07
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
| Rate for Payer: UMR Bronson Commercial |
$6.52
|
| Rate for Payer: UMR Bronson Commercial |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.27
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Aetna American Axle |
$5.43
|
| Rate for Payer: Aetna American Axle |
$10.88
|
| Rate for Payer: Aetna American Axle |
$9.63
|
| Rate for Payer: Aetna American Axle |
$20.78
|
| Rate for Payer: Aetna American Axle |
$19.83
|
| Rate for Payer: Aetna American Axle |
$6.68
|
| Rate for Payer: Aetna American Axle |
$24.04
|
| Rate for Payer: Aetna American Axle |
$5.41
|
| Rate for Payer: Aetna American Axle |
$5.42
|
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: Aetna Commercial |
$7.09
|
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna Commercial |
$25.93
|
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Medicare |
$15.98
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Aetna Medicare |
$7.41
|
| Rate for Payer: Aetna Medicare |
$8.37
|
| Rate for Payer: Aetna Medicare |
$4.18
|
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Aetna Medicare |
$18.49
|
| Rate for Payer: Aetna Medicare |
$15.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.42
|
| Rate for Payer: BCBS Complete |
$3.33
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: BCBS Complete |
$14.79
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cofinity Advantage |
$5.84
|
| Rate for Payer: Cofinity Advantage |
$10.37
|
| Rate for Payer: Cofinity Advantage |
$5.85
|
| Rate for Payer: Cofinity Advantage |
$5.82
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Advantage |
$25.89
|
| Rate for Payer: Cofinity Advantage |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$7.20
|
| Rate for Payer: Cofinity Advantage |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Cofinity Commercial |
$7.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.69
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$7.51
|
| Rate for Payer: Healthscope Commercial |
$13.33
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$7.52
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Commercial |
$7.11
|
| Rate for Payer: PHP Commercial |
$7.09
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$12.59
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: Priority Health SBD |
$19.22
|
| Rate for Payer: Priority Health SBD |
$6.48
|
| Rate for Payer: Priority Health SBD |
$20.14
|
| Rate for Payer: Priority Health SBD |
$9.33
|
| Rate for Payer: Priority Health SBD |
$5.25
|
| Rate for Payer: Priority Health SBD |
$5.27
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.43
|
| Rate for Payer: UHC Core |
$4.35
|
| Rate for Payer: UHC Core |
$19.27
|
| Rate for Payer: UHC Core |
$4.36
|
| Rate for Payer: UHC Core |
$8.72
|
| Rate for Payer: UHC Core |
$4.33
|
| Rate for Payer: UHC Core |
$5.36
|
| Rate for Payer: UHC Core |
$7.72
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: UHC Core |
$16.66
|
| Rate for Payer: UHC Exchange |
$3.27
|
| Rate for Payer: UHC Exchange |
$14.53
|
| Rate for Payer: UHC Exchange |
$12.56
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UHC Exchange |
$6.58
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Exchange |
$3.28
|
| Rate for Payer: UHC Exchange |
$3.29
|
| Rate for Payer: UHC Exchange |
$11.99
|
| Rate for Payer: UMR Bronson Commercial |
$3.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.29
|
| Rate for Payer: UMR Bronson Commercial |
$3.09
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: UMR Bronson Commercial |
$13.68
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$11.83
|
| Rate for Payer: UMR Bronson Commercial |
$3.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
|
OP
|
$861.28
|
|
|
Service Code
|
NDC 00186091612
|
| Hospital Charge Code |
96977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.67 |
| Max. Negotiated Rate |
$775.15 |
| Rate for Payer: Aetna American Axle |
$559.83
|
| Rate for Payer: Aetna Commercial |
$732.09
|
| Rate for Payer: Aetna Medicare |
$430.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.83
|
| Rate for Payer: BCBS Complete |
$344.51
|
| Rate for Payer: Cash Price |
$689.02
|
| Rate for Payer: Cofinity Advantage |
$602.90
|
| Rate for Payer: Cofinity Commercial |
$740.70
|
| 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: MI Amish Medical Board Commercial |
$689.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.96
|
| Rate for Payer: PHP Commercial |
$732.09
|
| Rate for Payer: Priority Health SBD |
$542.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.83
|
| Rate for Payer: UHC Core |
$448.73
|
| Rate for Payer: UHC Exchange |
$338.48
|
| Rate for Payer: UMR Bronson Commercial |
$318.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.96
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
|
IP
|
$861.28
|
|
|
Service Code
|
NDC 00186091612
|
| 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 Advantage |
$602.90
|
| Rate for Payer: Cofinity Commercial |
$740.70
|
| 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 Commercial |
$732.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.96
|
| Rate for Payer: PHP Commercial |
$732.09
|
| 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
|
OP
|
$10.28
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna American Axle |
$6.68
|
| Rate for Payer: Aetna American Axle |
$20.88
|
| Rate for Payer: Aetna American Axle |
$48.09
|
| Rate for Payer: Aetna Commercial |
$27.31
|
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$62.88
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Aetna Medicare |
$36.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS Complete |
$29.59
|
| Rate for Payer: BCBS Complete |
$12.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$59.18
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$59.18
|
| Rate for Payer: Cofinity Advantage |
$22.49
|
| Rate for Payer: Cofinity Advantage |
$51.79
|
| Rate for Payer: Cofinity Advantage |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$27.63
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$66.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.10
|
| Rate for Payer: PHP Commercial |
$27.31
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Commercial |
$62.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.05
|
| Rate for Payer: Priority Health SBD |
$46.61
|
| Rate for Payer: Priority Health SBD |
$20.24
|
| Rate for Payer: Priority Health SBD |
$6.48
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Tiered Network |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.09
|
| Rate for Payer: UHC Core |
$5.36
|
| Rate for Payer: UHC Core |
$38.54
|
| Rate for Payer: UHC Core |
$16.74
|
| Rate for Payer: UHC Exchange |
$12.63
|
| Rate for Payer: UHC Exchange |
$29.07
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: UMR Bronson Commercial |
$11.89
|
| Rate for Payer: UMR Bronson Commercial |
$27.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
|
|
BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$10.28
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna American Axle |
$6.68
|
| Rate for Payer: Aetna American Axle |
$48.09
|
| Rate for Payer: Aetna American Axle |
$20.88
|
| Rate for Payer: Aetna Commercial |
$27.31
|
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$62.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$59.18
|
| Rate for Payer: Cofinity Advantage |
$51.79
|
| Rate for Payer: Cofinity Advantage |
$7.20
|
| Rate for Payer: Cofinity Advantage |
$22.49
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Cofinity Commercial |
$27.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.18
|
| Rate for Payer: Healthscope Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.48
|
| Rate for Payer: PHP Commercial |
$27.31
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Commercial |
$62.88
|
| Rate for Payer: Priority Health SBD |
$6.48
|
| Rate for Payer: Priority Health SBD |
$20.24
|
| Rate for Payer: Priority Health SBD |
$46.61
|
| Rate for Payer: UMR Bronson Commercial |
$4.52
|
| Rate for Payer: UMR Bronson Commercial |
$32.55
|
| Rate for Payer: UMR Bronson Commercial |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.48
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$1,529.58
|
|
|
Service Code
|
NDC 00378715501
|
| 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 Advantage |
$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 Commercial |
$1,300.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,147.18
|
| Rate for Payer: PHP Commercial |
$1,300.14
|
| 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
|
OP
|
$317.76
|
|
|
Service Code
|
NDC 65162077810
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.57 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna American Axle |
$206.54
|
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Aetna Medicare |
$158.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.54
|
| Rate for Payer: BCBS Complete |
$127.10
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Advantage |
$222.43
|
| Rate for Payer: Cofinity Commercial |
$273.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$285.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: Priority Health SBD |
$200.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.54
|
| Rate for Payer: UHC Core |
$165.55
|
| Rate for Payer: UHC Exchange |
$124.88
|
| Rate for Payer: UMR Bronson Commercial |
$117.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.32
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
OP
|
$1,529.58
|
|
|
Service Code
|
NDC 00378715501
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$565.94 |
| 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 Medicare |
$764.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.23
|
| Rate for Payer: BCBS Complete |
$611.83
|
| Rate for Payer: Cash Price |
$1,223.66
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$1,223.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,147.18
|
| Rate for Payer: PHP Commercial |
$1,300.14
|
| Rate for Payer: Priority Health SBD |
$963.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$994.23
|
| Rate for Payer: UHC Core |
$796.91
|
| Rate for Payer: UHC Exchange |
$601.12
|
| Rate for Payer: UMR Bronson Commercial |
$565.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,147.18
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
OP
|
$440.64
|
|
|
Service Code
|
NDC 00574985510
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.04 |
| Max. Negotiated Rate |
$396.58 |
| Rate for Payer: Aetna American Axle |
$286.42
|
| Rate for Payer: Aetna Commercial |
$374.54
|
| Rate for Payer: Aetna Medicare |
$220.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.42
|
| Rate for Payer: BCBS Complete |
$176.26
|
| Rate for Payer: Cash Price |
$352.51
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$352.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.48
|
| Rate for Payer: PHP Commercial |
$374.54
|
| Rate for Payer: Priority Health SBD |
$277.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.42
|
| Rate for Payer: UHC Core |
$229.57
|
| Rate for Payer: UHC Exchange |
$173.17
|
| Rate for Payer: UMR Bronson Commercial |
$163.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.48
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$317.76
|
|
|
Service Code
|
NDC 65162077810
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.81 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna American Axle |
$206.54
|
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.54
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Advantage |
$222.43
|
| Rate for Payer: Cofinity Commercial |
$273.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$285.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: Priority Health SBD |
$200.19
|
| Rate for Payer: UMR Bronson Commercial |
$139.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.32
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$440.64
|
|
|
Service Code
|
NDC 00574985510
|
| 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 Advantage |
$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 Commercial |
$374.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.48
|
| Rate for Payer: PHP Commercial |
$374.54
|
| 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
|
|
