|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$100.87
|
|
|
Service Code
|
NDC 61314-637-05
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna American Axle |
$65.57
|
| Rate for Payer: Aetna Commercial |
$85.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cofinity Commercial |
$70.61
|
| Rate for Payer: Cofinity Commercial |
$86.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.70
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.74
|
| Rate for Payer: PHP Commercial |
$85.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.61
|
| Rate for Payer: Priority Health SBD |
$63.55
|
| Rate for Payer: UMR Bronson Commercial |
$44.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.65
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$7.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.19 |
| Rate for Payer: Aetna American Axle |
$5.19
|
| Rate for Payer: Aetna American Axle |
$590.09
|
| Rate for Payer: Aetna American Axle |
$503.21
|
| Rate for Payer: Aetna American Axle |
$12.45
|
| Rate for Payer: Aetna American Axle |
$3.97
|
| Rate for Payer: Aetna Commercial |
$771.66
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Commercial |
$658.04
|
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Commercial |
$5.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.19
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cash Price |
$15.33
|
| Rate for Payer: Cash Price |
$726.26
|
| Rate for Payer: Cash Price |
$619.34
|
| Rate for Payer: Cash Price |
$4.89
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Cofinity Commercial |
$13.41
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$4.28
|
| Rate for Payer: Cofinity Commercial |
$5.25
|
| Rate for Payer: Cofinity Commercial |
$635.48
|
| Rate for Payer: Cofinity Commercial |
$541.92
|
| Rate for Payer: Cofinity Commercial |
$665.79
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Cofinity Commercial |
$780.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.34
|
| Rate for Payer: Healthscope Commercial |
$696.75
|
| Rate for Payer: Healthscope Commercial |
$817.05
|
| Rate for Payer: Healthscope Commercial |
$7.19
|
| Rate for Payer: Healthscope Commercial |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$635.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$680.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$771.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$658.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.19
|
| Rate for Payer: PHP Commercial |
$771.66
|
| Rate for Payer: PHP Commercial |
$658.04
|
| Rate for Payer: PHP Commercial |
$5.19
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.48
|
| Rate for Payer: Priority Health SBD |
$487.73
|
| Rate for Payer: Priority Health SBD |
$12.07
|
| Rate for Payer: Priority Health SBD |
$3.85
|
| Rate for Payer: Priority Health SBD |
$5.03
|
| Rate for Payer: Priority Health SBD |
$571.93
|
| Rate for Payer: UMR Bronson Commercial |
$3.52
|
| Rate for Payer: UMR Bronson Commercial |
$8.43
|
| Rate for Payer: UMR Bronson Commercial |
$340.63
|
| Rate for Payer: UMR Bronson Commercial |
$399.45
|
| Rate for Payer: UMR Bronson Commercial |
$2.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$680.87
|
|
|
PREDNISONE 10 MG TABLET
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Aetna American Axle |
$276.48
|
| Rate for Payer: Aetna American Axle |
$248.98
|
| Rate for Payer: Aetna American Axle |
$2.51
|
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna American Axle |
$30.40
|
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$325.59
|
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna Commercial |
$39.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$37.42
|
| Rate for Payer: Cash Price |
$306.44
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$268.14
|
| Rate for Payer: Cofinity Commercial |
$329.42
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$297.74
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Cofinity Commercial |
$40.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$382.82
|
| Rate for Payer: Healthscope Commercial |
$3.47
|
| Rate for Payer: Healthscope Commercial |
$344.74
|
| Rate for Payer: Healthscope Commercial |
$42.09
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.75
|
| Rate for Payer: PHP Commercial |
$3.28
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: PHP Commercial |
$39.75
|
| Rate for Payer: PHP Commercial |
$325.59
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.74
|
| Rate for Payer: Priority Health SBD |
$267.97
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: Priority Health SBD |
$29.47
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: Priority Health SBD |
$241.32
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UMR Bronson Commercial |
$187.15
|
| Rate for Payer: UMR Bronson Commercial |
$169.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: UMR Bronson Commercial |
$20.58
|
| Rate for Payer: UMR Bronson Commercial |
$168.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
PREDNISONE 1 MG TABLET
|
Facility
|
IP
|
$196.65
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.53 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna American Axle |
$127.82
|
| Rate for Payer: Aetna American Axle |
$151.22
|
| Rate for Payer: Aetna American Axle |
$293.28
|
| Rate for Payer: Aetna Commercial |
$167.15
|
| Rate for Payer: Aetna Commercial |
$197.75
|
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: Cash Price |
$186.12
|
| Rate for Payer: Cash Price |
$157.32
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$200.08
|
| Rate for Payer: Cofinity Commercial |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$137.66
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$169.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Healthscope Commercial |
$209.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.15
|
| Rate for Payer: PHP Commercial |
$167.15
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$197.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.84
|
| Rate for Payer: Priority Health SBD |
$146.57
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: Priority Health SBD |
$123.89
|
| Rate for Payer: UMR Bronson Commercial |
$86.53
|
| Rate for Payer: UMR Bronson Commercial |
$102.37
|
| Rate for Payer: UMR Bronson Commercial |
$198.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.49
|
|
|
PREDNISONE 20 MG TABLET
|
Facility
|
IP
|
$20.14
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6496
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$18.13 |
| Rate for Payer: Aetna American Axle |
$13.09
|
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna American Axle |
$2,886.98
|
| Rate for Payer: Aetna American Axle |
$2.02
|
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna American Axle |
$1,458.76
|
| Rate for Payer: Aetna American Axle |
$300.92
|
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna Commercial |
$17.12
|
| Rate for Payer: Aetna Commercial |
$3,775.28
|
| Rate for Payer: Aetna Commercial |
$1,907.61
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Commercial |
$393.51
|
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,886.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,458.76
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$1,795.40
|
| Rate for Payer: Cash Price |
$16.11
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cash Price |
$370.36
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cash Price |
$3,553.20
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Cofinity Commercial |
$398.14
|
| Rate for Payer: Cofinity Commercial |
$1,570.98
|
| Rate for Payer: Cofinity Commercial |
$1,930.06
|
| Rate for Payer: Cofinity Commercial |
$324.06
|
| Rate for Payer: Cofinity Commercial |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Cofinity Commercial |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Commercial |
$3,109.05
|
| Rate for Payer: Cofinity Commercial |
$3,819.69
|
| Rate for Payer: Cofinity Commercial |
$317.48
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,795.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,553.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$2,019.82
|
| Rate for Payer: Healthscope Commercial |
$416.66
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$18.13
|
| Rate for Payer: Healthscope Commercial |
$3,997.35
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,109.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,570.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,331.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,683.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$393.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,907.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,775.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.69
|
| Rate for Payer: PHP Commercial |
$17.12
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: PHP Commercial |
$3,775.28
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: PHP Commercial |
$1,907.61
|
| Rate for Payer: PHP Commercial |
$393.51
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,109.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,570.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.10
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: Priority Health SBD |
$2,798.14
|
| Rate for Payer: Priority Health SBD |
$1.96
|
| Rate for Payer: Priority Health SBD |
$291.66
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: Priority Health SBD |
$12.69
|
| Rate for Payer: Priority Health SBD |
$1,413.88
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$987.47
|
| Rate for Payer: UMR Bronson Commercial |
$8.86
|
| Rate for Payer: UMR Bronson Commercial |
$129.25
|
| Rate for Payer: UMR Bronson Commercial |
$136.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$148.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,954.26
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: UMR Bronson Commercial |
$203.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,331.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,683.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.21
|
|
|
PREDNISONE 2.5 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna American Axle |
$206.21
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Commercial |
$269.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Cofinity Commercial |
$136.54
|
| Rate for Payer: Cofinity Commercial |
$222.08
|
| Rate for Payer: Cofinity Commercial |
$272.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$285.52
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.79
|
| Rate for Payer: PHP Commercial |
$269.66
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.08
|
| Rate for Payer: Priority Health SBD |
$199.87
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: UMR Bronson Commercial |
$139.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.94
|
|
|
PREDNISONE 50 MG TABLET
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.73 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna American Axle |
$302.44
|
| Rate for Payer: Aetna American Axle |
$187.10
|
| Rate for Payer: Aetna American Axle |
$192.66
|
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.66
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Commercial |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Cofinity Commercial |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$254.90
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Cofinity Commercial |
$201.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Healthscope Commercial |
$266.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$395.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$244.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.94
|
| Rate for Payer: PHP Commercial |
$251.94
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.71
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: Priority Health SBD |
$181.35
|
| Rate for Payer: Priority Health SBD |
$186.73
|
| Rate for Payer: UMR Bronson Commercial |
$204.73
|
| Rate for Payer: UMR Bronson Commercial |
$126.65
|
| Rate for Payer: UMR Bronson Commercial |
$130.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
PREDNISONE 5 MG TABLET
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna American Axle |
$28.26
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.62
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.44
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: Priority Health SBD |
$222.08
|
| Rate for Payer: UMR Bronson Commercial |
$155.10
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.61
|
|
|
PR EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 98960
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$505.58 |
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$505.58
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.07
|
| Rate for Payer: Priority Health Narrow Network |
$39.07
|
| Rate for Payer: Priority Health SBD |
$39.07
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 98961
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$656.15 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$656.15
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.86
|
| Rate for Payer: Priority Health Narrow Network |
$18.86
|
| Rate for Payer: Priority Health SBD |
$18.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PR EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 98962
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$888.07 |
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$888.07
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.93
|
| Rate for Payer: Priority Health Narrow Network |
$13.93
|
| Rate for Payer: Priority Health SBD |
$13.93
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
|
|
PR EEG,ALL NIGHT RECORD
|
Professional
|
Both
|
$1,319.00
|
|
|
Service Code
|
HCPCS 95827
|
| Min. Negotiated Rate |
$527.60 |
| Max. Negotiated Rate |
$923.30 |
| Rate for Payer: BCBS Complete |
$527.60
|
| Rate for Payer: Cash Price |
$1,055.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.30
|
| Rate for Payer: UMR Bronson Commercial |
$606.74
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 95721
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$405.73 |
| Rate for Payer: Aetna Commercial |
$226.71
|
| Rate for Payer: BCBS Complete |
$136.43
|
| Rate for Payer: BCBS Trust/PPO |
$405.73
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Meridian Medicaid |
$136.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.48
|
| Rate for Payer: Priority Health Narrow Network |
$269.48
|
| Rate for Payer: Priority Health SBD |
$269.48
|
| Rate for Payer: UMR Bronson Commercial |
$193.20
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 95722
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$276.49
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS Trust/PPO |
$240.38
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.33
|
| Rate for Payer: Priority Health Narrow Network |
$328.33
|
| Rate for Payer: Priority Health SBD |
$328.33
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 95723
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$364.70 |
| Rate for Payer: Aetna Commercial |
$280.96
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS Trust/PPO |
$282.64
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.67
|
| Rate for Payer: Priority Health Narrow Network |
$329.67
|
| Rate for Payer: Priority Health SBD |
$329.67
|
| Rate for Payer: UMR Bronson Commercial |
$239.66
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 95724
|
| Min. Negotiated Rate |
$198.30 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$352.81
|
| Rate for Payer: BCBS Complete |
$208.22
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Meridian Medicaid |
$208.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$415.91
|
| Rate for Payer: Priority Health Narrow Network |
$415.91
|
| Rate for Payer: Priority Health SBD |
$415.91
|
| Rate for Payer: UMR Bronson Commercial |
$299.46
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 95725
|
| Min. Negotiated Rate |
$181.90 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$320.41
|
| Rate for Payer: BCBS Complete |
$191.00
|
| Rate for Payer: BCBS Trust/PPO |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Meridian Medicaid |
$191.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.38
|
| Rate for Payer: Priority Health Narrow Network |
$376.38
|
| Rate for Payer: Priority Health SBD |
$376.38
|
| Rate for Payer: UMR Bronson Commercial |
$273.70
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG
|
Professional
|
Both
|
$823.00
|
|
|
Service Code
|
HCPCS 95726
|
| Min. Negotiated Rate |
$254.11 |
| Max. Negotiated Rate |
$576.10 |
| Rate for Payer: Aetna Commercial |
$446.61
|
| Rate for Payer: BCBS Complete |
$266.82
|
| Rate for Payer: BCBS Trust/PPO |
$530.41
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Meridian Medicaid |
$266.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$528.19
|
| Rate for Payer: Priority Health Narrow Network |
$528.19
|
| Rate for Payer: Priority Health SBD |
$528.19
|
| Rate for Payer: UMR Bronson Commercial |
$378.58
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$112.29 |
| Max. Negotiated Rate |
$692.07 |
| Rate for Payer: Aetna Commercial |
$449.62
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$692.07
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.29
|
| Rate for Payer: Priority Health Narrow Network |
$112.29
|
| Rate for Payer: Priority Health SBD |
$575.80
|
| Rate for Payer: UMR Bronson Commercial |
$391.46
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY TECH/NURSE
|
Professional
|
Both
|
$2,832.00
|
|
|
Service Code
|
HCPCS 95956
|
| Min. Negotiated Rate |
$1,132.80 |
| Max. Negotiated Rate |
$1,982.40 |
| Rate for Payer: BCBS Complete |
$1,132.80
|
| Rate for Payer: Cash Price |
$2,265.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,982.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,302.72
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, UNATTENDED
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
HCPCS 95953
|
| Min. Negotiated Rate |
$292.80 |
| Max. Negotiated Rate |
$512.40 |
| Rate for Payer: BCBS Complete |
$292.80
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.40
|
| Rate for Payer: UMR Bronson Commercial |
$336.72
|
|
|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$3,041.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$1,216.40 |
| Max. Negotiated Rate |
$2,128.70 |
| Rate for Payer: BCBS Complete |
$1,216.40
|
| Rate for Payer: BCBS Complete |
$610.00
|
| Rate for Payer: Cash Price |
$2,432.80
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,067.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.70
|
| Rate for Payer: UMR Bronson Commercial |
$701.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,398.86
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$729.05 |
| Rate for Payer: Aetna Commercial |
$111.64
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$729.05
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Meridian Medicaid |
$70.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.39
|
| Rate for Payer: Priority Health Narrow Network |
$133.39
|
| Rate for Payer: Priority Health SBD |
$133.39
|
| Rate for Payer: UMR Bronson Commercial |
$94.30
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$379.32 |
| Rate for Payer: Aetna Commercial |
$147.36
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS Trust/PPO |
$379.32
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.17
|
| Rate for Payer: Priority Health Narrow Network |
$175.17
|
| Rate for Payer: Priority Health SBD |
$175.17
|
| Rate for Payer: UMR Bronson Commercial |
$123.74
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$493.43 |
| Rate for Payer: Aetna Commercial |
$172.27
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS Trust/PPO |
$493.43
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Meridian Medicaid |
$106.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.60
|
| Rate for Payer: Priority Health Narrow Network |
$206.60
|
| Rate for Payer: Priority Health SBD |
$206.60
|
| Rate for Payer: UMR Bronson Commercial |
$145.82
|
|
