|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$29,410.65
|
|
|
Service Code
|
MSDRG 584
|
| Min. Negotiated Rate |
$16,311.65 |
| Max. Negotiated Rate |
$29,410.65 |
| Rate for Payer: Aetna Medicare |
$17,170.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,462.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,462.70
|
| Rate for Payer: BCBS MAPPO |
$17,170.16
|
| Rate for Payer: BCN Medicare Advantage |
$17,170.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,170.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,170.16
|
| Rate for Payer: Mclaren Medicare |
$17,170.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,028.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,745.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,887.18
|
| Rate for Payer: PACE Medicare |
$16,311.65
|
| Rate for Payer: PACE SWMI |
$17,170.16
|
| Rate for Payer: PHP Commercial |
$18,887.18
|
| Rate for Payer: PHP Medicare Advantage |
$17,170.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29,410.65
|
| Rate for Payer: Priority Health Medicare |
$17,170.16
|
| Rate for Payer: Priority Health Narrow Network |
$23,528.52
|
| Rate for Payer: Railroad Medicare Medicare |
$17,170.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,170.16
|
| Rate for Payer: UHC Exchange |
$26,613.75
|
| Rate for Payer: UHCCP DNSP |
$17,170.16
|
| Rate for Payer: VA VA |
$17,170.16
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,503.52
|
|
|
Service Code
|
MSDRG 585
|
| Min. Negotiated Rate |
$14,864.05 |
| Max. Negotiated Rate |
$26,503.52 |
| Rate for Payer: Aetna Medicare |
$15,646.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,557.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,557.96
|
| Rate for Payer: BCBS MAPPO |
$15,646.37
|
| Rate for Payer: BCN Medicare Advantage |
$15,646.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,646.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,646.37
|
| Rate for Payer: Mclaren Medicare |
$15,646.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,428.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,993.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,211.01
|
| Rate for Payer: PACE Medicare |
$14,864.05
|
| Rate for Payer: PACE SWMI |
$15,646.37
|
| Rate for Payer: PHP Commercial |
$17,211.01
|
| Rate for Payer: PHP Medicare Advantage |
$15,646.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,503.52
|
| Rate for Payer: Priority Health Medicare |
$15,646.37
|
| Rate for Payer: Priority Health Narrow Network |
$21,202.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15,646.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,646.37
|
| Rate for Payer: UHC Exchange |
$24,251.87
|
| Rate for Payer: UHCCP DNSP |
$15,646.37
|
| Rate for Payer: VA VA |
$15,646.37
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$11,401.99
|
|
|
Service Code
|
APR-DRG 3632
|
| Min. Negotiated Rate |
$10,308.76 |
| Max. Negotiated Rate |
$11,401.99 |
| Rate for Payer: BCBS Complete |
$11,401.99
|
| Rate for Payer: Mclaren Medicaid |
$10,859.04
|
| Rate for Payer: Meridian Medicaid |
$11,401.99
|
| Rate for Payer: PHP Medicaid |
$10,308.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,859.04
|
| Rate for Payer: UHC Medicaid |
$10,859.04
|
| Rate for Payer: UHCCP Medicaid |
$10,859.04
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$7,973.16
|
|
|
Service Code
|
APR-DRG 3631
|
| Min. Negotiated Rate |
$7,208.69 |
| Max. Negotiated Rate |
$7,973.16 |
| Rate for Payer: BCBS Complete |
$7,973.16
|
| Rate for Payer: Mclaren Medicaid |
$7,593.49
|
| Rate for Payer: Meridian Medicaid |
$7,973.16
|
| Rate for Payer: PHP Medicaid |
$7,208.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,593.49
|
| Rate for Payer: UHC Medicaid |
$7,593.49
|
| Rate for Payer: UHCCP Medicaid |
$7,593.49
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$17,513.60
|
|
|
Service Code
|
APR-DRG 3634
|
| Min. Negotiated Rate |
$15,834.39 |
| Max. Negotiated Rate |
$17,513.60 |
| Rate for Payer: BCBS Complete |
$17,513.60
|
| Rate for Payer: Mclaren Medicaid |
$16,679.62
|
| Rate for Payer: Meridian Medicaid |
$17,513.60
|
| Rate for Payer: PHP Medicaid |
$15,834.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,679.62
|
| Rate for Payer: UHC Medicaid |
$16,679.62
|
| Rate for Payer: UHCCP Medicaid |
$16,679.62
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$16,484.74
|
|
|
Service Code
|
APR-DRG 3633
|
| Min. Negotiated Rate |
$14,904.17 |
| Max. Negotiated Rate |
$16,484.74 |
| Rate for Payer: BCBS Complete |
$16,484.74
|
| Rate for Payer: Mclaren Medicaid |
$15,699.75
|
| Rate for Payer: Meridian Medicaid |
$16,484.74
|
| Rate for Payer: PHP Medicaid |
$14,904.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,699.75
|
| Rate for Payer: UHC Medicaid |
$15,699.75
|
| Rate for Payer: UHCCP Medicaid |
$15,699.75
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$1,264.59
|
|
|
Service Code
|
NDC 23932110
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$948.44 |
| Max. Negotiated Rate |
$1,264.59 |
| Rate for Payer: Aetna Commercial |
$1,138.13
|
| Rate for Payer: ASR ASR |
$1,226.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.48
|
| Rate for Payer: BCN Commercial |
$1,038.48
|
| Rate for Payer: Cash Price |
$1,011.67
|
| Rate for Payer: Cofinity Commercial |
$1,188.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.67
|
| Rate for Payer: Healthscope Commercial |
$1,226.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,264.59
|
| Rate for Payer: Mclaren Commercial |
$1,138.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.90
|
| Rate for Payer: Nomi Health Commercial |
$1,036.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.83
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$262.78
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.09 |
| Max. Negotiated Rate |
$262.78 |
| Rate for Payer: Aetna Commercial |
$236.50
|
| Rate for Payer: ASR ASR |
$254.90
|
| Rate for Payer: BCBS Trust/PPO |
$215.79
|
| Rate for Payer: BCN Commercial |
$215.79
|
| Rate for Payer: Cash Price |
$210.22
|
| Rate for Payer: Cofinity Commercial |
$247.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.22
|
| Rate for Payer: Healthscope Commercial |
$254.90
|
| Rate for Payer: Healthscope Whirlpool |
$262.78
|
| Rate for Payer: Mclaren Commercial |
$236.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.36
|
| Rate for Payer: Nomi Health Commercial |
$215.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.25
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 23932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$474.44 |
| Max. Negotiated Rate |
$632.59 |
| Rate for Payer: Aetna Commercial |
$569.33
|
| Rate for Payer: ASR ASR |
$613.61
|
| Rate for Payer: BCBS Trust/PPO |
$519.48
|
| Rate for Payer: BCN Commercial |
$519.48
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$594.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$613.61
|
| Rate for Payer: Healthscope Whirlpool |
$632.59
|
| Rate for Payer: Mclaren Commercial |
$569.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.68
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$632.59
|
|
|
Service Code
|
NDC 23932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.06 |
| Max. Negotiated Rate |
$632.59 |
| Rate for Payer: Aetna Commercial |
$569.33
|
| Rate for Payer: Aetna Medicare |
$234.06
|
| Rate for Payer: ASR ASR |
$613.61
|
| Rate for Payer: BCBS Complete |
$253.04
|
| Rate for Payer: BCBS Trust/PPO |
$521.57
|
| Rate for Payer: BCN Commercial |
$521.57
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$594.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$613.61
|
| Rate for Payer: Healthscope Whirlpool |
$632.59
|
| Rate for Payer: Mclaren Commercial |
$569.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$506.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$554.28
|
| Rate for Payer: Priority Health Narrow Network |
$443.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.68
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$262.78
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.23 |
| Max. Negotiated Rate |
$262.78 |
| Rate for Payer: Aetna Commercial |
$236.50
|
| Rate for Payer: Aetna Medicare |
$97.23
|
| Rate for Payer: ASR ASR |
$254.90
|
| Rate for Payer: BCBS Complete |
$105.11
|
| Rate for Payer: BCBS Trust/PPO |
$216.66
|
| Rate for Payer: BCN Commercial |
$216.66
|
| Rate for Payer: Cash Price |
$210.22
|
| Rate for Payer: Cofinity Commercial |
$247.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.22
|
| Rate for Payer: Healthscope Commercial |
$254.90
|
| Rate for Payer: Healthscope Whirlpool |
$262.78
|
| Rate for Payer: Mclaren Commercial |
$236.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.36
|
| Rate for Payer: Nomi Health Commercial |
$215.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$230.25
|
| Rate for Payer: Priority Health Narrow Network |
$184.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.25
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$1,264.59
|
|
|
Service Code
|
NDC 23932110
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$467.90 |
| Max. Negotiated Rate |
$1,264.59 |
| Rate for Payer: Aetna Commercial |
$1,138.13
|
| Rate for Payer: Aetna Medicare |
$467.90
|
| Rate for Payer: ASR ASR |
$1,226.65
|
| Rate for Payer: BCBS Complete |
$505.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.65
|
| Rate for Payer: BCN Commercial |
$1,042.65
|
| Rate for Payer: Cash Price |
$1,011.67
|
| Rate for Payer: Cofinity Commercial |
$1,188.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.67
|
| Rate for Payer: Healthscope Commercial |
$1,226.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,264.59
|
| Rate for Payer: Mclaren Commercial |
$1,138.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,011.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.90
|
| Rate for Payer: Nomi Health Commercial |
$1,036.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,108.03
|
| Rate for Payer: Priority Health Narrow Network |
$886.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.83
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 70069023201
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.20
|
| Rate for Payer: BCN Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Whirlpool |
$14.80
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.97
|
| Rate for Payer: Priority Health Narrow Network |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 70069023201
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Whirlpool |
$14.80
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$3,894.76
|
|
|
Service Code
|
APR-DRG 1382
|
| Min. Negotiated Rate |
$3,521.33 |
| Max. Negotiated Rate |
$3,894.76 |
| Rate for Payer: BCBS Complete |
$3,894.76
|
| Rate for Payer: Mclaren Medicaid |
$3,709.29
|
| Rate for Payer: Meridian Medicaid |
$3,894.76
|
| Rate for Payer: PHP Medicaid |
$3,521.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,709.29
|
| Rate for Payer: UHC Medicaid |
$3,709.29
|
| Rate for Payer: UHCCP Medicaid |
$3,709.29
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$8,644.54
|
|
|
Service Code
|
APR-DRG 1384
|
| Min. Negotiated Rate |
$7,815.70 |
| Max. Negotiated Rate |
$8,644.54 |
| Rate for Payer: BCBS Complete |
$8,644.54
|
| Rate for Payer: Mclaren Medicaid |
$8,232.90
|
| Rate for Payer: Meridian Medicaid |
$8,644.54
|
| Rate for Payer: PHP Medicaid |
$7,815.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,232.90
|
| Rate for Payer: UHC Medicaid |
$8,232.90
|
| Rate for Payer: UHCCP Medicaid |
$8,232.90
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$2,885.51
|
|
|
Service Code
|
APR-DRG 1381
|
| Min. Negotiated Rate |
$2,608.85 |
| Max. Negotiated Rate |
$2,885.51 |
| Rate for Payer: BCBS Complete |
$2,885.51
|
| Rate for Payer: Mclaren Medicaid |
$2,748.11
|
| Rate for Payer: Meridian Medicaid |
$2,885.51
|
| Rate for Payer: PHP Medicaid |
$2,608.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,748.11
|
| Rate for Payer: UHC Medicaid |
$2,748.11
|
| Rate for Payer: UHCCP Medicaid |
$2,748.11
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$6,543.21
|
|
|
Service Code
|
APR-DRG 1383
|
| Min. Negotiated Rate |
$5,915.85 |
| Max. Negotiated Rate |
$6,543.21 |
| Rate for Payer: BCBS Complete |
$6,543.21
|
| Rate for Payer: Mclaren Medicaid |
$6,231.63
|
| Rate for Payer: Meridian Medicaid |
$6,543.21
|
| Rate for Payer: PHP Medicaid |
$5,915.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,231.63
|
| Rate for Payer: UHC Medicaid |
$6,231.63
|
| Rate for Payer: UHCCP Medicaid |
$6,231.63
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$13,559.86
|
|
|
Service Code
|
MSDRG 202
|
| Min. Negotiated Rate |
$8,310.89 |
| Max. Negotiated Rate |
$13,559.86 |
| Rate for Payer: Aetna Medicare |
$8,748.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,935.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,935.38
|
| Rate for Payer: BCBS MAPPO |
$8,748.30
|
| Rate for Payer: BCN Medicare Advantage |
$8,748.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,748.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,748.30
|
| Rate for Payer: Mclaren Medicare |
$8,748.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,185.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,060.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,623.13
|
| Rate for Payer: PACE Medicare |
$8,310.89
|
| Rate for Payer: PACE SWMI |
$8,748.30
|
| Rate for Payer: PHP Commercial |
$9,623.13
|
| Rate for Payer: PHP Medicare Advantage |
$8,748.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,343.12
|
| Rate for Payer: Priority Health Medicare |
$8,748.30
|
| Rate for Payer: Priority Health Narrow Network |
$10,674.50
|
| Rate for Payer: Railroad Medicare Medicare |
$8,748.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,748.30
|
| Rate for Payer: UHC Exchange |
$13,559.86
|
| Rate for Payer: UHCCP DNSP |
$8,748.30
|
| Rate for Payer: VA VA |
$8,748.30
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$10,197.90
|
|
|
Service Code
|
MSDRG 203
|
| Min. Negotiated Rate |
$6,250.33 |
| Max. Negotiated Rate |
$10,197.90 |
| Rate for Payer: Aetna Medicare |
$6,579.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,224.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,224.11
|
| Rate for Payer: BCBS MAPPO |
$6,579.29
|
| Rate for Payer: BCN Medicare Advantage |
$6,579.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,579.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,579.29
|
| Rate for Payer: Mclaren Medicare |
$6,579.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,908.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,566.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,237.22
|
| Rate for Payer: PACE Medicare |
$6,250.33
|
| Rate for Payer: PACE SWMI |
$6,579.29
|
| Rate for Payer: PHP Commercial |
$7,237.22
|
| Rate for Payer: PHP Medicare Advantage |
$6,579.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,205.00
|
| Rate for Payer: Priority Health Medicare |
$6,579.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,364.00
|
| Rate for Payer: Railroad Medicare Medicare |
$6,579.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,579.29
|
| Rate for Payer: UHC Exchange |
$10,197.90
|
| Rate for Payer: UHCCP DNSP |
$6,579.29
|
| Rate for Payer: VA VA |
$6,579.29
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$13.33
|
| Rate for Payer: Aetna Commercial |
$27.45
|
| Rate for Payer: Aetna Commercial |
$11.04
|
| Rate for Payer: ASR ASR |
$29.59
|
| Rate for Payer: ASR ASR |
$16.69
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR ASR |
$11.90
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCBS Trust/PPO |
$10.08
|
| Rate for Payer: BCBS Trust/PPO |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$25.05
|
| Rate for Payer: BCN Commercial |
$10.08
|
| Rate for Payer: BCN Commercial |
$25.05
|
| Rate for Payer: BCN Commercial |
$12.16
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$28.67
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.82
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$11.90
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$29.59
|
| Rate for Payer: Healthscope Whirlpool |
$17.20
|
| Rate for Payer: Healthscope Whirlpool |
$30.50
|
| Rate for Payer: Healthscope Whirlpool |
$12.27
|
| Rate for Payer: Healthscope Whirlpool |
$14.81
|
| Rate for Payer: Mclaren Commercial |
$11.04
|
| Rate for Payer: Mclaren Commercial |
$27.45
|
| Rate for Payer: Mclaren Commercial |
$13.33
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.43
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Nomi Health Commercial |
$25.01
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Nomi Health Commercial |
$10.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.84
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$30.50
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Aetna Commercial |
$27.45
|
| Rate for Payer: Aetna Commercial |
$13.33
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$11.04
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: ASR ASR |
$16.69
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR ASR |
$11.90
|
| Rate for Payer: ASR ASR |
$29.59
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$4.91
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$25.15
|
| Rate for Payer: BCBS Trust/PPO |
$14.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.12
|
| Rate for Payer: BCN Commercial |
$25.15
|
| Rate for Payer: BCN Commercial |
$14.19
|
| Rate for Payer: BCN Commercial |
$10.12
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$28.67
|
| Rate for Payer: Cofinity Commercial |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$29.59
|
| Rate for Payer: Healthscope Commercial |
$11.90
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Whirlpool |
$12.27
|
| Rate for Payer: Healthscope Whirlpool |
$17.20
|
| Rate for Payer: Healthscope Whirlpool |
$30.50
|
| Rate for Payer: Healthscope Whirlpool |
$14.81
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$13.33
|
| Rate for Payer: Mclaren Commercial |
$11.04
|
| Rate for Payer: Mclaren Commercial |
$27.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Nomi Health Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Nomi Health Commercial |
$25.01
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.87
|
| Rate for Payer: Priority Health Narrow Network |
$0.87
|
| Rate for Payer: Priority Health Narrow Network |
$0.87
|
| Rate for Payer: Priority Health Narrow Network |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.03
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
|
OP
|
$861.28
|
|
|
Service Code
|
NDC 186091612
|
| Hospital Charge Code |
96977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.67 |
| Max. Negotiated Rate |
$861.28 |
| Rate for Payer: Aetna Commercial |
$775.15
|
| Rate for Payer: Aetna Medicare |
$318.67
|
| Rate for Payer: ASR ASR |
$835.44
|
| Rate for Payer: BCBS Complete |
$344.51
|
| Rate for Payer: BCBS Trust/PPO |
$710.13
|
| Rate for Payer: BCN Commercial |
$710.13
|
| Rate for Payer: Cash Price |
$689.02
|
| Rate for Payer: Cofinity Commercial |
$809.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.02
|
| Rate for Payer: Healthscope Commercial |
$835.44
|
| Rate for Payer: Healthscope Whirlpool |
$861.28
|
| Rate for Payer: Mclaren Commercial |
$775.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.09
|
| Rate for Payer: Nomi Health Commercial |
$706.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$754.65
|
| Rate for Payer: Priority Health Narrow Network |
$603.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.93
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
|
IP
|
$861.28
|
|
|
Service Code
|
NDC 186091612
|
| Hospital Charge Code |
96977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$645.96 |
| Max. Negotiated Rate |
$861.28 |
| Rate for Payer: Aetna Commercial |
$775.15
|
| Rate for Payer: ASR ASR |
$835.44
|
| Rate for Payer: BCBS Trust/PPO |
$707.28
|
| Rate for Payer: BCN Commercial |
$707.28
|
| Rate for Payer: Cash Price |
$689.02
|
| Rate for Payer: Cofinity Commercial |
$809.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.02
|
| Rate for Payer: Healthscope Commercial |
$835.44
|
| Rate for Payer: Healthscope Whirlpool |
$861.28
|
| Rate for Payer: Mclaren Commercial |
$775.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.09
|
| Rate for Payer: Nomi Health Commercial |
$706.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.93
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$198.66 |
| Rate for Payer: Aetna Commercial |
$178.79
|
| Rate for Payer: ASR ASR |
$192.70
|
| Rate for Payer: BCBS Trust/PPO |
$163.14
|
| Rate for Payer: BCN Commercial |
$163.14
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Commercial |
$186.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$192.70
|
| Rate for Payer: Healthscope Whirlpool |
$198.66
|
| Rate for Payer: Mclaren Commercial |
$178.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.86
|
| Rate for Payer: Nomi Health Commercial |
$162.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.82
|
|
