|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$115.07 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna Commercial |
$279.90
|
| Rate for Payer: Aetna Medicare |
$115.07
|
| Rate for Payer: ASR ASR |
$301.67
|
| Rate for Payer: BCBS Complete |
$124.40
|
| Rate for Payer: BCBS Trust/PPO |
$256.42
|
| Rate for Payer: BCN Commercial |
$256.42
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$292.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.80
|
| Rate for Payer: Healthscope Commercial |
$301.67
|
| Rate for Payer: Healthscope Whirlpool |
$311.00
|
| Rate for Payer: Mclaren Commercial |
$279.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.35
|
| Rate for Payer: Nomi Health Commercial |
$255.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.50
|
| Rate for Payer: Priority Health Narrow Network |
$218.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.68
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 93317
|
| Hospital Charge Code |
93317
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$426.97 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: BCN Commercial |
$128.98
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$245.17
|
| Rate for Payer: Priority Health Narrow Network |
$245.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.97
|
| Rate for Payer: UHC Exchange |
$426.97
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$426.97 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: BCN Commercial |
$128.98
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$245.17
|
| Rate for Payer: Priority Health Narrow Network |
$245.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.97
|
| Rate for Payer: UHC Exchange |
$426.97
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$149.40 |
| Max. Negotiated Rate |
$878.37 |
| Rate for Payer: Aetna Commercial |
$630.42
|
| Rate for Payer: BCN Commercial |
$149.40
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$283.99
|
| Rate for Payer: Priority Health Narrow Network |
$283.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$878.37
|
| Rate for Payer: UHC Exchange |
$878.37
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$225.88 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$302.68
|
| Rate for Payer: Aetna Medicare |
$225.88
|
| Rate for Payer: BCBS MAPPO |
$225.88
|
| Rate for Payer: BCN Commercial |
$347.09
|
| Rate for Payer: BCN Medicare Advantage |
$225.88
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cofinity Commercial |
$325.27
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.88
|
| Rate for Payer: Healthscope Commercial |
$271.06
|
| Rate for Payer: Healthscope Whirlpool |
$271.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$248.47
|
| Rate for Payer: Nomi Health Commercial |
$271.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.00
|
| Rate for Payer: PACE SWMI |
$225.88
|
| Rate for Payer: PHP Medicare Advantage |
$225.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$329.90
|
| Rate for Payer: Priority Health Medicare |
$225.88
|
| Rate for Payer: Priority Health Narrow Network |
$329.90
|
| Rate for Payer: Railroad Medicare Medicare |
$225.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$225.88
|
| Rate for Payer: UHC Exchange |
$381.92
|
| Rate for Payer: UHCCP DNSP |
$225.88
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$128.92 |
| Max. Negotiated Rate |
$261.75 |
| Rate for Payer: Aetna Commercial |
$172.75
|
| Rate for Payer: Aetna Commercial |
$172.75
|
| Rate for Payer: Aetna Medicare |
$128.92
|
| Rate for Payer: Aetna Medicare |
$128.92
|
| Rate for Payer: BCBS MAPPO |
$128.92
|
| Rate for Payer: BCBS MAPPO |
$128.92
|
| Rate for Payer: BCN Commercial |
$201.68
|
| Rate for Payer: BCN Commercial |
$201.68
|
| Rate for Payer: BCN Medicare Advantage |
$128.92
|
| Rate for Payer: BCN Medicare Advantage |
$128.92
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cofinity Commercial |
$172.75
|
| Rate for Payer: Cofinity Commercial |
$185.64
|
| Rate for Payer: Cofinity Commercial |
$172.75
|
| Rate for Payer: Cofinity Commercial |
$185.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.92
|
| Rate for Payer: Healthscope Commercial |
$154.70
|
| Rate for Payer: Healthscope Commercial |
$154.70
|
| Rate for Payer: Healthscope Whirlpool |
$154.70
|
| Rate for Payer: Healthscope Whirlpool |
$154.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.81
|
| Rate for Payer: Nomi Health Commercial |
$154.70
|
| Rate for Payer: Nomi Health Commercial |
$154.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.75
|
| Rate for Payer: PACE SWMI |
$128.92
|
| Rate for Payer: PACE SWMI |
$128.92
|
| Rate for Payer: PHP Medicare Advantage |
$128.92
|
| Rate for Payer: PHP Medicare Advantage |
$128.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Medicare |
$128.92
|
| Rate for Payer: Priority Health Medicare |
$128.92
|
| Rate for Payer: Priority Health Narrow Network |
$191.68
|
| Rate for Payer: Priority Health Narrow Network |
$191.68
|
| Rate for Payer: Railroad Medicare Medicare |
$128.92
|
| Rate for Payer: Railroad Medicare Medicare |
$128.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.92
|
| Rate for Payer: UHC Exchange |
$216.92
|
| Rate for Payer: UHC Exchange |
$216.92
|
| Rate for Payer: UHCCP DNSP |
$128.92
|
| Rate for Payer: UHCCP DNSP |
$128.92
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$151.10 |
| Rate for Payer: Aetna Commercial |
$126.23
|
| Rate for Payer: Aetna Commercial |
$126.23
|
| Rate for Payer: Aetna Medicare |
$94.20
|
| Rate for Payer: Aetna Medicare |
$94.20
|
| Rate for Payer: BCBS MAPPO |
$94.20
|
| Rate for Payer: BCBS MAPPO |
$94.20
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: BCN Medicare Advantage |
$94.20
|
| Rate for Payer: BCN Medicare Advantage |
$94.20
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$126.23
|
| Rate for Payer: Cofinity Commercial |
$135.65
|
| Rate for Payer: Cofinity Commercial |
$126.23
|
| Rate for Payer: Cofinity Commercial |
$135.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.20
|
| Rate for Payer: Healthscope Commercial |
$113.04
|
| Rate for Payer: Healthscope Commercial |
$113.04
|
| Rate for Payer: Healthscope Whirlpool |
$113.04
|
| Rate for Payer: Healthscope Whirlpool |
$113.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.62
|
| Rate for Payer: Nomi Health Commercial |
$113.04
|
| Rate for Payer: Nomi Health Commercial |
$113.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
| Rate for Payer: PACE SWMI |
$94.20
|
| Rate for Payer: PACE SWMI |
$94.20
|
| Rate for Payer: PHP Medicare Advantage |
$94.20
|
| Rate for Payer: PHP Medicare Advantage |
$94.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.20
|
| Rate for Payer: Priority Health Medicare |
$94.20
|
| Rate for Payer: Priority Health Medicare |
$94.20
|
| Rate for Payer: Priority Health Narrow Network |
$138.20
|
| Rate for Payer: Priority Health Narrow Network |
$138.20
|
| Rate for Payer: Railroad Medicare Medicare |
$94.20
|
| Rate for Payer: Railroad Medicare Medicare |
$94.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.20
|
| Rate for Payer: UHC Exchange |
$151.10
|
| Rate for Payer: UHC Exchange |
$151.10
|
| Rate for Payer: UHCCP DNSP |
$94.20
|
| Rate for Payer: UHCCP DNSP |
$94.20
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$292.52 |
| Rate for Payer: Aetna Commercial |
$233.00
|
| Rate for Payer: Aetna Commercial |
$233.00
|
| Rate for Payer: Aetna Medicare |
$173.88
|
| Rate for Payer: Aetna Medicare |
$173.88
|
| Rate for Payer: BCBS MAPPO |
$173.88
|
| Rate for Payer: BCBS MAPPO |
$173.88
|
| Rate for Payer: BCN Commercial |
$272.39
|
| Rate for Payer: BCN Commercial |
$272.39
|
| Rate for Payer: BCN Medicare Advantage |
$173.88
|
| Rate for Payer: BCN Medicare Advantage |
$173.88
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$233.00
|
| Rate for Payer: Cofinity Commercial |
$250.39
|
| Rate for Payer: Cofinity Commercial |
$233.00
|
| Rate for Payer: Cofinity Commercial |
$250.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.88
|
| Rate for Payer: Healthscope Commercial |
$208.66
|
| Rate for Payer: Healthscope Commercial |
$208.66
|
| Rate for Payer: Healthscope Whirlpool |
$208.66
|
| Rate for Payer: Healthscope Whirlpool |
$208.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.27
|
| Rate for Payer: Nomi Health Commercial |
$208.66
|
| Rate for Payer: Nomi Health Commercial |
$208.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.00
|
| Rate for Payer: PACE SWMI |
$173.88
|
| Rate for Payer: PACE SWMI |
$173.88
|
| Rate for Payer: PHP Medicare Advantage |
$173.88
|
| Rate for Payer: PHP Medicare Advantage |
$173.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$258.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$258.91
|
| Rate for Payer: Priority Health Medicare |
$173.88
|
| Rate for Payer: Priority Health Medicare |
$173.88
|
| Rate for Payer: Priority Health Narrow Network |
$258.91
|
| Rate for Payer: Priority Health Narrow Network |
$258.91
|
| Rate for Payer: Railroad Medicare Medicare |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$173.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.88
|
| Rate for Payer: UHC Exchange |
$292.52
|
| Rate for Payer: UHC Exchange |
$292.52
|
| Rate for Payer: UHCCP DNSP |
$173.88
|
| Rate for Payer: UHCCP DNSP |
$173.88
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$184.32 |
| Max. Negotiated Rate |
$772.50 |
| Rate for Payer: Aetna Commercial |
$246.99
|
| Rate for Payer: Aetna Commercial |
$246.99
|
| Rate for Payer: Aetna Medicare |
$184.32
|
| Rate for Payer: Aetna Medicare |
$184.32
|
| Rate for Payer: BCBS MAPPO |
$184.32
|
| Rate for Payer: BCBS MAPPO |
$184.32
|
| Rate for Payer: BCN Commercial |
$289.33
|
| Rate for Payer: BCN Commercial |
$289.33
|
| Rate for Payer: BCN Medicare Advantage |
$184.32
|
| Rate for Payer: BCN Medicare Advantage |
$184.32
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$265.42
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$265.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.32
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Healthscope Whirlpool |
$221.18
|
| Rate for Payer: Healthscope Whirlpool |
$221.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.75
|
| Rate for Payer: Nomi Health Commercial |
$221.18
|
| Rate for Payer: Nomi Health Commercial |
$221.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$772.50
|
| Rate for Payer: PACE SWMI |
$184.32
|
| Rate for Payer: PACE SWMI |
$184.32
|
| Rate for Payer: PHP Medicare Advantage |
$184.32
|
| Rate for Payer: PHP Medicare Advantage |
$184.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$274.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$274.99
|
| Rate for Payer: Priority Health Medicare |
$184.32
|
| Rate for Payer: Priority Health Medicare |
$184.32
|
| Rate for Payer: Priority Health Narrow Network |
$274.99
|
| Rate for Payer: Priority Health Narrow Network |
$274.99
|
| Rate for Payer: Railroad Medicare Medicare |
$184.32
|
| Rate for Payer: Railroad Medicare Medicare |
$184.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$184.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$184.32
|
| Rate for Payer: UHC Exchange |
$319.30
|
| Rate for Payer: UHC Exchange |
$319.30
|
| Rate for Payer: UHCCP DNSP |
$184.32
|
| Rate for Payer: UHCCP DNSP |
$184.32
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$280.54
|
| Rate for Payer: Aetna Medicare |
$209.36
|
| Rate for Payer: BCBS Complete |
$140.01
|
| Rate for Payer: BCBS MAPPO |
$209.36
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: BCN Medicare Advantage |
$209.36
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$301.48
|
| Rate for Payer: Cofinity Commercial |
$280.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.36
|
| Rate for Payer: Healthscope Commercial |
$251.23
|
| Rate for Payer: Healthscope Whirlpool |
$251.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.83
|
| Rate for Payer: Meridian Medicaid |
$140.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.30
|
| Rate for Payer: Nomi Health Commercial |
$251.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.00
|
| Rate for Payer: PACE SWMI |
$209.36
|
| Rate for Payer: PHP Medicare Advantage |
$209.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$367.90
|
| Rate for Payer: Priority Health Medicare |
$209.36
|
| Rate for Payer: Priority Health Narrow Network |
$367.90
|
| Rate for Payer: Railroad Medicare Medicare |
$209.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$209.36
|
| Rate for Payer: UHC Exchange |
$415.25
|
| Rate for Payer: UHC Medicaid |
$133.34
|
| Rate for Payer: UHCCP DNSP |
$209.36
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Aetna Commercial |
$415.95
|
| Rate for Payer: Aetna Medicare |
$310.41
|
| Rate for Payer: BCBS Complete |
$206.43
|
| Rate for Payer: BCBS MAPPO |
$310.41
|
| Rate for Payer: BCN Commercial |
$502.46
|
| Rate for Payer: BCN Medicare Advantage |
$310.41
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cofinity Commercial |
$446.99
|
| Rate for Payer: Cofinity Commercial |
$415.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.41
|
| Rate for Payer: Healthscope Commercial |
$372.49
|
| Rate for Payer: Healthscope Whirlpool |
$372.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.93
|
| Rate for Payer: Meridian Medicaid |
$206.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$341.45
|
| Rate for Payer: Nomi Health Commercial |
$372.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$812.25
|
| Rate for Payer: PACE SWMI |
$310.41
|
| Rate for Payer: PHP Medicare Advantage |
$310.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$540.34
|
| Rate for Payer: Priority Health Medicare |
$310.41
|
| Rate for Payer: Priority Health Narrow Network |
$540.34
|
| Rate for Payer: Railroad Medicare Medicare |
$310.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$614.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$310.41
|
| Rate for Payer: UHC Exchange |
$614.38
|
| Rate for Payer: UHC Medicaid |
$196.60
|
| Rate for Payer: UHCCP DNSP |
$310.41
|
| Rate for Payer: UHCCP Medicaid |
$196.60
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$552.55 |
| Rate for Payer: Aetna Commercial |
$376.98
|
| Rate for Payer: Aetna Medicare |
$281.33
|
| Rate for Payer: BCBS Complete |
$187.19
|
| Rate for Payer: BCBS MAPPO |
$281.33
|
| Rate for Payer: BCN Commercial |
$453.17
|
| Rate for Payer: BCN Medicare Advantage |
$281.33
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cofinity Commercial |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$376.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.33
|
| Rate for Payer: Healthscope Commercial |
$337.60
|
| Rate for Payer: Healthscope Whirlpool |
$337.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$295.40
|
| Rate for Payer: Meridian Medicaid |
$187.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$309.46
|
| Rate for Payer: Nomi Health Commercial |
$337.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.75
|
| Rate for Payer: PACE SWMI |
$281.33
|
| Rate for Payer: PHP Medicare Advantage |
$281.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$487.31
|
| Rate for Payer: Priority Health Medicare |
$281.33
|
| Rate for Payer: Priority Health Narrow Network |
$487.31
|
| Rate for Payer: Railroad Medicare Medicare |
$281.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$552.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$281.33
|
| Rate for Payer: UHC Exchange |
$552.55
|
| Rate for Payer: UHC Medicaid |
$178.28
|
| Rate for Payer: UHCCP DNSP |
$281.33
|
| Rate for Payer: UHCCP Medicaid |
$178.28
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$2,685.00
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$482.23 |
| Max. Negotiated Rate |
$2,013.75 |
| Rate for Payer: Aetna Commercial |
$1,022.25
|
| Rate for Payer: Aetna Medicare |
$762.87
|
| Rate for Payer: BCBS Complete |
$506.34
|
| Rate for Payer: BCBS MAPPO |
$762.87
|
| Rate for Payer: BCN Commercial |
$1,218.06
|
| Rate for Payer: BCN Medicare Advantage |
$762.87
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cofinity Commercial |
$1,098.53
|
| Rate for Payer: Cofinity Commercial |
$1,022.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.87
|
| Rate for Payer: Healthscope Commercial |
$915.44
|
| Rate for Payer: Healthscope Whirlpool |
$915.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$801.01
|
| Rate for Payer: Meridian Medicaid |
$506.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$839.16
|
| Rate for Payer: Nomi Health Commercial |
$915.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,013.75
|
| Rate for Payer: PACE SWMI |
$762.87
|
| Rate for Payer: PHP Medicare Advantage |
$762.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,309.88
|
| Rate for Payer: Priority Health Medicare |
$762.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,309.88
|
| Rate for Payer: Railroad Medicare Medicare |
$762.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,496.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$762.87
|
| Rate for Payer: UHC Exchange |
$1,496.77
|
| Rate for Payer: UHC Medicaid |
$482.23
|
| Rate for Payer: UHCCP DNSP |
$762.87
|
| Rate for Payer: UHCCP Medicaid |
$482.23
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 33954
|
| Min. Negotiated Rate |
$275.41 |
| Max. Negotiated Rate |
$853.40 |
| Rate for Payer: Aetna Commercial |
$583.25
|
| Rate for Payer: Aetna Medicare |
$435.26
|
| Rate for Payer: BCBS Complete |
$289.18
|
| Rate for Payer: BCBS MAPPO |
$435.26
|
| Rate for Payer: BCN Commercial |
$696.17
|
| Rate for Payer: BCN Medicare Advantage |
$435.26
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$626.77
|
| Rate for Payer: Cofinity Commercial |
$583.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.26
|
| Rate for Payer: Healthscope Commercial |
$522.31
|
| Rate for Payer: Healthscope Whirlpool |
$522.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$457.02
|
| Rate for Payer: Meridian Medicaid |
$289.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$478.79
|
| Rate for Payer: Nomi Health Commercial |
$522.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$744.75
|
| Rate for Payer: PACE SWMI |
$435.26
|
| Rate for Payer: PHP Medicare Advantage |
$435.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$748.64
|
| Rate for Payer: Priority Health Medicare |
$435.26
|
| Rate for Payer: Priority Health Narrow Network |
$748.64
|
| Rate for Payer: Railroad Medicare Medicare |
$435.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$853.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$435.26
|
| Rate for Payer: UHC Exchange |
$853.40
|
| Rate for Payer: UHC Medicaid |
$275.41
|
| Rate for Payer: UHCCP DNSP |
$435.26
|
| Rate for Payer: UHCCP Medicaid |
$275.41
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
HCPCS 33952
|
| Min. Negotiated Rate |
$245.38 |
| Max. Negotiated Rate |
$766.47 |
| Rate for Payer: Aetna Commercial |
$519.29
|
| Rate for Payer: Aetna Medicare |
$387.53
|
| Rate for Payer: BCBS Complete |
$257.65
|
| Rate for Payer: BCBS MAPPO |
$387.53
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$387.53
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cofinity Commercial |
$558.04
|
| Rate for Payer: Cofinity Commercial |
$519.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.53
|
| Rate for Payer: Healthscope Commercial |
$465.04
|
| Rate for Payer: Healthscope Whirlpool |
$465.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.91
|
| Rate for Payer: Meridian Medicaid |
$257.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$426.28
|
| Rate for Payer: Nomi Health Commercial |
$465.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.50
|
| Rate for Payer: PACE SWMI |
$387.53
|
| Rate for Payer: PHP Medicare Advantage |
$387.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$669.92
|
| Rate for Payer: Priority Health Medicare |
$387.53
|
| Rate for Payer: Priority Health Narrow Network |
$669.92
|
| Rate for Payer: Railroad Medicare Medicare |
$387.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$766.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$387.53
|
| Rate for Payer: UHC Exchange |
$766.47
|
| Rate for Payer: UHC Medicaid |
$245.38
|
| Rate for Payer: UHCCP DNSP |
$387.53
|
| Rate for Payer: UHCCP Medicaid |
$245.38
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 33953
|
| Min. Negotiated Rate |
$276.26 |
| Max. Negotiated Rate |
$847.66 |
| Rate for Payer: Aetna Commercial |
$585.07
|
| Rate for Payer: Aetna Medicare |
$436.62
|
| Rate for Payer: BCBS Complete |
$290.07
|
| Rate for Payer: BCBS MAPPO |
$436.62
|
| Rate for Payer: BCN Commercial |
$688.21
|
| Rate for Payer: BCN Medicare Advantage |
$436.62
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cofinity Commercial |
$628.73
|
| Rate for Payer: Cofinity Commercial |
$585.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.62
|
| Rate for Payer: Healthscope Commercial |
$523.94
|
| Rate for Payer: Healthscope Whirlpool |
$523.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.45
|
| Rate for Payer: Meridian Medicaid |
$290.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$480.28
|
| Rate for Payer: Nomi Health Commercial |
$523.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.50
|
| Rate for Payer: PACE SWMI |
$436.62
|
| Rate for Payer: PHP Medicare Advantage |
$436.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$740.08
|
| Rate for Payer: Priority Health Medicare |
$436.62
|
| Rate for Payer: Priority Health Narrow Network |
$740.08
|
| Rate for Payer: Railroad Medicare Medicare |
$436.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$847.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$436.62
|
| Rate for Payer: UHC Exchange |
$847.66
|
| Rate for Payer: UHC Medicaid |
$276.26
|
| Rate for Payer: UHCCP DNSP |
$436.62
|
| Rate for Payer: UHCCP Medicaid |
$276.26
|
|
|
PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 33986
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$938.14 |
| Rate for Payer: Aetna Commercial |
$645.20
|
| Rate for Payer: Aetna Medicare |
$481.49
|
| Rate for Payer: BCBS Complete |
$319.60
|
| Rate for Payer: BCBS MAPPO |
$481.49
|
| Rate for Payer: BCN Commercial |
$767.39
|
| Rate for Payer: BCN Medicare Advantage |
$481.49
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cofinity Commercial |
$693.35
|
| Rate for Payer: Cofinity Commercial |
$645.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.49
|
| Rate for Payer: Healthscope Commercial |
$577.79
|
| Rate for Payer: Healthscope Whirlpool |
$577.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.56
|
| Rate for Payer: Meridian Medicaid |
$319.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$529.64
|
| Rate for Payer: Nomi Health Commercial |
$577.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$849.75
|
| Rate for Payer: PACE SWMI |
$481.49
|
| Rate for Payer: PHP Medicare Advantage |
$481.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$825.23
|
| Rate for Payer: Priority Health Medicare |
$481.49
|
| Rate for Payer: Priority Health Narrow Network |
$825.23
|
| Rate for Payer: Railroad Medicare Medicare |
$481.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$938.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$481.49
|
| Rate for Payer: UHC Exchange |
$938.14
|
| Rate for Payer: UHC Medicaid |
$304.38
|
| Rate for Payer: UHCCP DNSP |
$481.49
|
| Rate for Payer: UHCCP Medicaid |
$304.38
|
|
|
PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 95836
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$181.09 |
| Rate for Payer: Aetna Commercial |
$117.34
|
| Rate for Payer: Aetna Medicare |
$87.57
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCBS MAPPO |
$87.57
|
| Rate for Payer: BCN Commercial |
$156.86
|
| Rate for Payer: BCN Medicare Advantage |
$87.57
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$126.10
|
| Rate for Payer: Cofinity Commercial |
$117.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.57
|
| Rate for Payer: Healthscope Commercial |
$105.08
|
| Rate for Payer: Healthscope Whirlpool |
$105.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.95
|
| Rate for Payer: Meridian Medicaid |
$59.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.33
|
| Rate for Payer: Nomi Health Commercial |
$105.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: PACE SWMI |
$87.57
|
| Rate for Payer: PHP Medicare Advantage |
$87.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$144.66
|
| Rate for Payer: Priority Health Medicare |
$87.57
|
| Rate for Payer: Priority Health Narrow Network |
$144.66
|
| Rate for Payer: Railroad Medicare Medicare |
$87.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$87.57
|
| Rate for Payer: UHC Exchange |
$181.09
|
| Rate for Payer: UHC Medicaid |
$56.45
|
| Rate for Payer: UHCCP DNSP |
$87.57
|
| Rate for Payer: UHCCP Medicaid |
$56.45
|
|
|
PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
HCPCS 43259
|
| Min. Negotiated Rate |
$126.74 |
| Max. Negotiated Rate |
$771.00 |
| Rate for Payer: Aetna Commercial |
$262.64
|
| Rate for Payer: Aetna Medicare |
$196.00
|
| Rate for Payer: BCBS Complete |
$133.08
|
| Rate for Payer: BCBS MAPPO |
$196.00
|
| Rate for Payer: BCN Commercial |
$333.15
|
| Rate for Payer: BCN Medicare Advantage |
$196.00
|
| Rate for Payer: Cash Price |
$822.40
|
| Rate for Payer: Cash Price |
$822.40
|
| Rate for Payer: Cofinity Commercial |
$282.24
|
| Rate for Payer: Cofinity Commercial |
$262.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$235.20
|
| Rate for Payer: Healthscope Whirlpool |
$235.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.80
|
| Rate for Payer: Meridian Medicaid |
$133.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$235.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$771.00
|
| Rate for Payer: PACE SWMI |
$196.00
|
| Rate for Payer: PHP Medicare Advantage |
$196.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$405.92
|
| Rate for Payer: Priority Health Medicare |
$196.00
|
| Rate for Payer: Priority Health Narrow Network |
$405.92
|
| Rate for Payer: Railroad Medicare Medicare |
$196.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$399.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$196.00
|
| Rate for Payer: UHC Exchange |
$399.03
|
| Rate for Payer: UHC Medicaid |
$126.74
|
| Rate for Payer: UHCCP DNSP |
$196.00
|
| Rate for Payer: UHCCP Medicaid |
$126.74
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: ASR ASR |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$4.92
|
| Rate for Payer: BCN Commercial |
$4.92
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.81
|
| Rate for Payer: Healthscope Whirlpool |
$5.99
|
| Rate for Payer: Mclaren Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.27
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna Medicare |
$2.22
|
| Rate for Payer: ASR ASR |
$5.81
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$4.94
|
| Rate for Payer: BCN Commercial |
$4.94
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.81
|
| Rate for Payer: Healthscope Whirlpool |
$5.99
|
| Rate for Payer: Mclaren Commercial |
$5.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.95
|
| Rate for Payer: Priority Health Narrow Network |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.27
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$845.85
|
|
|
Service Code
|
NDC 11980018010
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.96 |
| Max. Negotiated Rate |
$845.85 |
| Rate for Payer: Aetna Commercial |
$761.26
|
| Rate for Payer: Aetna Medicare |
$312.96
|
| Rate for Payer: ASR ASR |
$820.47
|
| Rate for Payer: BCBS Complete |
$338.34
|
| Rate for Payer: BCBS Trust/PPO |
$697.40
|
| Rate for Payer: BCN Commercial |
$697.40
|
| Rate for Payer: Cash Price |
$676.68
|
| Rate for Payer: Cofinity Commercial |
$795.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.68
|
| Rate for Payer: Healthscope Commercial |
$820.47
|
| Rate for Payer: Healthscope Whirlpool |
$845.85
|
| Rate for Payer: Mclaren Commercial |
$761.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$676.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.97
|
| Rate for Payer: Nomi Health Commercial |
$693.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$634.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$741.13
|
| Rate for Payer: Priority Health Narrow Network |
$592.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.34
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$143.22
|
|
|
Service Code
|
NDC 60758011905
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.99 |
| Max. Negotiated Rate |
$143.22 |
| Rate for Payer: Aetna Commercial |
$128.90
|
| Rate for Payer: Aetna Medicare |
$52.99
|
| Rate for Payer: ASR ASR |
$138.92
|
| Rate for Payer: BCBS Complete |
$57.29
|
| Rate for Payer: BCBS Trust/PPO |
$118.08
|
| Rate for Payer: BCN Commercial |
$118.08
|
| Rate for Payer: Cash Price |
$114.58
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.58
|
| Rate for Payer: Healthscope Commercial |
$138.92
|
| Rate for Payer: Healthscope Whirlpool |
$143.22
|
| Rate for Payer: Mclaren Commercial |
$128.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.74
|
| Rate for Payer: Nomi Health Commercial |
$117.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$125.49
|
| Rate for Payer: Priority Health Narrow Network |
$100.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.03
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$173.46
|
|
|
Service Code
|
NDC 61314063710
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$173.46 |
| Rate for Payer: Aetna Commercial |
$156.11
|
| Rate for Payer: Aetna Medicare |
$64.18
|
| Rate for Payer: ASR ASR |
$168.26
|
| Rate for Payer: BCBS Complete |
$69.38
|
| Rate for Payer: BCBS Trust/PPO |
$143.02
|
| Rate for Payer: BCN Commercial |
$143.02
|
| Rate for Payer: Cash Price |
$138.77
|
| Rate for Payer: Cofinity Commercial |
$163.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.77
|
| Rate for Payer: Healthscope Commercial |
$168.26
|
| Rate for Payer: Healthscope Whirlpool |
$173.46
|
| Rate for Payer: Mclaren Commercial |
$156.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.44
|
| Rate for Payer: Nomi Health Commercial |
$142.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.99
|
| Rate for Payer: Priority Health Narrow Network |
$121.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.64
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$105.67 |
| Rate for Payer: Aetna Commercial |
$95.10
|
| Rate for Payer: ASR ASR |
$102.50
|
| Rate for Payer: BCBS Trust/PPO |
$86.77
|
| Rate for Payer: BCN Commercial |
$86.77
|
| Rate for Payer: Cash Price |
$84.53
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.53
|
| Rate for Payer: Healthscope Commercial |
$102.50
|
| Rate for Payer: Healthscope Whirlpool |
$105.67
|
| Rate for Payer: Mclaren Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$86.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.99
|
|
