Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SEVELAMER CARBONATE 800 MG TABLET

Facility

$527.62

Service Code	NDC 60687032865
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$332.40
Max. Negotiated Rate	$474.86
Rate for Payer: Aetna Commercial	$448.48
Rate for Payer: Aetna New Business (MI Preferred)	$342.95
Rate for Payer: Cash Price	$422.10
Rate for Payer: Cofinity Commercial	$369.33
Rate for Payer: Cofinity Commercial	$453.75
Rate for Payer: Cofinity Medicare Advantage	$369.33
Rate for Payer: Encore Health Key Benefits Commercial	$422.10
Rate for Payer: Healthscope Commercial	$474.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$448.48
Rate for Payer: PHP Commercial	$448.48
Rate for Payer: Priority Health Cigna Priority Health	$342.95
Rate for Payer: Priority Health SBD	$332.40

SEVELAMER CARBONATE 800 MG TABLET

Facility

$928.53

Service Code	NDC 65162005827
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$584.97
Max. Negotiated Rate	$835.68
Rate for Payer: Aetna Commercial	$789.25
Rate for Payer: Aetna New Business (MI Preferred)	$603.54
Rate for Payer: Cash Price	$742.82
Rate for Payer: Cofinity Commercial	$649.97
Rate for Payer: Cofinity Commercial	$798.54
Rate for Payer: Cofinity Medicare Advantage	$649.97
Rate for Payer: Encore Health Key Benefits Commercial	$742.82
Rate for Payer: Healthscope Commercial	$835.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$789.25
Rate for Payer: PHP Commercial	$789.25
Rate for Payer: Priority Health Cigna Priority Health	$603.54
Rate for Payer: Priority Health SBD	$584.97

SEVELAMER CARBONATE 800 MG TABLET

Facility

$928.53

Service Code	NDC 65162005827
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$371.41
Max. Negotiated Rate	$835.68
Rate for Payer: Aetna Commercial	$789.25
Rate for Payer: Aetna Medicare	$464.26
Rate for Payer: Aetna New Business (MI Preferred)	$603.54
Rate for Payer: BCBS Complete	$371.41
Rate for Payer: Cash Price	$742.82
Rate for Payer: Cofinity Commercial	$649.97
Rate for Payer: Cofinity Commercial	$798.54
Rate for Payer: Cofinity Medicare Advantage	$649.97
Rate for Payer: Encore Health Key Benefits Commercial	$742.82
Rate for Payer: Healthscope Commercial	$835.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$789.25
Rate for Payer: PHP Commercial	$789.25
Rate for Payer: Priority Health Cigna Priority Health	$603.54
Rate for Payer: Priority Health SBD	$584.97

SEVELAMER CARBONATE 800 MG TABLET

Facility

$10.56

Service Code	NDC 60687032811
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$8.98
Rate for Payer: Aetna New Business (MI Preferred)	$6.86
Rate for Payer: Cash Price	$8.45
Rate for Payer: Cofinity Commercial	$7.39
Rate for Payer: Cofinity Commercial	$9.08
Rate for Payer: Cofinity Medicare Advantage	$7.39
Rate for Payer: Encore Health Key Benefits Commercial	$8.45
Rate for Payer: Healthscope Commercial	$9.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.98
Rate for Payer: PHP Commercial	$8.98
Rate for Payer: Priority Health Cigna Priority Health	$6.86
Rate for Payer: Priority Health SBD	$6.65

SEVELAMER CARBONATE 800 MG TABLET

Facility

$2,051.57

Service Code	NDC 00955105027
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$1,292.49
Max. Negotiated Rate	$1,846.41
Rate for Payer: Aetna Commercial	$1,743.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,333.52
Rate for Payer: Cash Price	$1,641.26
Rate for Payer: Cofinity Commercial	$1,436.10
Rate for Payer: Cofinity Commercial	$1,764.35
Rate for Payer: Cofinity Medicare Advantage	$1,436.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,641.26
Rate for Payer: Healthscope Commercial	$1,846.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,743.83
Rate for Payer: PHP Commercial	$1,743.83
Rate for Payer: Priority Health Cigna Priority Health	$1,333.52
Rate for Payer: Priority Health SBD	$1,292.49

SEVELAMER HCL 800 MG TABLET

Facility

$4,583.42

Service Code	NDC 58468002101
Hospital Charge Code	28715
Hospital Revenue Code	637
Min. Negotiated Rate	$1,833.37
Max. Negotiated Rate	$4,125.08
Rate for Payer: Aetna Commercial	$3,895.91
Rate for Payer: Aetna Medicare	$2,291.71
Rate for Payer: Aetna New Business (MI Preferred)	$2,979.22
Rate for Payer: BCBS Complete	$1,833.37
Rate for Payer: Cash Price	$3,666.74
Rate for Payer: Cofinity Commercial	$3,208.39
Rate for Payer: Cofinity Commercial	$3,941.74
Rate for Payer: Cofinity Medicare Advantage	$3,208.39
Rate for Payer: Encore Health Key Benefits Commercial	$3,666.74
Rate for Payer: Healthscope Commercial	$4,125.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,895.91
Rate for Payer: PHP Commercial	$3,895.91
Rate for Payer: Priority Health Cigna Priority Health	$2,979.22
Rate for Payer: Priority Health SBD	$2,887.55

SEVELAMER HCL 800 MG TABLET

Facility

$4,583.42

Service Code	NDC 58468002101
Hospital Charge Code	28715
Hospital Revenue Code	637
Min. Negotiated Rate	$2,887.55
Max. Negotiated Rate	$4,125.08
Rate for Payer: Aetna Commercial	$3,895.91
Rate for Payer: Aetna New Business (MI Preferred)	$2,979.22
Rate for Payer: Cash Price	$3,666.74
Rate for Payer: Cofinity Commercial	$3,208.39
Rate for Payer: Cofinity Commercial	$3,941.74
Rate for Payer: Cofinity Medicare Advantage	$3,208.39
Rate for Payer: Encore Health Key Benefits Commercial	$3,666.74
Rate for Payer: Healthscope Commercial	$4,125.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,895.91
Rate for Payer: PHP Commercial	$3,895.91
Rate for Payer: Priority Health Cigna Priority Health	$2,979.22
Rate for Payer: Priority Health SBD	$2,887.55

SEVOFLURANE INHALATION LIQUID

Facility

$223.13

Service Code	NDC 10019065164
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$200.82
Rate for Payer: Aetna Commercial	$189.66
Rate for Payer: Aetna Medicare	$111.56
Rate for Payer: Aetna New Business (MI Preferred)	$145.03
Rate for Payer: BCBS Complete	$89.25
Rate for Payer: Cash Price	$178.50
Rate for Payer: Cofinity Commercial	$156.19
Rate for Payer: Cofinity Commercial	$191.89
Rate for Payer: Cofinity Medicare Advantage	$156.19
Rate for Payer: Encore Health Key Benefits Commercial	$178.50
Rate for Payer: Healthscope Commercial	$200.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$189.66
Rate for Payer: PHP Commercial	$189.66
Rate for Payer: Priority Health Cigna Priority Health	$145.03
Rate for Payer: Priority Health SBD	$140.57

SEVOFLURANE INHALATION LIQUID

Facility

$211.75

Service Code	NDC 66794002225
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$190.57
Rate for Payer: Aetna Commercial	$179.99
Rate for Payer: Aetna Medicare	$105.88
Rate for Payer: Aetna New Business (MI Preferred)	$137.64
Rate for Payer: BCBS Complete	$84.70
Rate for Payer: Cash Price	$169.40
Rate for Payer: Cofinity Commercial	$148.22
Rate for Payer: Cofinity Commercial	$182.10
Rate for Payer: Cofinity Medicare Advantage	$148.22
Rate for Payer: Encore Health Key Benefits Commercial	$169.40
Rate for Payer: Healthscope Commercial	$190.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.99
Rate for Payer: PHP Commercial	$179.99
Rate for Payer: Priority Health Cigna Priority Health	$137.64
Rate for Payer: Priority Health SBD	$133.40

SEVOFLURANE INHALATION LIQUID

Facility

$223.13

Service Code	NDC 10019065164
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$140.57
Max. Negotiated Rate	$200.82
Rate for Payer: Aetna Commercial	$189.66
Rate for Payer: Aetna New Business (MI Preferred)	$145.03
Rate for Payer: Cash Price	$178.50
Rate for Payer: Cofinity Commercial	$156.19
Rate for Payer: Cofinity Commercial	$191.89
Rate for Payer: Cofinity Medicare Advantage	$156.19
Rate for Payer: Encore Health Key Benefits Commercial	$178.50
Rate for Payer: Healthscope Commercial	$200.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$189.66
Rate for Payer: PHP Commercial	$189.66
Rate for Payer: Priority Health Cigna Priority Health	$145.03
Rate for Payer: Priority Health SBD	$140.57

SEVOFLURANE INHALATION LIQUID

Facility

$211.75

Service Code	NDC 66794002225
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$133.40
Max. Negotiated Rate	$190.57
Rate for Payer: Aetna Commercial	$179.99
Rate for Payer: Aetna New Business (MI Preferred)	$137.64
Rate for Payer: Cash Price	$169.40
Rate for Payer: Cofinity Commercial	$148.22
Rate for Payer: Cofinity Commercial	$182.10
Rate for Payer: Cofinity Medicare Advantage	$148.22
Rate for Payer: Encore Health Key Benefits Commercial	$169.40
Rate for Payer: Healthscope Commercial	$190.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.99
Rate for Payer: PHP Commercial	$179.99
Rate for Payer: Priority Health Cigna Priority Health	$137.64
Rate for Payer: Priority Health SBD	$133.40

SEVOFLURANE INHALATION LIQUID

Facility

$214.38

Service Code	NDC 00074445604
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$85.75
Max. Negotiated Rate	$192.94
Rate for Payer: Aetna Commercial	$182.22
Rate for Payer: Aetna Medicare	$107.19
Rate for Payer: Aetna New Business (MI Preferred)	$139.35
Rate for Payer: BCBS Complete	$85.75
Rate for Payer: Cash Price	$171.50
Rate for Payer: Cofinity Commercial	$150.07
Rate for Payer: Cofinity Commercial	$184.37
Rate for Payer: Cofinity Medicare Advantage	$150.07
Rate for Payer: Encore Health Key Benefits Commercial	$171.50
Rate for Payer: Healthscope Commercial	$192.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$182.22
Rate for Payer: PHP Commercial	$182.22
Rate for Payer: Priority Health Cigna Priority Health	$139.35
Rate for Payer: Priority Health SBD	$135.06

SEVOFLURANE INHALATION LIQUID

Facility

$214.38

Service Code	NDC 00074445604
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$135.06
Max. Negotiated Rate	$192.94
Rate for Payer: Aetna Commercial	$182.22
Rate for Payer: Aetna New Business (MI Preferred)	$139.35
Rate for Payer: Cash Price	$171.50
Rate for Payer: Cofinity Commercial	$150.07
Rate for Payer: Cofinity Commercial	$184.37
Rate for Payer: Cofinity Medicare Advantage	$150.07
Rate for Payer: Encore Health Key Benefits Commercial	$171.50
Rate for Payer: Healthscope Commercial	$192.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$182.22
Rate for Payer: PHP Commercial	$182.22
Rate for Payer: Priority Health Cigna Priority Health	$139.35
Rate for Payer: Priority Health SBD	$135.06

SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBLINGUAL OR PAROTID, UNCOMPLICATED, INTRAORAL

Facility

$8,903.25

Service Code	CPT 42330
Hospital Revenue Code	360
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,780.71
Rate for Payer: VA VA	$3,162.90

SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$2,502.92

Service Code	CPT 45330
Hospital Revenue Code	360
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$500.60
Rate for Payer: VA VA	$889.17

SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)

Facility

$3,236.94

Service Code	CPT 45346
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$647.41
Rate for Payer: VA VA	$1,149.93

SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$2,502.92

Service Code	CPT 45331
Hospital Revenue Code	360
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$500.60
Rate for Payer: VA VA	$889.17

SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD

Facility

$3,236.94

Service Code	CPT 45334
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$647.41
Rate for Payer: VA VA	$1,149.93

SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE

Facility

$2,502.92

Service Code	CPT 45335
Hospital Revenue Code	360
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$500.60
Rate for Payer: VA VA	$889.17

SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S)

Facility

$3,236.94

Service Code	CPT 45332
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$647.41
Rate for Payer: VA VA	$1,149.93

SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$3,236.94

Service Code	CPT 45338
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$647.41
Rate for Payer: VA VA	$1,149.93

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$235.60

Service Code	NDC 00904667106
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$212.04
Rate for Payer: Aetna Commercial	$200.26
Rate for Payer: Aetna Medicare	$117.80
Rate for Payer: Aetna New Business (MI Preferred)	$153.14
Rate for Payer: BCBS Complete	$94.24
Rate for Payer: Cash Price	$188.48
Rate for Payer: Cofinity Commercial	$164.92
Rate for Payer: Cofinity Commercial	$202.62
Rate for Payer: Cofinity Medicare Advantage	$164.92
Rate for Payer: Encore Health Key Benefits Commercial	$188.48
Rate for Payer: Healthscope Commercial	$212.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.26
Rate for Payer: PHP Commercial	$200.26
Rate for Payer: Priority Health Cigna Priority Health	$153.14
Rate for Payer: Priority Health SBD	$148.43

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$130.80

Service Code	NDC 50268071715
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$82.40
Max. Negotiated Rate	$117.72
Rate for Payer: Aetna Commercial	$111.18
Rate for Payer: Aetna New Business (MI Preferred)	$85.02
Rate for Payer: Cash Price	$104.64
Rate for Payer: Cofinity Commercial	$112.49
Rate for Payer: Cofinity Commercial	$91.56
Rate for Payer: Cofinity Medicare Advantage	$91.56
Rate for Payer: Encore Health Key Benefits Commercial	$104.64
Rate for Payer: Healthscope Commercial	$117.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.18
Rate for Payer: PHP Commercial	$111.18
Rate for Payer: Priority Health Cigna Priority Health	$85.02
Rate for Payer: Priority Health SBD	$82.40

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$130.80

Service Code	NDC 50268071715
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$52.32
Max. Negotiated Rate	$117.72
Rate for Payer: Aetna Commercial	$111.18
Rate for Payer: Aetna Medicare	$65.40
Rate for Payer: Aetna New Business (MI Preferred)	$85.02
Rate for Payer: BCBS Complete	$52.32
Rate for Payer: Cash Price	$104.64
Rate for Payer: Cofinity Commercial	$112.49
Rate for Payer: Cofinity Commercial	$91.56
Rate for Payer: Cofinity Medicare Advantage	$91.56
Rate for Payer: Encore Health Key Benefits Commercial	$104.64
Rate for Payer: Healthscope Commercial	$117.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.18
Rate for Payer: PHP Commercial	$111.18
Rate for Payer: Priority Health Cigna Priority Health	$85.02
Rate for Payer: Priority Health SBD	$82.40

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$2.62

Service Code	NDC 50268071711
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.36
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare	$1.31
Rate for Payer: Aetna New Business (MI Preferred)	$1.70
Rate for Payer: BCBS Complete	$1.05
Rate for Payer: Cash Price	$2.10
Rate for Payer: Cofinity Commercial	$1.83
Rate for Payer: Cofinity Commercial	$2.25
Rate for Payer: Cofinity Medicare Advantage	$1.83
Rate for Payer: Encore Health Key Benefits Commercial	$2.10
Rate for Payer: Healthscope Commercial	$2.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.23
Rate for Payer: PHP Commercial	$2.23
Rate for Payer: Priority Health Cigna Priority Health	$1.70
Rate for Payer: Priority Health SBD	$1.65

Know your out-of-pocket cost for care.

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